Practical telehealth to improve control and engagement for patients with clinic-refractory diabetes mellitus (PRACTICE-DM): Protocol and baseline data for a randomized trial.

dc.contributor.author

Kobe, Elizabeth A

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Edelman, David

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Tarkington, Phillip E

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Bosworth, Hayden B

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Maciejewski, Matthew L

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Steinhauser, Karen

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Jeffreys, Amy S

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Coffman, Cynthia J

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Smith, Valerie A

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Strawbridge, Elizabeth M

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Szabo, Steven T

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Desai, Shivan

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Garrett, Mary P

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Wilmot, Theresa C

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Marcano, Teresa J

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Overby, Donna L

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Tisdale, Glenda A

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Durkee, Melissa

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Bullard, Susan

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Dar, Moahad S

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Mundy, Amy C

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Hiner, Janette

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Fredrickson, Sonja K

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Majette Elliott, Nadya T

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Howard, Teresa

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Jeter, Deborah H

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Danus, Susanne

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Crowley, Matthew J

dc.date.accessioned

2024-01-02T20:51:13Z

dc.date.available

2024-01-02T20:51:13Z

dc.date.issued

2020-11

dc.description.abstract

Background

Persistent poorly-controlled type 2 diabetes mellitus (PPDM), or maintenance of a hemoglobin A1c (HbA1c) ≥8.5% despite receiving clinic-based diabetes care, contributes disproportionately to the national diabetes burden. Comprehensive telehealth interventions may help ameliorate PPDM, but existing approaches have rarely been designed with clinical implementation in mind, limiting use in routine practice. We describe a study testing a novel telehealth intervention that comprehensively targets clinic-refractory PPDM, and was explicitly developed for practical delivery using existing Veterans Health Administration (VHA) clinical infrastructure.

Methods

Practical Telehealth to Improve Control and Engagement for Patients with Clinic-Refractory Diabetes Mellitus (PRACTICE-DM) is an ongoing randomized controlled trial comparing two 12-month interventions: 1) standard VHA Home Telehealth (HT) telemonitoring/care coordination; or 2) the PRACTICE-DM intervention, a comprehensive HT-delivered intervention combining telemonitoring, self-management support, diet/activity support, medication management, and depression management. The primary outcome is HbA1c. Secondary outcomes include diabetes distress, self-care, self-efficacy, weight, depressive symptoms, implementation barriers/facilitators, and costs. We hypothesize that the PRACTICE-DM intervention will reduce HbA1c by >0.6% versus standard HT over 12 months.

Results

Enrollment for this ongoing trial concluded in January 2020; 200 patients were randomized (99 to standard HT and 101 to the PRACTICE-DM intervention). The cohort has a mean age of 58 and is 23% female and 72% African American. Mean baseline HbA1c and BMI were 10.2% and 34.8 kg/m2.

Conclusions

Because it comprehensively targets factors underlying PPDM using existing clinical infrastructure, the PRACTICE-DM intervention may be well suited to lower the complications and costs of PPDM in routine practice.
dc.identifier

S1551-7144(20)30235-4

dc.identifier.issn

1551-7144

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1559-2030

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https://hdl.handle.net/10161/29647

dc.language

eng

dc.publisher

Elsevier BV

dc.relation.ispartof

Contemporary clinical trials

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10.1016/j.cct.2020.106157

dc.rights.uri

https://creativecommons.org/licenses/by-nc/4.0

dc.subject

Humans

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Diabetes Mellitus, Type 2

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Self Care

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Self Efficacy

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Telemedicine

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Female

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Male

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Randomized Controlled Trials as Topic

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Glycated Hemoglobin

dc.title

Practical telehealth to improve control and engagement for patients with clinic-refractory diabetes mellitus (PRACTICE-DM): Protocol and baseline data for a randomized trial.

dc.type

Journal article

duke.contributor.orcid

Edelman, David|0000-0001-7112-6151

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Bosworth, Hayden B|0000-0001-6188-9825

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Maciejewski, Matthew L|0000-0003-1765-5938

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Coffman, Cynthia J|0000-0002-4554-1463

duke.contributor.orcid

Smith, Valerie A|0000-0001-5170-9819

duke.contributor.orcid

Crowley, Matthew J|0000-0002-6205-4536

pubs.begin-page

106157

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Duke

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School of Medicine

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Student

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Basic Science Departments

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Clinical Science Departments

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Institutes and Centers

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Biostatistics & Bioinformatics

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Medicine

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Psychiatry & Behavioral Sciences

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Medicine, Endocrinology, Metabolism, and Nutrition

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Medicine, General Internal Medicine

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Duke Cancer Institute

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Duke Clinical Research Institute

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Institutes and Provost's Academic Units

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Center for the Study of Aging and Human Development

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Initiatives

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Duke Science & Society

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Population Health Sciences

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Duke Innovation & Entrepreneurship

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Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences

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Duke - Margolis Center For Health Policy

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Biostatistics & Bioinformatics, Division of Biostatistics

pubs.publication-status

Published

pubs.volume

98

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