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. 2025 Oct 1.
doi: 10.1007/s11606-025-09883-y. Online ahead of print.

Technology-Intensified Diabetes Education Study (TIDES) for African American Adults with Type 2 Diabetes: A Randomized Controlled Trial

Leonard E Egede  1 , Joni S Williams  2   3 , Rebecca G Knapp  4 , Rebekah J Walker  5
Affiliations

Technology-Intensified Diabetes Education Study (TIDES) for African American Adults with Type 2 Diabetes: A Randomized Controlled Trial

Leonard E Egede et al. J Gen Intern Med. .

Abstract

Objective: Assess the efficacy of a technology-intensified diabetes education and skills training (TIDES) intervention on improving glycemic control among African American (AA) adults with poorly controlled type 2 diabetes (T2DM).

Methods: Data from 200 AAs ≥ 21 years of age with T2DM (hemoglobin A1c (HbA1c) ≥ 8%) from the southeastern U.S. were randomized to TIDES or usual care. Participants in TIDES received a home telemonitoring device for daily uploads of blood glucose readings and 12 weeks of telephone-delivered diabetes education and skills training. The primary outcome was HbA1c at 12-months in the intent-to-treat (ITT) population. Participants were assessed at baseline, 3, 6, 9, and 12 months. Baseline adjusted random intercept models evaluated the reduction in HbA1c for TIDES compared to usual care. Per protocol samples and baseline adjusted marginal models were used as sensitivity analyses.

Results: Approximately 66.5% of the sample was women; 88.5% were < 70 years of age; and 85.3% had an annual household income < $50,000. The study maintained a 90% retention rate at 12-months. HbA1c at 3 months was marginally statistically significantly lower compared to usual care (p = 0.06); however, at 12-months, there was no statistically significant difference (p = 0.668). Per protocol samples and marginal models showed similar results.

Conclusions: Results found a more immediate drop in HbA1c during the intervention period compared to usual care, but no significant difference at 12-months. Possible co-interventions occurring in the primary care clinic at the time of the study and low intensity booster sessions may explain results and have implications for future diabetes multicomponent trials.

Keywords: African American adults; diabetes; diabetes education and skills training; technology.

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Conflict of interest statement

Declarations. Human Ethics and Consent to Participate: All study procedures were approved by the IRB at the Medical University of South Carolina, and all study participants provided informed consent prior to being enrolled in the study. A partial waiver for Health Insurance Portability and Accountability Act (HIPAA) was also approved for use of clinical records. In addition, the trial was registered at clinicaltrials.gov prior to patient enrollment (NCT02088658). Conflict of interest: The authors report no potential conflicts of interest relevant to this article. Disclaimer: This article represents the views of the authors and not those of the funders.

References

REFERENCES

    1. Centers for Disease Control and Prevention. National Diabetes Statistics Report website. https://www.cdc.gov/diabetes/data/statistics-report/index.html . Accessed: February 8, 2024.
    1. U.S. Department of Health and Human Services Office of Minority Health. Diabetes and African Americans. Accessible at: https://minorityhealth.hhs.gov/diabetes-and-african-americans . Accessed: 8 Feb 2024.
    1. Bancks MP, Kershaw K, Carson AP, Gordon-Larsen P, Schreiner PJ, Carnethon MR. Association of modifiable risk factors in young adulthood with racial disparity in incident type 2 diabetes during middle adulthood. JAMA. 2017;318(24):2457-2465.
    1. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Board on Health Care Services; Committee on Unequal Treatment Revisited: The Current State of Racial and Ethnic Disparities in Health Care; Nass SJ, Amankwah FK, DeVoe JE, et al., editors. Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All. Washington (DC): National Academies Press (US); 2024 Aug 23. 1, Unequal Treatment: 20 Years After. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK607584/ .
    1. Egede LE, Walker RJ, Williams JS. Addressing Structural Inequalities, Structural Racism, and Social Determinants of Health: a Vision for the Future. J Gen Intern Med. 2024;39(3):487-491.

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