University of Massachusetts, Worcester
Continuous glucose monitoring (CGM) can help improve blood sugar management in type 2 diabetes. A sequential, multiple assignment, randomized trial will evaluate clinical pharmacists, community health workers, and telehealth in supporting CGM use to improve blood sugar control.
Continuous glucose monitoring (CGM) has demonstrable benefits for people living with diabetes, including improvement in diabetes control and reduction in hypoglycemia. Randomized controlled trials have demonstrated that CGM can reduce hemoglobin A1c (HbA1c) and increase in the time in range metric. Little is known about CGM use in the broader population with type 2 diabetes (T2DM) in low-income, minority populations not receiving insulin therapy. This proposed study will rigorously evaluate CGM in a diverse and vulnerable population with T2DM in the primary care setting. The proposed study wil…
Inclusion Criteria: * Age 25-75. * History of T2DM \> 1 year. * Speak English or Spanish. * A1c ≥ 8% (within past 6 months) - with reduction if necessary based on recruitment. * eGFR (estimated glomerular filtration rate) \> 30. * Willingness to use continuous glucose monitoring (CGM) and work with a community health worker (including home visits) and clinical pharmacist. Exclusion Criteria: * Plans for weight reduction surgery or prescription weight loss medication (specific for weight loss, not GLP-1). * Current, recent, or planned use of CGM. * Current use of steroids. * Abuse of illicit…
Clinical pharmacists conduct encounters with patients by videoconferencing or phone. Pharmacists conduct a broad range of activities including ongoing evaluation of medication and lifestyle adherence, setting therapeutic goals, formulating a provider-approved plan of care, and documenting the plan in the electronic health record. Pharmacists propose medication changes based on algorithms and protocols derived from national guidelines under physician guidance.
Patients will receive the Continuous Glucose Monitoring (CGM) system. The instruction on use of device is the intervention being tested, not the effectiveness of the device itself. Participants will receive instruction and training on how to use the device and will wear the device for 10 days.
Patients are connected to a community health worker (CHW). CHWs conduct telehealth or home visits and facilitate 3-way Telehealth visits (Patients, pharmacists, and CHWs) via an iPad with cellular plan. Additional CHW activities include social determinants of health screening, health behavior education, problem solving, goal setting, and medication adherence support.
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