Optimizing diabetes management interventions for Black and Hispanic adults using the multiphase optimization...

Area of Science:

• Public Health
• Health Disparities
• Diabetes Management

Background:

• Black and Hispanic adults with diabetes face higher complication and mortality rates compared to non-Hispanic whites.
• Social determinants of health (SDOH) and negative health beliefs can impede medication adherence in these populations.
• Pharmacist-delivered medication therapy management (MTM) improves outcomes, but often lacks capacity to address SDOH and misperceptions.

Purpose of the Study:

• To determine the optimal combination of MTM and community health worker (CHW) interventions for Black and Hispanic adults with uncontrolled type 2 diabetes.
• To investigate how MTM and CHWs, addressing SDOH and health misperceptions, can be best integrated.
• To identify the most effective intervention strategy for improving diabetes management in underserved populations.

Main Methods:

• A 2x2 factorial design randomized 376 Black or Hispanic adults with type 2 diabetes (HbA1c ≥8%) to four groups over 6 months.
• Interventions included pharmacist-delivered MTM and CHW support for SDOH and misperceptions, delivered primarily via phone.
• Primary outcome was HbA1c at 6 and 12 months; secondary outcome was medication adherence, with psychosocial mediators examined.

Main Results:

• The study aims to identify which intervention component(s) – MTM, CHW, or both – yield the best clinical outcomes.
• Analysis will reveal the most effective and efficient intervention strategy for improving diabetes control.
• Participant perspectives will be gathered through qualitative interviews to assess intervention acceptability.

Conclusions:

• Findings will pinpoint the optimized intervention for improving diabetes outcomes in Black and Hispanic adults.
• The study will inform the dissemination of effective strategies to reduce diabetes disparities.
• Identifying the best combination of MTM and CHW support is crucial for equitable diabetes care.