The goal of this pilot clinical trial is to assess feasibility of an intervention to deliver comprehensive, high-quality diabetes care through telemedicine among adults with type 2 diabetes who use insulin and have multiple chronic health conditions. The main question it aims to answer is: Is an enhanced telemedicine intervention for type 2 diabetes compared to usual telemedicine care feasible? Researchers will compare the enhanced telemedicine intervention to usual telemedicine care to see if there are differences in patient satisfaction or preliminary clinical outcomes. Participants will complete 2-3 telemedicine diabetes care visits over approximately 6 months, as well as complete survey measures with each diabetes care visit. Patients in the intervention group will also receive additional support, including pre-visit preparation phone calls, diabetes self-management education and support aligned with their visits, and post-visit follow-up calls.
This pilot study will compare an intervention to deliver high-quality diabetes care through telemedicine for adults with type 2 diabetes who have additional chronic health conditions and use insulin with usual telemedicine care. The investigators will assess feasibility, patient satisfaction, and preliminary clinical outcomes. Fifty adults will be recruited from primary care practices. Once patients are confirmed eligible, they will be consented and enrolled. Patients will be randomized to the intervention arm or usual telemedicine care, stratified by age (above or below 65 years) and rurality, as these factors are associated with technological literacy and broadband access, which may impact telemedicine use and outcomes. Both groups will complete baseline survey measures and baseline clinical data will be collected via chart review. As this is a pragmatic pilot trial, intervention components will be delivered by usual clinical providers and staff for the intervention group. The telemedicine care intervention will include 2-3 synchronous visits with endocrinology providers over 6 months plus additional visits with multidisciplinary providers on an individualized basis. Telemedicine care will proceed as usual for the control group. The investigators will focus pilot trial outcomes on standard metrics to assess feasibility for a future large trial. The investigators will also measure preliminary clinical outcomes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
50
Telemedicine-based endocrinology specialty care for type 2 diabetes with multidisciplinary diabetes care team support including pre-visit preparation, in-visit support and self-management education, and post-visit follow-up.
Routine telemedicine-based endocrinology specialty care for type 2 diabetes, generally consisting of synchronous virtual visit with an endocrinologist and additional support including self-management education on an individualized basis.
University of Pittsburgh
Pittsburgh, Pennsylvania, United States
Recruitment percentage
Percent of eligible patients approached who are enrolled
Time frame: 12 months
Loss to follow up
Percent of enrolled patients who do not complete study, defined as not completing at least 2 study visits and associated surveys
Time frame: 6 months
Recruitment rate
Number of patients recruited per month
Time frame: 12 months
Eligibility percentage
Percent of patients approached who are eligible
Time frame: 12 months
Visit attendance
Percent of scheduled visits completed per patient
Time frame: 6 months
Number of between-visit contacts
Number of successful and attempted patient contacts by clinicians between visits per patient
Time frame: 6 months
Blood glucose data availability
Number of telemedicine visits with blood glucose data available at visit per patient
Time frame: 6 months
Patient satisfaction with telemedicine diabetes care
Percent of patients reporting satisfied or very satisfied on a 5-point Likert scale ranging from 1 "strongly disagree" to 5 "strongly agree" with the statement "Overall, I am satisfied with the quality of service being provided via telemedicine" with higher scores indicating greater satisfaction
Time frame: 6 months
Diabetes Treatment Satisfaction Questionnaire-static version
Total score of 8-item measure of global satisfaction with diabetes treatment regimen. The static version will be used at baseline. Items 1, 4, 5, 6, 7 \& 8 are summed to produce a Treatment Satisfaction score (range:0 to 36). The higher the score, the greater the satisfaction with treatment. 'Perceived frequency of hyperglycaemia' (item 2) \& 'Perceived frequency of hypoglycaemia' (item 3): Both rated: 6 ('most of the time') to 0 ('none of the time'). Here, lower scores indicate blood glucose levels closer to the ideal. Higher scores indicate problems.
Time frame: Baseline
Diabetes Treatment Satisfaction Questionnaire-change version
Total score of 8-item measure of global satisfaction with diabetes treatment regimen. The change version will be used at 6 months.Items 1, 4, 5, 6, 7 and 8 are summed to produce a Treatment Satisfaction (change) score (range: +18 to -18). The higher the score, the greater the improvement in satisfaction with treatment; the lower the score, the greater the deterioration in satisfaction with treatment. A score of 0 represents no change. Two remaining items ('Perceived change in frequency of hyperglycaemia' (item 2) and 'Perceived change in frequency of hypoglycaemia' (item 3)) are treated individually: Both rated: +3 ('much more of the time now') to -3 ('much less of the time now'). Here, negative scores indicate fewer problems with blood glucose levels. Positive scores indicate more problems than before.
Time frame: 6 months
T2D Diabetes Distress Core Scale
Change in total score of 8-item measure of diabetes-related distress over prior month from baseline to 6 months. The Diabetes Distress Core scale is scored by averaging the value for each item, ranked from 1 to 5 scale (score range 1-5), with higher scores indicating more distress.
Time frame: Baseline and 6 months
HbA1c change
Change in glycemic control from baseline to 6 months
Time frame: Baseline and 6 months
Prescription of guideline-based GLP-1 receptor agonist
Number of patients with indications for GLP-1 receptor agonist therapy who are prescribed the indicated medication
Time frame: Baseline and 6 months
Prescription of guideline-based SGLT2 inhibitor
Number of patients with indications for SGLT2 inhibitor therapy who are prescribed the indicated medication
Time frame: Baseline and 6 months
Retinal examination
Number of patients with documentation of retinal examination performed in last year in medical record
Time frame: 6 months
Urine protein testing
Number of patients with documentation of urine protein testing performed in last year in medical record
Time frame: 6 months
Immunization-pneumococcal
Number of patients with documentation of pneumococcal vaccination in medical record
Time frame: 6 months
Immunization-influenza
Number of patients with documentation of influenza vaccination in medical record
Time frame: 6 months
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