REMEDIES4D: REdesigning MEDication Intensification Effectiveness Study for Diabetes

NCT ID: NCT01611168

Last Updated: 2023-06-02

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 240 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2012-04-30
• Study Completion Date: 2015-12-31

Brief Summary

The proposed research study aims to determine whether applying the University of Pittsburgh Medical Center Nurse-Directed Diabetes Management Protocols (NDMPs) leads to improved clinical outcome and process measures as recommended by American Diabetes Association (ADA), quality of life, treatment satisfaction and medication adherence for adults with diabetes, and favorable providers' satisfaction as compared to usual diabetes care. Furthermore, the cost-effectiveness of performing the NDMPs compared to usual diabetes care in primary care settings will also be assessed.

Detailed Description

This proposed study is a multi-practice, cluster-design, prospective randomized controlled trial with a total study intervention period of 12 months. This prospective randomized controlled trial will assess the effectiveness of performing NDMPs by the registered nurse supervised by a physician (the intervention group) in comparison with usual diabetes care (the usual care group) for adults with diabetes in primary care settings. The study population will be recruited from University of Pittsburgh Medical Center Community Medicine Inc. (CMI) primary care practices in urban and suburban communities surrounding Pittsburgh, PA. Among these CMI practices, ten practices receive diabetes education services from University of Pittsburgh Diabetes Institute and will be the intervention group. These diabetes education services will be enhanced by the addition of NDMPs intervention. In addition, we will select another 10 CMI practices to be the usual care group. This group receives standard diabetes education with no use of NDMPs. One-hundred and fifty participants will be recruited across practices within each study group (i.e., 300 in total). Outcomes assessed in this study include clinical outcome and process measures as recommended by ADA, participants' quality of life, treatment satisfaction, and medication adherence, and providers' satisfaction, and costs/expenditure. Assessments will be done at baseline, and three and 12 months after the study entry. Analysis of the study outcomes will be based on intention-to-treat to determine (1) within-group differences between the baseline and follow-up visits, and (2) between-group differences between the intervention group and the usual care group.

Conditions

Type 2 Diabetes

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Usual Care

Group Type: NO_INTERVENTION

No interventions assigned to this group

Intervention Group, treatment algorithms

Group Type: EXPERIMENTAL

Treatment Algorithms

Intervention Type: OTHER

subjects in the intervention group will receive diabetes care from a well-trained registered nurse (RN) who will follow approved treatment algorithms/protocols for glycemia, high blood pressure, lipids and microalbuminuria.

Interventions

Treatment Algorithms

subjects in the intervention group will receive diabetes care from a well-trained registered nurse (RN) who will follow approved treatment algorithms/protocols for glycemia, high blood pressure, lipids and microalbuminuria.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

1. Adults aged 18 or greater

2. The diagnosis of type 2 diabetes of the subjects should be 1 year or more prior to the inception of this study

3. Subjects will be on medication treatment for their type 2 diabetes

4. Subjects' A1C levels should be higher than 7% for study entry

5. LDLc>100mg/d*l or

6. Blood Pressure >130/80*mg/dl

7. Any combination of the #4, 5 &6 At least one visit to the practice within the previous 12 months.

Exclusion Criteria

1. Non-ambulatory

2. Gestational diabetes

3. Pregnant women (by self-report)

4. Subjects have received diabetes education services performed by the registered nurse from UPDI

5. Subjects are treated with exercise and diet only

6. Subjects are participating or will participate in other research studies

7. Subjects do not have insurance or cannot afford payments for diabetes care/treatment

8. Subjects are unable to read and comprehend English

9. Subjects are unable to provide informed consent

10. Other medical conditions for which these protocols are deemed inappropriate by the physician.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

American Diabetes Association

OTHER

Sponsor Role: collaborator

University of Pittsburgh

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Janice Zgibor, RPh PhD

Role: PRINCIPAL_INVESTIGATOR

University of South Florida

Locations

University of Pittsburgh Medical Center Community Medicine Inc. (UPMC CMI) Primary Care Practices

Pittsburgh, Pennsylvania, United States

Countries

United States

References

Zgibor JC, Maloney MA, Malmi M Jr, Fabio A, Kuo S, Solano FX, Tilves D, Tu L, Davidson MB. Effectiveness of certified diabetes educators following pre-approved protocols to redesign diabetes care delivery in primary care: Results of the REMEDIES 4D trial. Contemp Clin Trials. 2018 Jan;64:201-209. doi: 10.1016/j.cct.2017.10.003. Epub 2017 Oct 6.

Reference Type: DERIVED

PMID: 28993287 (View on PubMed)

Other Identifiers

PRO08040023

Identifier Type: -

Identifier Source: org_study_id