PCORI Answers Critical Questions
Although many care options are available to prevent and manage diabetes, questions remain about what options work best for whom, and about the most effective ways to deliver care. PCORI is funding comparative clinical effectiveness research that will provide answers to such questions as:
Caregiver: The treatment plan recommended for my son's type 1 diabetes isn’t something we can easily work into our schedules. Can my son safely monitor his diabetes and stay healthy if we tailor the plan to better fit our lifestyle?
Clinician: Have doctors serving diverse populations with high rates of diabetes seen better results when they use prevention programs that are culturally tailored?
Patient: I was diagnosed with type 2 diabetes, and taking care of myself has been challenging. I want to change that. Should I get a health coach, read more about diabetes care, or go to the doctor more often?
Study Results that Support Better-Informed Decisions
Type 2 diabetes has become a well-known part of daily life for the Marshallese community. In Northwest Arkansas, health screenings found 38.4 percent of Marshallese people with hemoglobin A1c (HbA1c) levels indicating diabetes. Read about a PCORI-funded study, which found that Marshallese adults in a culturally adapted diabetes education program experienced significantly greater reductions in hemoglobin A1c after one year in the program, compared with adults in a standard program.
The PCORnet® Bariatric Study has published several papers in prominent medical journals. The most recent clinical findings, published in JAMA Surgery, are on diabetes remission outcomes among patients who underwent gastric bypass and gastric sleeve surgeries. Another article, also published in JAMA Surgery, details the five-year outcomes of patients who underwent either gastric bypass or adjustable banding, finding that gastric bypass patients were significantly more likely than gastric sleeve patients to end up back in the hospital in the years following surgery.
Native Americans have the highest rate of diabetes of all US racial and ethnic groups. In response, this Massachusetts-based study trained laypeople known as community health representatives to coach and help coordinate care for people in their own Navajo communities. As reported in International Journal for Equity in Health, compared to those not in the program, people in it lowered blood sugar and cholesterol levels at a greater level, and they also were more likely to make and keep appointments with doctors and other health providers.
Diabetes Study Spotlights
A PCORI-funded project led by David Kent, MD, MS, of Tufts Medical Center, shows that data from large clinical studies can provide not just the average effect of a treatment, as most studies now do, but indicate which patients are likely to benefit—or not. Kent’s team is now working with the American Medical Group Association to spread the risk model to 50 clinics in two major health systems.
Native Americans have disproportionately high rates of diabetes. Two PCORI-funded studies are searching for answers in the Navajo Nation and its health data. Challenges abound—including far-flung geography, low health resources, and language barriers—but together, Navajo researchers and community health workers are meeting them.
This project evaluates whether utilizing a system of text message reminders alone, support from a community health worker alone, or a strategy that employs both, is most successful in improving healthy behaviors among Medicaid recipients with diabetes.