The Diabetes Telemonitoring (DiaTel) Study (DiaTel)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00245882
Recruitment Status : Completed
First Posted : October 28, 2005
Last Update Posted : September 18, 2012
Information provided by:
VA Pittsburgh Healthcare System

Brief Summary:
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.

Condition or disease Intervention/treatment Phase
Diabetes Behavioral: Care Coordination Behavioral: Home Telemedicine Not Applicable

Detailed Description:

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.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 150 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: The Diabetes Telemonitoring (DiaTel) Study
Study Start Date : October 2005
Actual Primary Completion Date : December 2007
Actual Study Completion Date : December 2007

Arm Intervention/treatment
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

Primary Outcome Measures :
  1. HbA1c [ Time Frame: 3 months ]

Secondary Outcome Measures :
  1. 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 ]
  2. 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 ]
  3. For subjects not on insulin at enrollment, time to prescription of insulin [ Time Frame: 6 months, 12 months ]
  4. For subjects on insulin at enrollment, time to change in dose and/or type of insulin [ Time Frame: 6 months, 12 months ]
  5. Subject satisfaction with care [ Time Frame: 6 months, 12 months ]
  6. Factors influencing adherence to diabetes regimen [ Time Frame: 6 months, 12 months ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 79 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. enrolled for primary care at a VA Pittsburgh Healthcare System (VAPHS)site with at least one visit from June 1, 2004 through December 31, 2005
  2. diagnosed with diabetes mellitus with at least 12 months of ongoing pharmacologic treatment (at least one oral hypoglycemic agent, insulin, or both)
  3. born in 1926 or later
  4. have an HbA1c level >/= 8.0% at the last assessment (between 6/1/04 and 12/31/05)
  5. have an HbA1c level >/= 7.5% (by finger stick) at the time of enrollment
  6. mentally competent to give informed consent

Exclusion Criteria:

  1. one or more visits to the VAPHS Diabetes Clinic from June 1, 2004 through December 31, 2005
  2. metastatic or inoperable cancer
  3. Child-Pugh Class B or C end-stage liver disease
  5. end-stage renal disease requiring dialysis
  6. ongoing home oxygen therapy
  7. a history of major organ transplant (i.e., heart, lung, kidney, liver)
  8. residence in an institution (e.g. nursing home, personal care home, or prison)
  9. incompatible telephone service (i.e., either none or digital)
  10. concurrent participation in any other research protocol

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00245882

United States, Pennsylvania
VA Pittsburgh Healthcare System
Pittsburgh, Pennsylvania, United States, 15240
Sponsors and Collaborators
United States Department of Defense
Principal Investigator: Frederick R DeRubertis, MD VA Pittsburgh Healthcare System

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Frederick R. DeRubertis, MD, VA Pittsburgh Healthcare System Identifier: NCT00245882     History of Changes
Other Study ID Numbers: 02324; 02489
First Posted: October 28, 2005    Key Record Dates
Last Update Posted: September 18, 2012
Last Verified: September 2012

Keywords provided by VA Pittsburgh Healthcare System:
Glycemic control
Active care management
Care coordination

Additional relevant MeSH terms:
Diabetes Mellitus
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases