Technology-Enhanced Diabetes Education for Type 2 Diabetes

(TIDES Trial)

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: State University of New York at Buffalo

Disqualifiers: Dementia, Alcohol abuse, Psychosis, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 17

Duration: 12 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if combining technology with diabetes education and skills training can improve type 2 diabetes management in African Americans. Participants will use a monitoring system, receive weekly phone coaching on diabetes management, and gain tools to ask better questions during doctor visits. Individuals with type 2 diabetes, an HbA1c of 8% or more, who are African American, and willing to use tech tools for a year may be suitable candidates. As an unphased trial, this study provides a unique opportunity to contribute to innovative diabetes management strategies.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this intervention is safe for African Americans with poorly controlled type 2 diabetes?

Research has shown that technology can significantly aid in safely managing type 2 diabetes. Studies demonstrate that technology for diabetes education and monitoring improves condition management. This includes easier tracking of blood sugar levels and medication reminders.

One study found that technology-based programs enhance adherence to treatment plans without causing serious side effects. Another study suggested that using technology like continuous glucose monitors improves blood sugar control and reduces diabetes-related health issues.

Overall, technology in diabetes education and management is well-received and considered safe. This approach has proven effective in helping people with diabetes manage their health. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Technology-Enhanced Diabetes Education approach for Type 2 Diabetes because it offers a more interactive and personalized way to manage the condition. Unlike standard care, which relies mainly on periodic doctor visits and patient-initiated contact, this method uses the FORA system for self-monitoring, providing continuous feedback and support. Additionally, it empowers patients with weekly telephone-based education sessions and tools like personal goal setting and diabetes responsibility contracts, potentially leading to better engagement and outcomes in diabetes management.

What evidence suggests that this technology-enhanced diabetes education is effective for type 2 diabetes?

Research shows that using technology to teach people about diabetes can help control blood sugar levels in those with type 2 diabetes. In this trial, participants in the Technology Intensified arm will use the FORA system for self-monitoring. Previous studies have shown that this system leads to a quicker decrease in HbA1c (a measure of blood sugar) compared to standard care. These programs focus on teaching patients how to manage their diabetes, which helps improve their overall health. Learning self-management skills and feeling empowered positively affect adherence to diabetes care plans and improve quality of life. This evidence suggests that combining technology with diabetes education effectively manages blood sugar levels. ^{3 6 7 8 9}

Who Is on the Research Team?

Leonard E Egede, MD, MS

Principal Investigator

Medical College of Wisconsin

Are You a Good Fit for This Trial?

This trial is for African Americans aged 21 or older with poorly controlled type 2 diabetes (HbA1c ≥8%). Participants must be willing to use the FORA monitoring system, communicate in English, and have telephone access. Those with acute mental disorders, substance abuse issues, other clinical trial participation, significant dementia or a life expectancy under one year cannot join.

Inclusion Criteria

Subjects must have access to a telephone (landline for data uploads) for the study period

I am willing to use the FORA monitoring system for a year.

I have type 2 diabetes with an HbA1c level of 8% or higher.

Exclusion Criteria

You cannot be taking part in any other research studies for diabetes.

You have a problem with drinking alcohol or using drugs.

You are currently experiencing severe mental health problems.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Treatment

Participants receive weekly telephone-delivered diabetes education and skills training for 12 weeks

12 weeks

12 visits (virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with blood specimens collected and blood pressure measured at multiple intervals

12 months

4 visits (in-person) at 3, 6, 9, and 12 months

What Are the Treatments Tested in This Trial?

Interventions

• Technology Intensified

Trial Overview The study tests an intervention that uses technology alongside diabetes education and skills training tailored for African Americans with type 2 diabetes to see if it can help manage their condition better.

How Is the Trial Designed?

Group I: Techonology Intensified Experimental Treatment 1 Intervention

Subjects randomized to this group will receive: 1) the FORA system for self-monitoring; 2) weekly telephone-delivered diabetes education/skills training; 3) patient activation (list of 5 questions to ask their provider at every visit and training on how to ask the questions); and 4) patient empowerment (diabetes responsibility contracts, personal goals, and flow charts for patients to record lab results/medications and training on how to use the empowerment tools). The intervention will be delivered by telephone once a week for 12 weeks with each session lasting \~30 minutes.

Group II: Usual Care Active Control 1 Intervention

Apart from study visits, patients will be followed by their primary care providers. The provider will be responsible for determining treatment parameters, making changes in the treatment regimen, and determining the timing of follow up visits. Between scheduled office encounters, contact between patient and provider will be patient initiated. The provider may use clinic nurses to follow up on problematic patients or patients with abnormal results. In essence, this group will receive the current standard of care at the study clinics.

Who Is Running the Clinical Trial?

State University of New York at Buffalo

Lead Sponsor

Trials

279

Recruited

52,600+

Medical College of Wisconsin

Lead Sponsor

Trials

645

Recruited

1,180,000+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials

2,513

Recruited

4,366,000+

Medical University of South Carolina

Collaborator

Trials

994

Recruited

7,408,000+

Published Research Related to This Trial

The myDiabetes app, a digital health intervention, successfully activated nearly 50% of users referred by healthcare teams, indicating its potential to enhance diabetes education delivery.

Post-COVID-19, there was a significant increase in app usage, suggesting that digital health tools can effectively support diabetes self-management and may improve education rates when combined with traditional methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can digital health apps provide patients with support to promote structured diabetes education and ongoing self-management? A real-world evaluation of myDiabetes usage. Blythin, AM., Elkes, J., van Lindholm, T., et al.[2023]

A randomized clinical trial involving 48 insulin-dependent diabetes patients showed that a 12-week electronic education program significantly reduced hemoglobin A1C levels (p < 0.001) and low-density lipoprotein cholesterol (p < 0.002) in the intervention group.

The study suggests that electronic education can effectively improve metabolic control in diabetes patients, enhancing health outcomes and patient satisfaction while reducing the need for additional training personnel.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of electronic education on metabolic control indicators in patients with diabetes who need insulin: a randomised clinical control trial. Moattari, M., Hashemi, M., Dabbaghmanesh, MH.[2022]

A study involving 31 diabetes educators in Australia revealed that they found the use of technology in managing type 1 diabetes to be burdensome, indicating a need for better support and training in technology use.

Despite the potential benefits of diabetes-related technologies, care delivery was often fragmented and inconsistent, suggesting that improvements in policy and service structure are necessary to enhance the effectiveness of these tools in patient care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diabetes Educators: Perceived Experiences, Supports and Barriers to Use of Common Diabetes-Related Technologies. James, S., Perry, L., Gallagher, R., et al.[2018]

Information technology significantly enhances diabetes management by providing patients with tailored, just-in-time support, allowing for better self-management of their condition through online tools and resources.

The integration of technology in diabetes care enables clinicians to efficiently support a larger number of patients, facilitating continuous communication and personalized guidance without the constraints of traditional office hours.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet and information technology use in treatment of diabetes. Kaufman, N.[2022]

Insulin pump therapy (CSII) is crucial for managing type 1 diabetes, but it carries risks of serious complications like hyperglycemia and hypoglycemia due to various factors including pump failures and user errors.

There is a lack of transparency and sufficient data on the safety and long-term efficacy of insulin pumps, highlighting the need for better regulatory practices and more public funding for research to improve user education and prevent adverse events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting, and research needs: a joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Heinemann, L., Fleming, GA., Petrie, JR., et al.[2022]

A study involving 549 participants from the TuDiabetes.org online community found that 75 reported device-related adverse events, with nearly half requiring intervention, highlighting the potential for online networks to capture real-world device issues.

Only 4% of these adverse events were reported to the FDA, suggesting that online participatory surveillance can provide more comprehensive outcome data compared to traditional reporting methods, which often lack detailed information.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Participatory surveillance of diabetes device safety: a social media-based complement to traditional FDA reporting. Mandl, KD., McNabb, M., Marks, N., et al.[2021]

A total of 7076 individual case safety reports (ICSRs) were analyzed, revealing that 63.6% came from the Middle East, with most reports being nonserious (91.5%) and primarily reported by consumers (70.7%).

Patients in the Middle East were younger (average age 34.2 years) and often used insulin for gestational diabetes, while those in Africa were older (average age 48.1 years) and more likely to have type 2 diabetes, indicating significant regional differences in insulin use and associated adverse events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Individual Case Safety Reports Analysis for Patients with Diabetes Mellitus on Insulin in Africa and the Middle East. Mlotshwa, CRN., Burger, JR., Vorster, M., et al.[2022]

Insulin pump therapy (CSII) is crucial for managing type 1 diabetes, but users face significant risks from potential errors in insulin delivery, which can lead to serious health issues like hyperglycemia or hypoglycemia.

Current safety evaluations of insulin pumps are inadequate, with limited transparency in reporting adverse events and insufficient long-term data on real-world usage, highlighting the need for improved regulatory practices and more comprehensive research on pump therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting and research needs. A joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Heinemann, L., Fleming, GA., Petrie, JR., et al.[2018]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/41034605/

Technology-Intensified Diabetes Education Study (TIDES) for ... Results found a more immediate drop in HbA1c during the intervention period compared to usual care, but no significant difference at ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4289359/

Technology-Intensified Diabetes Education Study (TIDES) in ... The primary aim of this study is to test the efficacy of a TIDES intervention using the FORA two-in-one and TeleHealth System for diabetes in improving HbA1c ...

3. ncbi.ncbi.grantome.com ncbi.ncbi.grantome.com/grant/NIH/R01-DK098529-05

Technology-Intensified Diabetes Education/Skills ... Self-management interventions that include diabetes education and skills training are effective at improving metabolic control in diabetes. Recent findings ...

4. researchgate.net researchgate.net/publication/396088949_Technology-Intensified_Diabetes_Education_Study_TIDES_for_African_American_Adults_with_Type_2_Diabetes_A_Randomized_Controlled_Trial

Technology-Intensified Diabetes Education Study (TIDES ... Data from 200 AAs ≥ 21 years of age with T2DM (hemoglobin A1c (HbA1c) ≥ 8%) from the southeastern U.S. were randomized to TIDES or usual care.

5. sciencedirect.com sciencedirect.com/science/article/abs/pii/S175199182400161X

Efficacy of a health education technology program in ... This study examined the efficacy of a health education technology program on self-management adherence behavior and quality of life among people with type 2 ...

6. trialsjournal.biomedcentral.com trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-15-460

Technology-Intensified Diabetes Education Study (TIDES) in ... We describe an ongoing 4-year randomized clinical trial, which will test the efficacy of a technology-intensified diabetes education and skills ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7611289/

Technology in the management of type 2 diabetes Recent advances in technology provide valuable means of improving the accuracy and safety of insulin therapy and simplifying glucose monitoring.

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12140636/

Diabetes Care and Education: A Look Backward ... Artificial intelligence technologies are already being integrated into diabetes education interventions for dietary and exercise and insulin ...

9. ajmc.com ajmc.com/view/the-role-of-advanced-technologies-in-improving-diabetes-outcomes

The Role of Advanced Technologies in Improving Diabetes ... Numerous studies have shown that use of CGM and AID improves glycemia, diabetes-related events, and health care resource utilization and lowers overall health ...