Diabetes Mellitus
Conditions
Keywords
Diabetes self management, Second Life platform, Medical group visits
Brief summary
This study evaluates the comparative effectiveness of a diabetes self management (DSM) group medical visit in the virtual world (Second life) verses a face-to-face format, aimed to increase physical activity and improve glucose control among Black/African American and Hispanic women with uncontrolled diabetes mellitus.
Detailed description
The prevalence of diabetes mellitus (DM) in the US is disproportionately high among minority women. In order to participate as partners in healthcare, DM patients need self-management education and support. Diabetes self-management (DSM) support is effective in helping DM patients make good choices and achieve clinical goals but is difficult to deliver in medical practice settings. Virtual reality technology can assist DM patients and their clinical teams with DSM support by providing effective educational tools in an engaging, learner-centered context that fosters self-efficacy and skill proficiency. Our prior work demonstrated that virtual worlds, like Second Life (SL), are suitable for supporting DSM education for patients. SL, an Internet-based virtual world, is an example of an immersive, three-dimensional environment which supports social networking and interaction with information. The investigators now aim to enhance the existing diabetes curriculum using a medical group visit design to study whether the Women in Control virtual world group medical visit leads to similarly effective health and educational outcomes compared to face-to-face group medical visits. The investigators aims are to conduct a randomized, controlled trial of the comparative effectiveness of a virtual world DSM group medical visit format vs. a face-to-face DSM group visit format to increase physical activity and improve glucose control among Black/African American and Hispanic women with uncontrolled DM at six month follow up, and to conduct a qualitative, ethnographic study of participant engagement with the virtual world platform during the virtual world group sessions, between group sessions, and following completion of the eight-week curriculum to characterize learners' self-directed interactions with the technology platform and assess the correlation of these interactions with DSM behaviors and diabetes control.
Interventions
BEHAVIORALDiabetes Self Management Medical Group Visits
The Women in Control DSM intervention involves: (1) 8-wk series of interactive, educational medical group visit sessions with groups of 10-12 participants, led by clinicians & peer leaders lasting \ 100'' in length conducted either in Spanish or English and (2) Individual consultation with a clinician lasting 10-15 minutes. Group visits will consist of experiential and discussion based learning of topics including the importance of diet, physical activity, medications, mindfulness and stress reduction to diabetes self management.
Sponsors
University of Massachusetts, Worcester
Boston University
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Boston Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Diagnosed with type 2 diabetes mellitus (documented in the medical chart) * Last recorded HbA1c \>8.0 * Currently treated with diet, oral hypoglycemic agents or insulin * Black/African American or Hispanic/Latina origin * Has telephone access * Able to understand and participate in study protocol * Functionally capable of meeting the activity goals * Understand and give informed consent * Physician approval to participate in study * Can communicate in English or Spanish
Exclusion criteria
* History of diabetic ketoacidosis * Currently or planning pregnancy * Unable or unwilling to provide informed consent * Plans to leave area within 6 month study period that would interfere with ability to attend 8 weekly sessions and/or 6 month follow up * Required intermittent glucocorticoid therapy within past 3 months. * Experienced acute coronary event (myocardial infarction or unsable angina) within previous 6 months * Medical condition that precludes adherence to study dietary recommendations (i.e. Crohn's, ulcerative colitis, etc) * Medical or serious psychiatric illness (dementia, suicidal within last 5 months, psychiatric hospitalization). Those with diagnosis of depression or who take antidepressents are eligible.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in physical activity level | Data collection at baseline, post-intervention (8 weeks) and at 6 months follow up | Participants will wear an activity monitor for a week at each collection point. Results measured in METs/hr. |
| Change in disease control (HbA1c) | Data collection at baseline, post-intervention (8 weeks) and at 6 months follow up | Change in HbA1c from BMC laboratory blood testing results |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Depression | Data collection at baseline, post-intervention (8 weeks) and at 6 months follow up | Change in Patient Health Questionnaire (PHQ8) score |
| Improvement in cholesterol, hypertension and body weight | Data collection at baseline, post-intervention (8 weeks) and at 6 months follow up | Serum LDL/HDL from BMC laboratory results. BP from home blood pressure monitor readings. BMI from weight/height measurements. |
| Health-Related Quality of Life | Data collection at baseline, post-intervention (8 weeks) and at 6 months follow up | Change in Q-LES-Q screening survey |
| Dietary Habits | Data collection at baseline, post-intervention (8 weeks) and at 6 months follow up | Multiple measures of 24-hr dietary recall |
| Patient Activation | Data collection at baseline, post-intervention (8 weeks) and at 6 months follow up | Measured by change in PAM 13 score |
| Stress | Data collection at baseline, post-intervention (8 weeks) and at 6 months follow up | Measured by perceived stress scale (PSS-10) |
| Social Support | Data collection at baseline, post-intervention (8 weeks) and at 6 months follow up | Measured by MOS social support survey |
| Health Service Utilization | Data collection at baseline, post-intervention (8 weeks) and at 6 months follow up | Self-report and chart review of hospitalizations, PCP and specialist visits |
| Functional Status | Data collection at baseline, post-intervention (8 weeks) and at 6 months follow up | Measured by Sheehan disability scale |
| Medication Adherence | Data collection at baseline, post-intervention (8 weeks) and at 6 months follow up | Prescription fulfillment ratio per i2b2 database claims data analysis |
Countries
United States
Outcome results
None listed