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09.01.2020 | Original Research | Ausgabe 4/2020

Journal of General Internal Medicine 4/2020

The Partnership to Improve Diabetes Education Trial: a Cluster Randomized Trial Addressing Health Communication in Diabetes Care

Journal of General Internal Medicine > Ausgabe 4/2020
MD, MSc Richard O. White, MD, MHS Rosette James Chakkalakal, PhD Kenneth A. Wallston, APRN, BC-FNP, BC-ADM Kathleen Wolff, MS, RD, LDN, CDE Becky Gregory, RD, LDN, CDE Dianne Davis, PhD David Schlundt, MLAS Karen M. Trochez, MBA, CCRP Shari Barto, RD, MVTE, CDE Laura A. Harris, MPH Aihua Bian, PhD Jonathan S. Schildcrout, MD, MSc, SFHM Sunil Kripalani, MD, MPP Russell L. Rothman
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11606-019-05617-z) contains supplementary material, which is available to authorized users.

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Effective type 2 diabetes care remains a challenge for patients including those receiving primary care in safety net settings.


The Partnership to Improve Diabetes Education (PRIDE) trial team and leaders from a regional department of health evaluated approaches to improve care for vulnerable patients.


Cluster randomized controlled trial.


Adults with uncontrolled type 2 diabetes seeking care across 10 unblinded, randomly assigned safety net clinics in Middle TN.


A literacy-sensitive, provider-focused, health communication intervention (PRIDE; 5 clinics) vs. standard diabetes education (5 clinics).

Main Measures

Participant-level primary outcome was glycemic control [A1c] at 12 months. Secondary outcomes included select health behaviors and psychosocial aspects of care at 12 and 24 months. Adjusted mixed effects regression models were used to examine the comparative effectiveness of each approach to care.

Key Results

Of 410 patients enrolled, 364 (89%) were included in analyses. Median age was 51 years; Black and Hispanic patients represented 18% and 25%; 96% were uninsured, and 82% had low annual income level (< $20,000); adequate health literacy was seen in 83%, but numeracy deficits were common. At 12 months, significant within-group treatment effects occurred from baseline for both PRIDE and control sites: adjusted A1c (− 0.76 [95% CI, − 1.08 to − 0.44]; P < .001 vs − 0.54 [95% CI, − 0.86 to − 0.21]; P = .001), odds of poor eating (0.53 [95% CI, 0.33–0.83]; P = .01 vs 0.42 [95% CI, 0.26–0.68]; P < .001), treatment satisfaction (3.93 [95% CI, 2.48–6.21]; P < .001 vs 3.04 [95% CI, 1.93–4.77]; P < .001), and self-efficacy (2.97 [95% CI, 1.89–4.67]; P < .001 vs 1.81 [95% CI, 1.1–2.84]; P = .01). No significant difference was observed between study arms in adjusted analyses.


Both interventions improved the participant’s A1c and behavioral outcomes. PRIDE was not more effective than standard education. Further research may elucidate the added value of a focused health communication program in this setting.

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