Results Summary

What was the research about?

Type 2 diabetes is a long-term illness that causes blood sugar levels to rise. Diabetes causes many health problems and can be hard to manage. It is the seventh leading cause of death in the United States. Many patients use diet, exercise, and medicines to control diabetes. But less than seven percent of patients with diabetes manage it effectively.

The research team compared three ways to help patients with Medicaid manage their diabetes:

  • Daily cell phone interactive text message reminders
  • Talking to a community health worker with diabetes, a person trained to help others with diabetes get the health care they need
  • Both daily text messages and talking to a community health worker

What were the results?

The study found that all three methods worked about the same to improve patients’ health and encourage healthy behaviors.

At the end of the study, patients in all three groups met more of their healthcare goals. They also had lower blood sugar and cholesterol levels. In addition, patients were more likely to monitor their blood pressure than at the start of the study, and their worry about diabetes decreased. Patients had fewer hospital and urgent care visits but didn’t have fewer emergency room visits.

Who was in the study?

The study included 166 patients with type 2 diabetes. Of these, 91 percent were African American, and 9 percent were other races. The average patient age was 53, and 72 percent were women. All patients had Medicaid and received care at one of three clinics in the Washington, DC, area.

What did the research team do?

The research team assigned patients to one of three groups by chance. Patients in the first group received text messages on their cell phones with reminders to check their blood sugar and take their medicine. They also received text messages to encourage behaviors to control their illness. The cell phone app allowed patients to report their blood sugars and activities.

Patients in the second group talked on the phone or in person with a community health worker. At first, community health workers had frequent calls with each patient and often attended patients’ clinic visits. After two months, patients decided how often they would be in contact with the community health worker, mostly once a month. The third group received both text messages and talked with a community health worker. All programs lasted for one year.

The research team collected information about patients at the start of the study and again after a year. The team looked at

  • How patients managed their illness
  • How often patients needed urgent care or went to the hospital or emergency room
  • How much stress diabetes caused the patients

An advisory board made up of patients, a diabetes educator, and representatives of a Medicaid insurer and the American Diabetes Association helped design the study.

What were the limits of the study?

Because the original clinic closed, patients couldn’t meet with community health workers for six weeks. This lapse may have affected the study results. The study included patients from three clinics in Washington, DC. Results may be different for patients in other locations.

Future research could test using text messages and community health workers with other patients in more locations.

How can people use the results?

Doctors’ offices and clinics may consider using text messages or community health workers to help patients with diabetes meet their health goals.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer review identified the following strengths and limitations in the report:

  • In response to reviewers’ questions about the handling of missing data, the researchers explained that the rate of missing data was low. The researchers also noted that there were no differences between study groups in the amount of missing data or in the characteristics of participants with missing data. Therefore, the researchers assumed that data were missing at random and did not attempt to input data for these participants or conduct sensitivity analyses.
  • The reviewers noted that the study did not prove the main hypothesis, which was that the combination of community health worker and mobile health interventions would produce better results than either intervention alone. The researchers revised the discussion and conclusion sections to clarify that point.

Conflict of Interest Disclosures

Project Information

Richard Jeffrey Katz, MD
George Washington University
$1,802,800
10.25302/4.2019.IH.13046797
Changing the Healthcare Delivery Model: A Community Health Worker/Mobile Chronic Care Team Strategy

Key Dates

September 2013
October 2017
2013
2018

Study Registration Information

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Last updated: January 25, 2023