Research that reaches out to help
July 23, 2021
Racial disparities in diabetes are profound. Racial and ethnic minorities have higher prevalence rates, higher blood glucose levels, and higher rates of complications. Indeed, African Americans are at higher risk of premature death from diabetes than non-Hispanic whites.
We are conducting research initiatives aimed at ending these disparities. They will study strategies to support people with diabetes in our community, and in the process provide important resources to patients.
Using Technology to Address Disparities and Promote Healthcare Equity in Type 1 Diabetes (EquiT1D)
Continuous glucose monitors (CGMs) are a powerful diabetes technology. Using them improves glucose control and reduces the risk of diabetes complications in people with type 1 diabetes. However, there are stark racial and income disparities in access to and usage of CGMs. Non-Hispanic Black people with diabetes are far less likely to use CGMs than non-Hispanic whites, even when they are at the same income level.
Celeste Thomas, MD, MS, is overseeing a study titled, Using Technology to Address Disparities and Promote Healthcare Equity in Type 1 Diabetes, or EquiT1D, that will provide CGMs, and support in using them, to a cohort of patients in the UChicago Medicine community who need them the most.
The research team will enroll up to 50 people between 18 and 64 years old with type 1 diabetes who have been hospitalized with diabetic ketoacidosis more than once in the last five years.
The project will provide them with a patient navigator who will help them get a CGM and learn how to use it. The navigator will download and review participants’ CGM data to monitor their glucose levels, share this information with their care team, provide support for using the CGM, and identify and help remove any barriers.
“If the patient doesn’t have a prescription for a CGM, we’ll ask a physician to put one in. If there’s an insurance issue, our clinical pharmacist Margaret Allison will work with the insurance company to get it approved," said Rabia Ali, RN, the project’s research nurse and one of the navigators. “If patients are not using their CGM, we’ll try to find out why and help them overcome any barriers.”
The study will evaluate the intervention’s impact on participants’ diabetes measurements and self-management practices. Its findings could create a new standard of care for diabetes management.
'My Diabetes, My Community'
Kovler Diabetes Center nurses are working with colleagues at UChicago Medicine on a four-year research trial testing two interventions to help adults 60 and older identify and reach their diabetes goals.
“My Diabetes, My Community” will study the impact of two strategies to personalize blood sugar control goals, engage patients, and enhance self-care. The project is led by Elbert Huang, MD, a core investigator with the Chicago Center for Diabetes Translation Research, and Stacy Lindau, MD, whose interdisciplinary lab focuses on engineering solutions to injustice with the patients and communities they serve. It is funded with a $5 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
The study will enroll 600 patients age 60 and older and randomize them into three arms. Each arm will complete a baseline survey and may complete an additional module based on their assigned arm.
The first arm will receive monthly care management calls from a nurse to discuss personalized goal settings and provide education and hospital-based resources to overcome health barriers.
“Participants will identify any diabetes goals and personal goals they may have. A personal goal can be something like learning a new activity like yoga — it could be anything,” said Ali, the project’s lead nurse, who developed the nurse care management protocol. “It’s trying to tackle barriers that may be preventing them from caring for their health in general.”
The second arm will receive the same intervention as the first arm, plus another component: Community Rx (CRx), a referral system that will provide lists of personalized resources in the community to address needs such as food, housing, and diabetes self-management supplies.
The third arm, an attention control group, will receive monthly phone calls from a member of the study team (not a nurse) to talk about topics not directly related to diabetes and goal-setting.
Researchers will evaluate each approach’s impact on measures like glycemic control and unplanned hospital visits. They also will track participants’ experiences, satisfaction, and utilization of community resources.
“My Diabetes, My Community” hopes to help patients feel more confident in their ability to care for themselves, and reach their diabetes care management goals.
And those goals are ones they set themselves. “We’re not deciding what their goal should be. We’re asking, ‘What do you think?’ and coming to a decision based on what they want,” Ali said. “They ultimately dictate their goal; we are not dictating it for them.”
Stacy Tessler Lindau, MD, MA
Stacy Tessler Lindau, MD, MA, focuses on patient care, research, education and advocacy related to the health of aging women and urban populations. Dr. Lindau is the director of the Program in Integrative Sexual Medicine (PRISM), a program that provides care for and studies female sexual function in the context of aging and common illnesses.Learn more about Dr. Lindau
Celeste Thomas, MD
Celeste Thomas, MD, is the associate director of the Kovler Diabetes Center. Her clinical and academic interests are focused on understanding ways to efficiently improve the quality of diabetes care in both inpatient and outpatient settings. Specifically, she is working with cross-specialty teams to decrease iatrogenic hypoglycemia and improve blood glucose control for patients.See Dr. Thomas' bio
Kovler Diabetes Center
UChicago Medicine offers a patient-centered, science-based approach for managing insulin-dependent Type 1 diabetes, complex Type 2 diabetes, gestational, pre-diabetes and monogenic diabetes.Learn more about our expertise.