Virta Intervention in CommuniTies in ColORado (VICTOR) Pilot Study to Improve Diabetes and Cardiovascular Risk in...

Innovative strategies combining local community health workers (CHWs) and digital health may improve type 2 diabetes (T2D) care and cardiovascular risk in rural communities. To conduct a cluster-randomized, open-label, multisite study to evaluate the hypothesis that in rural communities served by CHW in the Colorado Heart Healthy Solutions (CHHS) program, referral to a digital continuous care intervention (CCI) would improve hemoglobin A1c (A1c) in patients with T2D as compared with CHHS alone.

Adults in the CHHS program with T2D taking at least 1 antihyperglycemic medication, A1c ≥ 7.5%, body mass index ≥25 kg/m² and who provided electronic informed consent were cluster-randomized to CHHS vs CCI+CHHS. The primary outcome was change in A1c from baseline to end of phase 1 (3 months).

Fifty-one individuals had evaluable data. Mean ± SD age was 59.6 ± 10 years, body mass index 34.4 ± 7 kg/m², and A1c 8.9 ± 1.3% at baseline. The change in A1c from baseline was not significant between groups. However, A1c decreased from baseline to end of phase 1 by -1.2% in CHHS and -1.5% in CCI+CHHS, P < .001 in each group. A higher proportion of individuals in CCI+CHHS achieved 5% or greater weight loss (P < .05), and significant net decrease in number and/or dose of antihyperglycemic medications (P < .05).

Combining a CHW program with referral to CCI did not result in greater A1c reduction, but led to improvements in A1c, weight, and medication burden in individuals with T2D in a rural setting.