Dulce Wireless Tijuana: A Randomized Control Trial Evaluating the Impact of Project Dulce and Short-Term Mobile Technology on Glycemic Control in a Family Medicine Clinic in Northern Mexico

Abstract

Background: The global epidemic of diabetes calls for innovative interventions. This study evaluated the effectiveness of the Project Dulce model, with and without wireless technology, on glycemic control and other clinical and self-reported outcomes in patients with poorly controlled type 2 diabetes in Mexico.Subjects and Methods: Adults with type 2 diabetes and a glycated hemoglobin A1c (HbA1c) level of ≥8% were recruited from Family Medical Unit #27 of the Instituto Mexicano del Seguro Social (IMSS) in Tijuana, México, and randomly assigned to one of three groups: Project Dulce–only (PD); Project Dulce technology-enhanced with mobile tools (PD-TE); or IMSS standard of care/control group (CG). Clinical and self-reported outcomes were assessed at baseline, Month 4, and Month 10. Time-by-group interactions and within-group changes were analyzed.Results: HbA1c reductions from baseline to Month 10 were significantly greater in PD-TE (−3.0% [−33 mmol/mol]) and PD (−2.6% [−28.7 mmol/mol]) compared with CG (−1.3% [−14.2 mmol/mol]) (P = 0.009 and 0.001, respectively). PD-TE and PD also exhibited significant improvement in diabetes knowledge when compared with CG (P < 0.05 for both). No statistically significant differences were detected between PD and PD-TE on these indicators (P = 0.54 and 0.86, respectively). Several within-group improvements were observed on other clinical and self-report indicators but did not vary significantly across groups.Conclusions: Project Dulce with and without wireless technology substantially improved glycemic control and diabetes knowledge in high-risk patients with type 2 diabetes in a Mexican family medical unit, suggesting that integrating peer-led education, nurse coordination, and 3G wireless technology is an effective approach for improving diabetes outcomes in high-risk populations.

Peer support interventions in type 2 diabetes: Review of components and process outcomes

“…Potential PLs were primarily identified through recommendations from health professionals or through centers or databases that contained information on patients with diabetes . Eighteen studies defined eligibility criteria for PL recruitment . Most studies required a personal history of diabetes as an eligibility criterion.…”

“…Most studies required a personal history of diabetes as an eligibility criterion. In three studies, however, a PL could be an individual without diabetes who had cared for or lived with a patient with diabetes . Peer leaders were selected primarily based on their interest in joining the study and acceptable glycemic control (HbA1c ≤8.5%), with some studies requiring PLs to demonstrate strong communication skills—as assessed via interview .…”

“…The programs were primarily led by research teams and health professionals, including certified diabetes educators, clinical psychologists, nurses, nutritionists, and, in one study, endocrinologists. The core elements of each training program, in order of frequency, were (a) communication skills, (b) diabetes knowledge, (c) facilitation skills, (d) behavioral modification skills, (e) motivational interviewing, (f) ethics, and (g) available community resources . Role plays were a popular teaching approach.…”

Sitagliptin 100 mg vs glimepiride 1–3 mg as an add-on to insulin and metformin in type 2 diabetes (SWIM)

“…Secondary end points assessed were change from baseline in insulin TDD (calculated as 30-day geometric mean) at 24 weeks, proportion of patients achieving an HbA1c targets of <6.5% (16) and <7.0% (17) at 24 weeks, changes in body weight and BMI at 24 weeks and episodes of hypoglycemia during the study period. Hypoglycemia was assessed by a questionnaire and supplemented by plasma glucose values (wherever available).…”

Scope of mobile health in Indian health care system – the way forward

“…13 Interventions such as tele-consultation, video consultation over 3G, appointment scheduling, triaging and SMS prescription services are among the widely prevalent spectra of healthcare service provision. 14 Other common application domains for mHealth are client education and behaviour change, registries and vital events tracking, data collection and reporting, electronic health record, electronic decision support: information, protocols, algorithms, checklists, providerprovider communication: user groups consultation, patient-provider communication, provider work planning and scheduling, provider training and education, sensors and point of care diagnostics, human resource management, supply chain management, financial transaction and incentives.…”