The Diabetes Telemonitoring (DiaTel) Study
The purpose of this research study is to compare two different methods of helping veterans with diabetes better manage their disease. This study will compare an "Active Care Management" method using home-based technology and self-monitoring techniques with a lower-intensity "Care Coordination" method based on monthly telephone contact with a nurse.
|Study Design:||Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||The Diabetes Telemonitoring (DiaTel) Study|
- HbA1c [ Time Frame: 3 months ] [ Designated as safety issue: No ]
- Proportion of subjects in each cohort with HbA1c </= 7%, BP </= 130/80, LDL-cholesterol </= 100 mg/dl, and triglycerides </= 150 mg/dl at six months [ Time Frame: 3 months, 6 months, 9 months, 12 months ] [ Designated as safety issue: No ]
- Proxy measures for cost of care (number of outpatient clinic visits, emergency room visits, hospital bed days, and pharmacy costs) [ Time Frame: 3 months, 6 months, 9 months, 12 months ] [ Designated as safety issue: No ]
- For subjects not on insulin at enrollment, time to prescription of insulin [ Time Frame: 6 months, 12 months ] [ Designated as safety issue: No ]
- For subjects on insulin at enrollment, time to change in dose and/or type of insulin [ Time Frame: 6 months, 12 months ] [ Designated as safety issue: No ]
- Subject satisfaction with care [ Time Frame: 6 months, 12 months ] [ Designated as safety issue: No ]
- Factors influencing adherence to diabetes regimen [ Time Frame: 6 months, 12 months ] [ Designated as safety issue: No ]
|Study Start Date:||October 2005|
|Study Completion Date:||December 2007|
|Primary Completion Date:||December 2007 (Final data collection date for primary outcome measure)|
Active Comparator: Care Coordination
Care Coordination with monthly follow-up by a diabetes nurse educator
Behavioral: Care Coordination
Care coordination with monthly follow-up by a diabetes nurse educator
Other Name: Control
Active Comparator: Home Telemedicine
Active Care Management with Home Telemedicine
Behavioral: Home Telemedicine
Active care management by a nurse practitioner using home telemedicine
Other Name: Active Care Management
The objectives of this study are to design, implement, and evaluate two medical care initiatives of different levels of intensity for veterans with diabetes and suboptimal glycemic control. The higher-intensity initiative ("Active Care Management") will use home-based technology that enables home messaging and reminders for compliance with recommended guidelines for treatment, as well as self-monitoring of blood glucose, blood pressure, and weight. Data will be transmitted to health care providers. This initiative will feature active care management, including changes in medication and/or diet implemented by the study's certified registered nurse practitioner under the supervision of a study physician in collaboration with the subject's primary care provider (PCP).
The lower-intensity initiative ("Care Coordination") will consist of care coordination in the form of monthly monitoring of subjects via telephone by the study's research nurse who will refer the subject to his/her PCP as needed for additional care. Both initiatives represent a supplementation to current usual care practices for the treatment of diabetes in the VA.
The objective of Phase Two of the study is to determine the appropriate level of subsequent management required for sustaining glycemic, blood pressure (BP), and lipid control among subjects randomized in Phase One to care coordination (CC) or to active care management (ACM). CC involved monthly telephone calls from a diabetes nurse (RN), whereas ACM involved home messaging and monitoring with the Viterion TeleHealth System plus active management of glycemia, BP, and lipids by a nurse practitioner (NP). ACM subjects transmitted blood glucose, BP, and weight measurements daily for review and intervention, if necessary, by the NP.
Subjects who complete Phase One and consent to participate in Phase Two will be randomized to subsequent management at the same or lower intensity and followed for an additional six months. Phase One ACM subjects will be randomized in Phase Two to either care coordination with monthly telephone calls (i.e., ACM-to-CC), or care coordination with monthly telephone calls plus home telehealth monitoring but with no active management by the NP (ACM-to-CCHT). CCHT subjects will continue to transmit home blood glucose, BP, and weight daily to the project office, but abnormal values will be referred to their primary care provider (PCP) for action. Phase One CC subjects will be randomized to either continued care coordination with monthly telephone calls (CC-to-CC), or referral back to their PCP for usual care (CC-to-UC). Randomization within both groups for Phase Two will be stratified according to HbA1c (<7% or >7%) at the conclusion of the subject's six-month participation in Phase One.
The primary aim of Phase Two is to assess whether glycemic, blood pressure, and lipid control at the end of an additional six months of follow-up differs for patients randomized to the four groups specified above (i.e., ACM-to-CC, ACM-to-CCHT, CC-to-CC, and CC-to-UC), adjusted for their corresponding HbA1c levels at the end of Phase One.
|United States, Pennsylvania|
|VA Pittsburgh Healthcare System|
|Pittsburgh, Pennsylvania, United States, 15240|
|Principal Investigator:||Frederick R DeRubertis, MD||VA Pittsburgh Healthcare System|