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Controlling Hyperglycemia Among Minority Populations (CHAMP Study)

Project:

CHAMP study: A Randomized Controlled Trial of Two Diabetes Interventions for Underserved Communities

Introduction:

The acute and long-term consequences of diabetes and uncontrolled hyperglycemia are well known. Long-term complications include blindness, renal failure and amputations. In addition, individuals with diabetes have a 2 to 4 fold increased risk for cardiovascular disease and stroke. Not surprisingly, diabetes is also associated with increased mortality and decreased life expectancy. 

Unfortunately, the communities served by the Sinai Health System are disproportionately burdened by this disease. The recently conducted Sinai Community Health Survey 2.0, which surveyed over 1,500 adults living in the system’s service area, showed that the prevalence of diagnosed diabetes was 14% among Mexican adults and 11% for Black adults (compared to 7% of non-Hispanic White adults). Moreover, the communities we serve have age-adjusted diabetes mortality rates (AADMR) that are significantly above the city and national rates.

The community health worker (CHW) model is an increasingly prevalent method for reaching and engaging vulnerable populations with diabetes. CHWs play a variety of roles in helping patients overcome barriers to diabetes control, and can be successfully integrated into a health care system's care coordination strategy. Mobile phones are also emerging as an effective platform for improving a person’s ability to properly manage a chronic disease such as diabetes.

Controlling Hyperglycemia Among Minority Populations (CHAMP) was a randomized controlled trial to test the efficacy of two interventions designed to lower blood glucose levels among adults with diabetes. Through this trial, SUHI assessed whether diabetes education provided by a trained community health worker or diabetes education provided by text message was more effective compared to usual care.

Project Plan:

The primary outcome studied was mean levels of HbA1C, otherwise known as glycated hemoglobin. Secondary outcomes include healthcare access and utilization; diabetes knowledge, beliefs, and self-efficacy; and behavioral outcomes.

We recruited patients from three Sinai Health System sites: Mount Sinai Hospital, Holy Cross Hospital, and the outpatient clinic at the Sinai Community Institute.  We randomly assigned these participants to the following arms: Text Message Group, Community Health Worker (CHW) Group, and Control Group. Enrolled participants completed a 6-month intervention protocol for their assigned arm. Individuals in the Text Message Group received educational text messages related to diet, physical activity, health care utilization, and other relevant topics. Individuals in the CHW Group received six home-based, individualized diabetes education and goal setting visits, as well as phone calls in between visits. The topics covered by the CHWs mirrored those covered by the texts, though in more detail. The participants in the Control Group received the usual care provided by the hospital or clinic they attended. 

In total, 222 participants completed the 6-month follow-up visit, resulting in a 81% retention rate. We also interviewed a sample of CHAMP participants (n=24) to collect qualitative data to contextualize the quantitative findings, as well as to help plan for future diabetes-related interventions.

The project was generously funded by Blue Cross Blue Shield (BCBS) of Illinois.

Project Updates:

Recruitment for CHAMP ended in January 2017. The intervention was completed in September 2017. Quantitative and qualitative data analysis is on-going.

Publications:

Forthcoming

Resources: