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Effect of Diabetes Education During Retinal Ophthalmology Visits on Diabetes Control

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: NCT01323348
Recruitment Status : Completed
First Posted : March 25, 2011
Last Update Posted : August 26, 2016
National Eye Institute (NEI)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Information provided by (Responsible Party):
Jaeb Center for Health Research

Brief Summary:
The purpose of this study is to assess whether glycemic control (assessed with HbA1c measurement) in individuals with type 1 or type 2 diabetes can be improved with a point-of-care measurement of HbA1c in the ophthalmologist's office combined with a personalized risk assessment for diabetic retinopathy and other complications of diabetes.

Condition or disease Intervention/treatment Phase
Diabetes Diabetic Retinopathy Behavioral: Diabetes Education Phase 3

Detailed Description:

Although each patient with diabetes should be receiving diabetic education as part of their on-going routine medical care, it is likely that such education is delivered with different details and intensity. Motivating a patient with diabetes to become involved in his or her care is of primary importance in achieving better systemic control.

Ocular complications from diabetes remain the most common cause of blindness among American adults 20-74 years of age. A recent survey reported that loss of vision is the most feared of all diabetic complications. Thus, it is possible that an educational intervention at an ophthalmology office may have additional impact beyond the current standard of diabetes education at a primary care or diabetologist/endocrinologist office alone. This study will determine whether diabetes education in the ophthalmology office (which includes same-visit feedback of HbA1c levels, combined with standardized education regarding same-visit blood pressure, retinopathy status and overall diabetes education) can improve subsequent HbA1c as compared with current standard care in an ophthalmology office.

Materials used in this research setting must be applicable for use in ophthalmology practices. Therefore, the materials and procedures for this study have been developed with the goal of easy translation to this audience.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1875 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Effect of Diabetes Education During Retinal Ophthalmology Visits on Diabetes Control
Study Start Date : October 2011
Actual Primary Completion Date : July 2014
Actual Study Completion Date : January 2015

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Diabetes Educational Intervention
Study participants in the intervention group will receive a diabetes management educational intervention at baseline and at follow-up visits. For those on an annual follow-up schedule, educational intervention will take place at baseline and 12 months. For those whose standard care involves more frequent, than annual, visits the educational intervention will take place no more than once every 12 weeks.
Behavioral: Diabetes Education

The intervention will consist of the following at enrollment and at each follow-up visit (but no more frequently than once every 12 weeks):

  • Measurement of HbA1c in office with immediate feedback
  • Measurement of blood pressure with immediate feedback
  • Assessment of retinopathy risk with immediate feedback
  • Personalized risk assessment reports based on current HbA1c
  • Brief assessment of patient understanding of key issues with immediate feedback
  • Supplemental diabetes management educational materials (provided at baseline only)
  • Feedback to primary care provider
  • Email reminder to study participants with email access of individualized risk assessment findings

No Intervention: Standard Care
Usual care

Primary Outcome Measures :
  1. Change in HbA1c [ Time Frame: 12 Months ]
    Mean change in HbA1c from baseline to 12 months in intervention versus control for study participants being seen for standard care more frequently than every 12 months

Secondary Outcome Measures :
  1. Diabetes Care Knowledge [ Time Frame: 12 Months/24 Months ]
    At baseline and at annual visits, study participants in all treatment groups will complete self-assessment questionnaires in order to assess perception of emotional problems frequently reported in type 1 and type 2 diabetes and to measure perceived adherence to diabetes self-care recommendations. At the annual visits, summary statistics will be presented on the responses as appropriate to the distribution and the treatment groups will be compared controlling for baseline responses.

  2. Blood Pressure [ Time Frame: 12 Months/24 Months ]
    For analyses, systolic and diastolic blood pressure will be converted to an overall mean blood pressure according to the following calculation: diastolic blood pressure + 1/3 (systolic blood pressure - diastolic blood pressure). Blood pressure will be analyzed as the change in the weighted mean blood pressure from baseline to 12 months adjusted for the baseline weighted mean blood pressure. Treatment group comparisons will be made using ANCOVA to adjust for the baseline blood pressure, with GEE to adjust for the correlation within subjects of the same cluster.

  3. Body Mass Index [ Time Frame: 12 Months/24 Months ]
    Treatment group comparisons will be made using analysis of covariance (ANCOVA) to adjust for the baseline HbA1c, with generalized estimating equations (GEE) to adjust for the correlation within subjects of the same randomization cluster.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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

Inclusion Criteria:

  1. Age >18 years
  2. Diagnosis of type 1 or type 2 diabetes mellitus

    Any one of the following will be considered to be sufficient evidence that diabetes is present:

    • Current regular use of insulin for the treatment of diabetes
    • Current regular use of oral anti-hyperglycemia agents for the treatment of diabetes
    • Documented diabetes by American Diabetes Associate and/or World Health Organization criteria
  3. Routine care follow-up is yearly or more frequent
  4. English or Spanish speaking
  5. Able and willing to provide informed consent
  6. Willing to complete 24 months of study follow up

Exclusion Criteria:

  1. Known HbA1c (patient report or available records at time of enrollment) <7.5% within prior 6 months
  2. Active participation in any type of intervention study
  3. Initiation of insulin treatment within 3 months from date of enrollment
  4. Prior complete panretinal photocoagulation or prior diabetes-related vitrectomy in both eyes
  5. Advanced visual acuity loss in both eyes which prohibits ability to read study materials (tested as needed with reading test using materials in appropriate size script)
  6. Significant renal disease including use of erythropoietin (Procrit, Epogen, Eprex) or a history of chronic renal failure requiring dialysis or kidney transplant

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): NCT01323348

Hide Hide 34 study locations
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United States, California
Loma Linda University Health Care, Dept. of Ophthalmology
Loma Linda, California, United States, 92354
California Retina Consultants
Santa Barbara, California, United States, 93103
United States, Florida
Retina Vitreous Consultants
Ft. Lauderdale, Florida, United States, 33334
University of Florida College of Med., Department of Ophthalmology
Jacksonville, Florida, United States, 32209
Central Florida Retina Institute
Lakeland, Florida, United States, 33805
United States, Illinois
University of Illinois at Chicago Medical Center
Chicago, Illinois, United States, 60612
United States, Indiana
Raj K. Maturi, M.D., P.C.
Indianapolis, Indiana, United States, 46280
John-Kenyon American Eye Institute
New Albany, Indiana, United States, 47150
United States, Kentucky
Retina and Vitreous Associates of Kentucky
Lexington, Kentucky, United States, 40509-1802
Paducah Retinal Center
Paducah, Kentucky, United States, 42001
United States, Maryland
Elman Retina Group, P.A.
Baltimore, Maryland, United States, 21237
Wilmer Ophthalmological Institute at Johns Hopkins
Baltimore, Maryland, United States, 21287-9277
United States, Massachusetts
Joslin Diabetes Center
Boston, Massachusetts, United States, 02215
United States, Michigan
Henry Ford Health System, Dept of Ophthalmology and Eye Care Services
Detroit, Michigan, United States, 48202
United States, Minnesota
Retina Center, PA
Minneapolis, Minnesota, United States, 55404
United States, Missouri
Barnes Retina Institute
St. Louis, Missouri, United States, 63110
United States, New York
The New York Eye and Ear Infirmary/Faculty Eye Practice
New York, New York, United States, 10003
United States, North Carolina
University of North Carolina, Dept of Ophthalmology
Chapel Hill, North Carolina, United States, 27599-7040
Charlotte Eye, Ear, Nose and Throat Assoc., PA
Charlotte, North Carolina, United States, 28210
Wake Forest University Eye Center
Winston-Salem, North Carolina, United States, 27157
United States, Ohio
Retina Associates of Cleveland, Inc.
Beachwood, Ohio, United States, 44122
Case Western Reserve University
Cleveland, Ohio, United States, 44106
United States, Oregon
Casey Eye Institute
Portland, Oregon, United States, 97239
United States, Pennsylvania
Penn State College of Medicine
Hershey, Pennsylvania, United States, 17033
University of Pennsylvania Scheie Eye Institute
Philadelphia, Pennsylvania, United States, 19104
United States, South Carolina
Palmetto Retina Center
Columbia, South Carolina, United States, 29169
Carolina Retina Center
Columbia, South Carolina, United States, 29223
United States, Texas
Retina Research Center
Austin, Texas, United States, 78705
Retina and Vitreous of Texas
Houston, Texas, United States, 77025
Valley Retina Institute
McAllen, Texas, United States, 78503
Retinal Consultants of San Antonio
San Antonio, Texas, United States, 78240
United States, Washington
University of Washington Medical Center
Seattle, Washington, United States, 98195
United States, Wisconsin
University of Wisconsin-Madison, Dept of Ophthalmology/Retina Service
Madison, Wisconsin, United States, 53705
Medical College of Wisconsin
Milwaukee, Wisconsin, United States, 53226
Sponsors and Collaborators
Jaeb Center for Health Research
National Eye Institute (NEI)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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Study Chair: Lloyd P Aiello, M.D. Joslin Diabetes Center
Additional Information:
Publications of Results:
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Responsible Party: Jaeb Center for Health Research Identifier: NCT01323348    
Other Study ID Numbers: M
First Posted: March 25, 2011    Key Record Dates
Last Update Posted: August 26, 2016
Last Verified: August 2016
Keywords provided by Jaeb Center for Health Research:
Diabetes Education
Diabetic Retinopathy
Additional relevant MeSH terms:
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Retinal Diseases
Diabetic Retinopathy
Diabetes Mellitus
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Eye Diseases
Diabetic Angiopathies
Vascular Diseases
Cardiovascular Diseases
Diabetes Complications