Digital Health and Community Health Worker Support for Diabetes Management: a Randomized Controlled Trial.

Abstract

The aim of this study was to evaluate the effectiveness of a digital health intervention plus community health worker (CHW) support on self-monitoring of blood glucose and glycosylated hemoglobin (HbA1c) among adult Medicaid beneficiaries with diabetes. Randomized controlled trial. Urban outpatient clinic. Adult Medicaid beneficiaries living with diabetes and treated with insulin and who had a HbA1c ≥ 9%. Participants were randomly assigned to one of three arms. Participants in the usual-care arm received a wireless glucometer if needed. Those in the digital arm received a lottery incentive for daily glucose monitoring. Those in the hybrid arm received the lottery plus support from a CHW if they had low adherence or high blood glucose levels. The primary outcome was the difference in adherence to daily glucose self-monitoring at 3 months between the hybrid and usual-care arms. The secondary outcome was difference in HbA1c from baseline at 6 months. A total of 150 participants were enrolled in the study. A total of 102 participants (68%) completed the study. At 3 months, glucose self-monitoring rates in the hybrid versus usual-care arms were 0.72 vs 0.65, p = 0.23. At 6 months, change in HbA1c in the hybrid versus usual-care arms was - 0.74% vs - 0.49%, p = 0.69. There were no statistically significant differences between the hybrid and usual care in glucose self-monitoring adherence or improvements in HbA1C. This trial is registered with clinicaltrials.gov identifier: NCT03939793.