R01DK133265

Team Support to Improve Glycemic Control Using CGM in Diverse Populations (TEAM CGM) - Project Summary

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 (TIR) 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 will integrate CGM into our previously studied approach of mobile health (mHealth) diabetes management. Our prior research has leveraged mHealth tools and a community health worker (CHW)/clinical pharmacist team to manage low-income, minority populations with T2DM. Clinical pharmacists embedded in the healthcare system review patient glucose levels, promote medication adherence, and collaboratively adjust therapy to help patients reach HbA1C goals. CHWs augment pharmacist-led efforts and address social determinants of health and provide individualized, contextual self-management support.

In partnership with Baystate Community Health Centers and UMass Memorial Family Medicine Health Centers, we propose an effectiveness study of team-supported CGM using a sequential multiple assignment randomized trial (SMART) study design. We plan to study a diverse population with 318 T2DM patients receiving pharmacist- and CHW-supported CGM delivered through community health centers (CHCs) in Massachusetts.

The specific aims include:
(1) Conduct a randomized, controlled trial to evaluate the effectiveness of pharmacist-supported CGM in a diverse patient population with T2DM in the primary care setting. We hypothesize that pharmacist-supported CGM will result in improved HbA1C, CGM metrics, and other secondary outcomes (e.g., quality of life) at 6 months compared with pharmacist-only care.
(2) Re-randomize patients not at HbA1C goal after 6 months to receive or not receive CHW support beyond pharmacist-supported CGM. We hypothesize that adding CHWs will result in improved HbA1C, CGM metrics, and other secondary outcomes at 12 months compared with pharmacist-supported CGM alone.
(3) Evaluate reach, effectiveness, adoption, implementation, and maintenance using the RE-AIM framework.
(4) Determine total cost and cost-effectiveness of CGM and the supportive components (e.g., clinical pharmacist and CHW) from the perspective of the healthcare organization.

If this team support model of diabetes care is found to be cost-effective, such evidence may influence insurance restrictions on ambulatory CGM coverage in T2DM.

University Of Massachusetts Medical School

(1) TO PROMOTE EXTRAMURAL BASIC AND CLINICAL BIOMEDICAL RESEARCH THAT IMPROVES THE UNDERSTANDING OF THE MECHANISMS UNDERLYING DISEASE AND LEADS TO IMPROVED PREVENTIONS, DIAGNOSIS, AND TREATMENT OF DIABETES, DIGESTIVE, AND KIDNEY DISEASES. PROGRAMMATIC AREAS WITHIN THE NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES INCLUDE DIABETES, DIGESTIVE, ENDOCRINE, HEMATOLOGIC, LIVER, METABOLIC, NEPHROLOGIC, NUTRITION, OBESITY, AND UROLOGIC DISEASES. SPECIFIC PROGRAMS AREAS OF INTEREST INCLUDE THE FOLLOWING: (A) FOR DIABETES, ENDOCRINE, AND METABOLIC DISEASES AREAS: FUNDAMENTAL AND CLINICAL STUDIES INCLUDING THE ETIOLOGY, PATHOGENESIS, PREVENTION, DIAGNOSIS, TREATMENT AND CURE OF DIABETES MELLITUS AND ITS COMPLICATIONS; NORMAL AND ABNORMAL FUNCTION OF THE PITUITARY, THYROID, PARATHYROID, ADRENAL, AND OTHER HORMONE SECRETING GLANDS; HORMONAL REGULATION OF BONE, ADIPOSE TISSUE, AND LIVER; ON FUNDAMENTAL ASPECTS OF SIGNAL TRANSDUCTION, INCLUDING THE ACTION OF HORMONES, COREGULATORS, AND CHROMATIN REMODELING PROTEINS; HORMONE BIOSYNTHESIS, SECRETION, METABOLISM, AND BINDING; AND ON HORMONAL REGULATION OF GENE EXPRESSION AND THE ROLE(S) OF SELECTIVE RECEPTOR MODULATORS AS PARTIAL AGONISTS OR ANTAGONISTS OF HORMONE ACTION; AND FUNDAMENTAL STUDIES RELEVANT TO METABOLIC DISORDERS INCLUDING MEMBRANE STRUCTURE, FUNCTION, AND TRANSPORT PHENOMENA AND ENZYME BIOSYNTHESIS; AND BASIC AND CLINICAL STUDIES ON THE ETIOLOGY, PATHOGENESIS, PREVENTION, AND TREATMENT OF INHERITED METABOLIC DISORDERS (SUCH AS CYSTIC FIBROSIS). (B) FOR DIGESTIVE DISEASE AND NUTRITION AREAS: GENETICS AND GENOMICS OF THE GI TRACT AND ITS DISEASES; GENETICS AND GENOMICS OF LIVER/PANCREAS AND DISEASES; GENETICS AND GENOMICS OF NUTRITION; GENETICS AND GENOMICS OF OBESITY; BARIATRIC SURGERY; CLINICAL NUTRITION RESEARCH; CLINICAL OBESITY RESEARCH; COMPLICATIONS OF CHRONIC LIVER DISEASE; FATTY LIVER DISEASE; GENETIC LIVER DISEASE; HIV AND LIVER; CELL INJURY, REPAIR, FIBROSIS AND INFLAMMATION IN THE LIVER; LIVER CANCER; LIVER TRANSPLANTATION; PEDIATRIC LIVER DISEASE; VIRAL HEPATITIS AND INFECTIOUS DISEASES; GASTROINTESTINAL AND NUTRITION EFFECTS OF AIDS; GASTROINTESTINAL MUCOSAL AND IMMUNOLOGY; GASTROINTESTINAL MOTILITY; BASIC NEUROGASTROENTEROLOGY; GASTROINTESTINAL DEVELOPMENT; GASTROINTESTINAL EPITHELIAL BIOLOGY; GASTROINTESTINAL INFLAMMATION; DIGESTIVE DISEASES EPIDEMIOLOGY AND DATA SYSTEMS; NUTRITIONAL EPIDEMIOLOGY AND DATA SYSTEMS; AUTOIMMUNE LIVER DISEASE; BILE, BILIRUBIN AND CHOLESTASIS; BIOENGINEERING AND BIOTECHNOLOGY RELATED TO DIGESTIVE DISEASES, LIVER, NUTRITION AND OBESITY; CELL AND MOLECULAR BIOLOGY OF THE LIVER; DEVELOPMENTAL BIOLOGY AND REGENERATION; DRUG-INDUCED LIVER DISEASE; GALLBLADDER DISEASE AND BILIARY DISEASES; EXOCRINE PANCREAS BIOLOGY AND DISEASES; GASTROINTESTINAL NEUROENDOCRINOLOGY; GASTROINTESTINAL TRANSPORT AND ABSORPTION; NUTRIENT METABOLISM; PEDIATRIC CLINICAL OBESITY; CLINICAL TRIALS IN DIGESTIVE DISEASES; LIVER CLINICAL TRIALS; OBESITY PREVENTION AND TREATMENT; AND OBESITY AND EATING DISORDERS. (C) FOR KIDNEY, UROLOGIC AND HEMATOLOGIC DISEASES AREAS: STUDIES OF THE DEVELOPMENT, PHYSIOLOGY, AND CELL BIOLOGY OF THE KIDNEY; PATHOPHYSIOLOGY OF THE KIDNEY; GENETICS OF KIDNEY DISORDERS; IMMUNE MECHANISMS OF KIDNEY DISEASE; KIDNEY DISEASE AS A COMPLICATION OF DIABETES; EFFECTS OF DRUGS, NEPHROTOXINS AND ENVIRONMENTAL TOXINS ON THE KIDNEY; MECHANISMS OF KIDNEY INJURY REPAIR; IMPROVED DIAGNOSIS, PREVENTION AND TREATMENT OF CHRONIC KIDNEY DISEASE AND END-STAGE RENAL DISEASE; IMPROVED APPROACHES TO MAINTENANCE DIALYSIS THERAPIES; BASIC STUDIES OF LOWER URINARY TRACT CELL BIOLOGY, DEVELOPMENT, PHYSIOLOGY, AND PATHOPHYSIOLOGY; CLINICAL STUDIES OF BLADDER DYSFUNCTION, INCONTINENCE, PYELONEPHRITIS, INTERSTITIAL CYSTITIS, BENIGN PROSTATIC HYPERPLASIA, UROLITHIASIS, AND VESICOURETERAL REFLUX; DEVELOPMENT OF NOVEL DIAGNOSTIC TOOLS AND IMPROVED THERAPIES, INCLUDING TISSUE ENGINEERING STRATEGIES, FOR UROLOGIC DISORDERS;RESEARCH ON HEMATOPOIETIC CELL DIFFERENTIATION; METABOLISM OF IRON OVERLOAD AND DEFICIENCY; STRUCTURE, BIOSYNTHESIS AND GENETIC REGULATION OF HEMOGLOBIN; AS WELL AS RESEARCH ON THE ETIOLOGY, PATHOGENESIS, AND THERAPEUTIC MODALITIES FOR THE ANEMIA OF INFLAMMATION AND CHRONIC DISEASES.(2) TO ENCOURAGE BASIC AND CLINICAL RESEARCH TRAINING AND CAREER DEVELOPMENT OF SCIENTISTS DURING THE EARLY STAGES OF THEIR CAREERS. THE RUTH L. KIRSCHSTEIN NATIONAL RESEARCH SERVICE AWARD (NRSA) FUNDS BASIC AND CLINICAL RESEARCH TRAINING, SUPPORT FOR CAREER DEVELOPMENT, AND THE TRANSITION FROM POSTDOCTORAL BIOMEDICAL RESEARCH TRAINING TO INDEPENDENT RESEARCH RELATED TO DIABETES, DIGESTIVE, ENDOCRINE, HEMATOLOGIC, LIVER, METABOLIC, NEPHROLOGIC, NUTRITION, OBESITY, AND UROLOGIC DISEASES. (3) TO EXPAND AND IMPROVE THE SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM. THE SBIR PROGRAM AIMS TO INCREASE AND FACILITATE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT; TO ENHANCE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT; AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. (4) TO UTILIZE THE SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM. THE STTR PROGRAM INTENDS TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS; TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS; TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT; AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.847 - Diabetes, Digestive, and Kidney Diseases Extramural Research

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [HHS - NIH]

Worcester, Massachusetts 01655 United States

Single Zip Code

Research Project Grant (Parent R01 Clinical Trial Required) (PA-20-183)

Amendment Since initial award the total obligations have increased 325% from $725,449 to $3,084,319.