Long-Term Effectiveness of the TIME Intervention to Improve Diabetes Outcomes in Low-Income Settings: a 2-Year Follow-Up

Elizabeth M. Vaughan, Evan Johnson, Aanand D. Naik, Amber B. Amspoker, Ashok Balasubramanyam, Salim S. Virani, Christie M. Ballantyne, Craig A. Johnston, John P. Foreyt

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We previously found that a 6-month multidimensional diabetes program, TIME (Telehealth-Supported, Integrated Community Health Workers, Medication-Access) resulted in improved clinical outcomes. Objective: To follow TIME participant clinical outcomes for 24 months Participants: Low-income Latino(a)s with type 2 diabetes Design and Intervention: We collected post-intervention clinical data for five cohorts (n = 101, mean n = 20/cohort) who participated in TIME programs from 2018 to 2020 in Houston, Texas. Main Measures: We gathered HbA1c (primary outcome), weight, body mass index (BMI), and blood pressure data at baseline, 6 months (intervention end), and semiannually thereafter until 24 months after baseline to assess sustainability. We also evaluated participant loss to follow-up until 24 months. Key Results: Participants decreased HbA1c levels during the intervention (p < 0.0001) and maintained these improvements at each timepoint from baseline to 24 months (p range: < 0.0001 to 0.015). Participants reduced blood pressure levels during TIME and maintained these changes at each timepoint from baseline until 18 months (systolic p range < 0.0001 to 0.0005, diastolic p range: < 0.0001 to 0.008) but not at 24 months (systolic: p = 0.065; diastolic: p = 0.85). There were no significant weight changes during TIME or post-intervention: weight (p range = 0.07 to 0.77), BMI (p range = 0.11 to 0.71). Attrition rates (loss to follow-up during the post-intervention period) were 5.9% (6 months), 24.8% (12 months), 35.6% (18 months), and 41.8% (24 months). Conclusions: It is possible for vulnerable populations to maintain long-term glycemic and blood pressure improvements using a multiple dimensional intervention. Attrition rates rose over time but show promise given the majority of post-intervention timepoints occurred during the COVID-19 pandemic when low-income populations were most susceptible to suboptimal healthcare access. Future studies are needed to evaluate longitudinal outcomes of diabetes interventions conducted by local clinics rather than research teams.

Original languageEnglish (US)
JournalJournal of general internal medicine
DOIs
StateAccepted/In press - 2022
Externally publishedYes

Keywords

  • access to care
  • community health worker (CHW)
  • diabetes
  • disparities
  • group visits or shared medical appointments
  • low-income
  • telehealth or telemedicine

ASJC Scopus subject areas

  • Internal Medicine

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