Put Me In, Coach: Mobile Health for Diabetes Management

Diabetes disparities are a major issue within an already serious public health problem. From 2019 to 2021, 14.5% of adults with diabetes in the United States were American Indian/Alaska Native, 12.1% were non-Hispanic Black, and 11.7% were Hispanic/Latinx.¹ Care models incorporating mobile health (mHealth), pharmacists and health coaches can help reach groups disproportionately affected by diabetes.^2-4 Although research shows pharmacists’ importance in diabetes management, the involvement of mHealth and health coaches is a growing field that JAMA Network Open featured in its September 2023 issue.^5,6

An interprofessional group of researchers from universities in Massachusetts and Illinois investigated mHealth among African American and Latinx adults with unmanaged type 2 diabetes. In this crossover randomized control trial, they assigned 221 patients to receive usual diabetes care or an mHealth intervention delivered by pharmacists and health coaches. The groups switched treatments after one year and were followed for a total of 24 months.⁷

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The mHealth intervention included clinical care (e.g. glucose level assessment and medication intensification) from pharmacists via a video telehealth platform. Health coach activities (e.g. coordination of care and medication use assistance) occurred via in-person home visits, phone calls, and text messages. Usual diabetes care consisted of patients’ primary care physicians performing routine care, such as medication reconciliation and adjustment.⁷

The study found that the intervention decreased hemoglobin A1c (HbA1c) levels over 12 months in both groups. Patients maintained this benefit 12 months after stopping the intervention. The researchers noted, however, that most patients did not achieve their goal despite HbA1c improvement.⁷

The authors propose that health coaches supporting remote pharmacist services can improve diabetes disparities. Health coach activity logs indicating communication about social determinants of health allowed pharmacists and primary care providers to optimize patient care. Likewise, health coaches served to address other barriers such as transportation and literacy. Suggested future research includes sustainability and economic outcomes.⁷

About the Author

Angela Y. Su is a PharmD candidate at the University of Connecticut in Storrs, CT.

References

1. Centers for Disease Control and Prevention. By the Numbers: Diabetes in America. United States Department of Health & Human Services. Updated October 25, 2022. Accessed December 14, 2023. https://www.cdc.gov/diabetes/health-equity/diabetes-by-the-numbers.html

2. Anderson A, O'Connell SS, Thomas C, Chimmanamada R. Telehealth Interventions to Improve Diabetes Management Among Black and Hispanic Patients: a Systematic Review and Meta-Analysis. J Racial Ethn Health Disparities. 2022;9(6):2375-2386. doi:10.1007/s40615-021-01174-6

3. Mitchell SE, Bragg A, De La Cruz BA, et al. Effectiveness of an Immersive Telemedicine Platform for Delivering Diabetes Medical Group Visits for African American, Black and Hispanic, or Latina Women With Uncontrolled Diabetes: The Women in Control 2.0 Noninferiority Randomized Clinical Trial. J Med Internet Res. 2023;25:e43669. Published 2023 May 10. doi:10.2196/43669

4. Gerber BS, Cano AI, Caceres ML, et al. A pharmacist and health promoter team to improve medication adherence among Latinos with diabetes. Ann Pharmacother. 2010;44(1):70-79. doi:10.1345/aph.1M389

5. Fazel MT, Bagalagel A, Lee JK, Martin JR, Slack MK. Impact of Diabetes Care by Pharmacists as Part of Health Care Team in Ambulatory Settings: A Systematic Review and Meta-analysis. Ann Pharmacother. 2017;51(10):890-907. doi:10.1177/1060028017711454

6. Orabone AW, Do V, Cohen E. Pharmacist-Managed Diabetes Programs: Improving Treatment Adherence and Patient Outcomes. Diabetes Metab Syndr Obes. 2022;15:1911-1923. Published 2022 Jun 20. doi:10.2147/DMSO.S342936

7. Gerber BS, Biggers A, Tilton JJ, et al. Mobile Health Intervention in Patients With Type 2 Diabetes: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(9):e2333629. Published 2023 Sep 5. doi:10.1001/jamanetworkopen.2023.33629