Researchers at the University of Chicago Medicine are launching a four-year research trial to test the effects of two evidenced-based interventions for personalized diabetes care for older adults, thanks to a new $5 million grant provided by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The "My Diabetes, My Community" research trial incorporates two existing interventions designed to personalize sugar control goals, engage patients and enhance self-care.
This trial is particularly novel in that its target patient population is adults over age 65.
"Many clinical interventions are determined by research trials conducted in patient populations that aren't very representative of the majority of patients living with that condition," said Elbert Huang, MD, a professor of medicine at the University of Chicago Medicine. "In the case of diabetes, little research has been done to understand what strategies are most beneficial for older patients managing their condition day to day. This trial will answer for the first time whether or not a personalized approach to diabetes care in older adults works and which approach is most helpful."
The first intervention, known as Managing Diabetes to Gain Opportunities for a More Active Life (My Diabetes GOAL), has participants complete a screening survey to assess their diabetes care needs. Those needs are then discussed with a diabetes nurse to determine personalized diabetes goals for each patient. Ongoing care management between the patient and nurse then continues on the telephone.
The second intervention, called CommunityRx (CRx), is a community resource referral information system that has been developed and expanded upon in partnership with healthcare and community stakeholders to provide patients with lists of vetted, personalized resources to address basic needs, such as food, housing, and diabetes self-management needs like fitness resources and glycemic testing supplies. Prior research has found that receiving information about available resources increases knowledge and confidence in finding and accessing community resources for self-care.
The randomized, controlled research trial seeks to enroll 600 participants and will include three arms: one in which patients receive current standard diabetes care, one in which patients receive the My Diabetes GOAL intervention and one in which patients receive both My Diabetes GOAL and CRx. The researchers will then evaluate how these three approaches influence clinical outcomes such as glycemic control and unplanned hospital visits. They will also track patient experience and satisfaction, including metrics such as sense of self-efficacy, knowledge, utilization of community-based resources and self-reported diabetes care goals.
"This combination of personalized goal setting, telephonic care management and the connection to community-based organizations will support individuals in taking care of themselves at home," said Huang. "The trial will help determine which of these components, both separately and together, can really move the needle for supporting this special population."
UChicago Medicine is particularly well positioned for this research trial due to existing relationships with community stakeholders, which uses a network of community members to feed information about local resources into a database that can then be shared back out with the community.
"CommunityRx was developed with deep and wide collaboration with stakeholders, including older adults and youth, on the South Side of Chicago," said Stacy Lindau, MD, MA, a professor of obstetrics/gynecology and geriatric medicine at UChicago Medicine. "Economic development groups, federally qualified health centers and even residents of the South Side have been part of the team that co-designed and iterated this intervention over time. This is an opportunity to learn how and why connecting people to the health-promoting resources of our communities can work to support diabetes care."
In particular, the researchers credit MAPSCorps, a non-profit organization that employs youth to conduct an annual census of community resources, as key to CommunityRx. "MAPSCorps youth are active in many of our same communities that are the focus of the My Diabetes, My Community trial. They gather critical data about local businesses and organizations that we use to keep CommunityRx up to date," said Lindau.
The investigators hope that this approach will help patients feel more confident in their ability to care for themselves while also reaching their personal diabetes care management goals. Participants will receive direct support in identifying and setting those objectives through My Diabetes GOAL. Then they'll be provided with the information they need to access resources that will support those goals through CRx.
"Healthcare professionals have long worked with the assumption that if we direct a patient to do something outside of the clinic -- for example, to lose weight, exercise or get their eyes checked -- they know where to go," said Lindau. "But not everyone knows where to find the resources that are right for their needs. The trial gives us an opportunity to boost that educational component of care by giving people personalized, reliable, hyperlocal information about where they can go to do the things that are critical to reaching their diabetes goals."
With a relatively short timeline of four years to complete the trial, the team is working quickly to recruit participants and make sure all of the resources are up to date and ready to share, especially during a time when individuals are spending more time at home and may not be seeing their healthcare providers as much as they usually do. Recruitment for this study will happen virtually, through existing UChicago Medicine patient contact systems and through local community outreach.
"We would ordinarily recruit participants at the doctor's office, but many of those visits are virtual now," explained Huang. "So, we are adapting our approach to account for that reality. But really, this is a great time to test this strategy -- we need to empower individual patients to take care of themselves at home and find ways to keep them connected with care resources when they're not able to get into the clinic."
This research trial is expected to begin recruiting participants soon. In the meantime, individuals who are interested in learning more about this trial can reach out to senior research project manger Aviva Nathan at anathan (at) bsd.uchicago.edu.
This research is funded through NIDDK grant 1R01 DK127961-01.
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The University of Chicago Medicine, with a history dating back to 1927, is one of the nation's leading academic health systems. It unites the missions of the University of Chicago Medical Center, Pritzker School of Medicine and the Biological Sciences Division. Twelve Nobel Prize winners in physiology or medicine have been affiliated with the University of Chicago Medicine. Its main Hyde Park campus is home to the Center for Care and Discovery, Bernard Mitchell Hospital, Comer Children's Hospital and the Duchossois Center for Advanced Medicine. It also has ambulatory facilities in Orland Park, South Loop and River East as well as affiliations and partnerships that create a regional network of care. UChicago Medicine offers a full range of specialty-care services for adults and children through more than 40 institutes and centers including an NCI-designated Comprehensive Cancer Center. Together with Harvey-based Ingalls Memorial, UChicago Medicine has 1,296 licensed beds, nearly 1,300 attending physicians, over 2,800 nurses and about 970 residents and fellows.
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