Clinical Trial for Veterans with Diabetes

Approximately 12 percent of all veterans with type 2 diabetes contribute disproportionately to the Veterans Health Administration’s (VHA) burden of diabetes in terms of complications and costs. VHA needs effective practical management alternatives for veterans whose diabetes does not respond to clinic-based management.

VHA has an ongoing (2018-2021) clinical trial titled “Practical Telemedicine to Improve Control and Engagement for Veterans with Clinic-Refractory Diabetes Mellitus” (PRACTICE-DM) being sponsored by the VA Office of Research and Development

PRACTICE-DM is a comprehensive telemedicine intervention that bundles tele-monitoring, self-management support, diet/activity support, medication management, and depression support to target a critical factor underlying “Persistent Poorly-controlled Diabetes Mellitus” (PPDM)

The Clinical Trial with 200 participants from 18-70 in age are coming from two sites including veterans from Durham North Carolina, and Richmond Virginia. The trial is studying how effective the VHA’s use of home telehealth is delivering comprehensive telemedicine-based management for veterans with persistently poor type 2 diabetes control despite clinic-based care.

The trial participants will be randomized to receive one of two home telehealth delivered interventions. This will include one group of participants continuing the current treatment or the new intervention which includes standard home telehealth care coordination and tele monitoring.

In the trial, the encounter frequency for the standard home telehealth care coordination and the use of tele-monitoring will be every two weeks, but may be extended to every four weeks so participants can achieve their HbA1c goal.

This study uses the telemedicine infrastructure to deliver comprehensive management designed for PPDM to improve outcome in this high risk high cost population. Since the proposed intervention is using existing home telehealth services, this method may be an effective practical approach to reduce the burden of poor diabetes control across the VA healthcare system.

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