Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, United States; Sealy Institute for Vaccine Scienes, University of Texas Medical Branch, Galveston, TX, United States.
Department of Biostatistics, University of Texas Medical Branch, Galveston, TX, United States.
J Diabetes Complications. 2024 Aug;38(8):108794. doi: 10.1016/j.jdiacomp.2024.108794. Epub 2024 Jun 10.
Conduct a secondary analysis of the TIME (Telehealth-supported, Integrated Community Health Workers (CHWs), Medication access, diabetes Education) made simple trial (SIMPLE) to evaluate healthcare utilization and explore variables that may have influenced HbA1c.
Participants (N = 134 [67/group]) were low-income, uninsured Hispanics with or at risk for type 2 diabetes mellitus. We included in-person and telehealth clinician visits, other visits, missed visits, orders placed, and guideline-adherence (e.g., vaccinations, quarterly HbA1c for uncontrolled diabetes). Using multivariable models, we explored for associations between HbA1c changes and these measures.
The control arm had higher missed visits rates (intervention: 45 %; control: 56 %; p = 0.007) and missed telehealth appointments (intervention: 10 %; control: 27.4 %; p = 0.04). The intervention group received more COVID vaccinations than the control (p = 0.005). Other health measures were non-significant between groups. Intervention individuals' HbA1c improved with more missed visits (-0.60 %; p < 0.01) and worsened with improved guideline-adherent HbA1c measurements (HbA1c: 1.2 %; p = 0.057). The control group had non-significant HbA1c associations.
Findings suggest that the SIMPLE trial's improved HbA1c levels stemmed from a CHW-driven intervention and not additional healthcare contact. Exploratory outcomes resulted in seemingly counterintuitive HbA1c associations with missed visits and guideline-adherent measurements; these may suggest that an intervention that enhances communication provides support to reduce the amount of follow-up needed by participants without sacrificing clinical improvements.
对 TIME（远程医疗支持、综合社区卫生工作者（CHW）、药物获取、糖尿病教育）简化试验（SIMPLE）进行二次分析，以评估医疗保健的利用情况，并探讨可能影响 HbA1c 的变量。
参与者（N=134[每组 67 人]）为收入低、无保险的西班牙裔，患有或有 2 型糖尿病风险。我们包括面对面和远程医疗临床医生就诊、其他就诊、错过就诊、下订单和遵循指南（例如，接种疫苗、未控制糖尿病的每季度 HbA1c）。使用多变量模型，我们探讨了 HbA1c 变化与这些措施之间的关联。
对照组的错过就诊率更高（干预组：45%；对照组：56%；p=0.007）和错过远程医疗预约（干预组：10%；对照组：27.4%；p=0.04）。干预组接受的 COVID 疫苗接种多于对照组（p=0.005）。组间其他健康措施无显著性差异。干预组的 HbA1c 随着更多的错过就诊而改善（-0.60%；p<0.01），随着更符合指南的 HbA1c 测量而恶化（HbA1c：1.2%；p=0.057）。对照组的 HbA1c 无显著相关性。
研究结果表明，SIMPLE 试验 HbA1c 水平的改善源自 CHW 驱动的干预，而不是额外的医疗保健接触。探索性结果导致了似乎与错过就诊和符合指南的测量有关的 HbA1c 反常关联；这可能表明，增强沟通的干预措施为参与者提供了支持，减少了他们需要的随访量，而不会牺牲临床改善。
