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A Telehealth-supported, Integrated care with CHWs, and MEdication-access (TIME) Program for Diabetes Improves HbA1c:
Elizabeth M Vaughan1, David J Hyman2, Aanand D Naik2,3,4,5
1Division of General Internal Medicine, Department of Medicine , Baylor College of Medicine, Houston, TX, USA. elizabeth.vaughan@bcm.edu.
Journal of General Internal Medicine
|July 24, 2020
Summary
A telehealth program using Community Health Workers (CHWs) significantly improved glycemic control (HbA1c) and adherence to care standards for low-income adults with type 2 diabetes.
Area of Science:
- Diabetes management in resource-limited settings
- Telehealth applications in healthcare
- Community Health Worker interventions
Background:
- Diabetes affects many in low-income regions, where glycemic control is difficult due to healthcare barriers.
- Effective interventions are needed to improve diabetes care in underserved populations.
Purpose of the Study:
- To compare HbA1c outcomes in a telehealth-supported integrated care program with Community Health Workers (CHWs) and medication access (TIME) versus usual care.
- To assess the impact of the TIME program on blood pressure, BMI, weight, and adherence to American Diabetes Association (ADA) standards of care.
Main Methods:
- A randomized clinical trial involving low-income Latino(a) adults with type 2 diabetes.
- The TIME intervention included CHW-participant telehealth, CHW-led group visits, and telehealth-based CHW-physician training.
- Outcomes measured included HbA1c, blood pressure, BMI, weight, and ADA guideline adherence over 6 months.
Main Results:
- TIME participants showed significant reductions in HbA1c (1.43% vs. 0.45%) and blood pressure compared to controls.
- A higher percentage of TIME participants achieved clinically significant HbA1c reductions (>0.50%).
- CHWs identified numerous barriers to care, particularly medication access issues, for participants.
Conclusions:
- The TIME program effectively improved HbA1c and other health outcomes for individuals with type 2 diabetes.
- Community Health Workers play a crucial role in identifying and addressing healthcare barriers, especially medication-related ones.
- Further research is needed to evaluate the scalability and long-term sustainability of this intervention.
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