Care Navigator Support for Younger Latinx Adults With Type 2 Diabetes

Diabetes Mellitus, Type 2 Clinical Trial

— AURORA  

Official title:

A Randomized Trial of Care Navigator to Support Younger Latinx Adults Newly Diagnosed With Type 2 Diabetes (AURORA)

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05754008
• Other study ID #: 1833646
• Status: Recruiting
• Phase: N/A
• Start date: March 31, 2023
• Est. completion date: December 2025

Study information

• Verified date: May 2024
• Source: Kaiser Permanente
• Contact: Amy Valdati
• Phone: 510-410-6659
• Email: amy.valdati[@]kp.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The study proposes to rigorously evaluate a proactive, culturally responsive care navigator intervention targeting younger-onset Latinx individuals with a new T2D diagnosis (AURORA [Active Outreach to Younger Latinx]) within Kaiser Permanente Northern California (KPNC).

Description:

The study has three primary objectives: 1) learn what is required to create and sustain a care navigator workforce and document our experience hiring a care navigator for the study, 2) implement and evaluate the AURORA strategy within KPNC, and 3) refine and adapt the AURORA strategy for future Kaiser Permanente (KP) wide dissemination. The AURORA strategy centers on a care navigator who will proactively conduct three telemedicine visits tailored to Latinx adults with early onset type 2 diabetes (T2D, defined as age <45 years). The AURORA strategy will conducted with the following five goals: 1) assessment of familiarity and use of T2D care within KP, 2) assessment of individual's self-management support needs, 3) motivational interviewing to support behavior change, 4) pragmatic skills training, including use of crucial technologies to support self-management, and 5) matching member's needs with existing KPNC T2D resources.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 204
• Est. completion date: December 2025
• Est. primary completion date: April 1, 2025
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 21 Years to 44 Years

Eligibility

Inclusion Criteria:

• KPNC member, age >20 and age <45 with

• New clinical diagnosis of T2D within the prior 1-8 months

• HbA1c=8%. If the study team are having trouble recruiting an adequate sample, the study team may lower the HbA1c threshold to =7.5%

• Proficient (written and spoken) in English or Spanish

Exclusion Criteria:

• Pregnant women

• Type 1 Diabetes

Related Conditions & MeSH terms

• Diabetes Mellitus
• Diabetes Mellitus, Type 2

Intervention

Behavioral:
• AURORA Care Strategy
Participants will be invited to partake in three telemedicine visits with the care navigator during the months following diagnosis. The visits center around proactive and tailored T2D self-management support.

Locations

Country	Name	City	State
United States	Kaiser Permanente Northern California	Oakland	California

Sponsors (1)

Lead Sponsor	Collaborator
Kaiser Permanente

Country where clinical trial is conducted

United States, 

References & Publications (32)

Adair R, Wholey DR, Christianson J, White KM, Britt H, Lee S. Improving chronic disease care by adding laypersons to the primary care team: a parallel randomized trial. Ann Intern Med. 2013 Aug 6;159(3):176-84. doi: 10.7326/0003-4819-159-3-201308060-00007. — View Citation

American Diabetes Association. 1. Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021 Jan;44(Suppl 1):S7-S14. doi: 10.2337/dc21-S001. — View Citation

American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021 Jan;44(Suppl 1):S15-S33. doi: 10.2337/dc21-S002. Erratum In: Diabetes Care. 2021 Sep;44(9):2182. — View Citation

Barbosa CE, Masho SW, Carlyle KE, Mosavel M. Factors Distinguishing Positive Deviance Among Low-Income African American Women: A Qualitative Study on Infant Feeding. J Hum Lact. 2017 May;33(2):368-378. doi: 10.1177/0890334416673048. Epub 2016 Nov 24. — View Citation

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77-101. DOI: 10.1191/1478088706qp063oa.

Campbell MK, Piaggio G, Elbourne DR, Altman DG; CONSORT Group. Consort 2010 statement: extension to cluster randomised trials. BMJ. 2012 Sep 4;345:e5661. doi: 10.1136/bmj.e5661. No abstract available. — View Citation

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009 Aug 7;4:50. doi: 10.1186/1748-5908-4-50. — View Citation

Flores-Luevano S, Pacheco M, Shokar GS, Dwivedi AK, Shokar NK. Impact of a Culturally Tailored Diabetes Education and Empowerment Program in a Mexican American Population Along the US/Mexico Border: A Pragmatic Study. J Clin Med Res. 2020 Aug;12(8):517-529. doi: 10.14740/jocmr4273. Epub 2020 Jul 22. — View Citation

Gopalan A, Blatchins MA, Altschuler A, Mishra P, Fakhouri I, Grant RW. Disclosure of New Type 2 Diabetes Diagnoses to Younger Adults: a Qualitative Study. J Gen Intern Med. 2021 Jun;36(6):1622-1628. doi: 10.1007/s11606-020-06481-y. Epub 2021 Jan 26. — View Citation

Gopalan A, Mishra P, Alexeeff SE, Blatchins MA, Kim E, Man A, Karter AJ, Grant RW. Initial Glycemic Control and Care Among Younger Adults Diagnosed With Type 2 Diabetes. Diabetes Care. 2020 May;43(5):975-981. doi: 10.2337/dc19-1380. Epub 2020 Mar 4. — View Citation

Hartzler AL, Tuzzio L, Hsu C, Wagner EH. Roles and Functions of Community Health Workers in Primary Care. Ann Fam Med. 2018 May;16(3):240-245. doi: 10.1370/afm.2208. — View Citation

Hildebrand JA, Billimek J, Lee JA, Sorkin DH, Olshansky EF, Clancy SL, Evangelista LS. Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis. Patient Educ Couns. 2020 Feb;103(2):266-275. doi: 10.1016/j.pec.2019.09.009. Epub 2019 Sep 9. — View Citation

Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008 Oct 9;359(15):1577-89. doi: 10.1056/NEJMoa0806470. Epub 2008 Sep 10. — View Citation

Islam NS, Wyatt LC, Taher MD, Riley L, Tandon SD, Tanner M, Mukherji BR, Trinh-Shevrin C. A Culturally Tailored Community Health Worker Intervention Leads to Improvement in Patient-Centered Outcomes for Immigrant Patients With Type 2 Diabetes. Clin Diabetes. 2018 Apr;36(2):100-111. doi: 10.2337/cd17-0068. — View Citation

Klompas M, Eggleston E, McVetta J, Lazarus R, Li L, Platt R. Automated detection and classification of type 1 versus type 2 diabetes using electronic health record data. Diabetes Care. 2013 Apr;36(4):914-21. doi: 10.2337/dc12-0964. Epub 2012 Nov 27. — View Citation

Kvedar J, Coye MJ, Everett W. Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth. Health Aff (Millwood). 2014 Feb;33(2):194-9. doi: 10.1377/hlthaff.2013.0992. — View Citation

Laiteerapong N, Ham SA, Gao Y, Moffet HH, Liu JY, Huang ES, Karter AJ. The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study). Diabetes Care. 2019 Mar;42(3):416-426. doi: 10.2337/dc17-1144. Epub 2018 Aug 13. — View Citation

Makam AN, Nguyen OK, Moore B, Ma Y, Amarasingham R. Identifying patients with diabetes and the earliest date of diagnosis in real time: an electronic health record case-finding algorithm. BMC Med Inform Decis Mak. 2013 Aug 1;13:81. doi: 10.1186/1472-6947-13-81. — View Citation

Molyneaux LM, Constantino MI, McGill M, Zilkens R, Yue DK. Better glycaemic control and risk reduction of diabetic complications in Type 2 diabetes: comparison with the DCCT. Diabetes Res Clin Pract. 1998 Nov;42(2):77-83. doi: 10.1016/s0168-8227(98)00095-3. — View Citation

Palmas W, March D, Darakjy S, Findley SE, Teresi J, Carrasquillo O, Luchsinger JA. Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes: A Systematic Review and Meta-Analysis. J Gen Intern Med. 2015 Jul;30(7):1004-12. doi: 10.1007/s11606-015-3247-0. Epub 2015 Mar 4. — View Citation

Pandit AU, Bailey SC, Curtis LM, Seligman HK, Davis TC, Parker RM, Schillinger D, DeWalt D, Fleming D, Mohr DC, Wolf MS. Disease-related distress, self-care and clinical outcomes among low-income patients with diabetes. J Epidemiol Community Health. 2014 Jun;68(6):557-64. doi: 10.1136/jech-2013-203063. Epub 2014 Jan 31. — View Citation

Ratanawongsa N, Karter AJ, Parker MM, Lyles CR, Heisler M, Moffet HH, Adler N, Warton EM, Schillinger D. Communication and medication refill adherence: the Diabetes Study of Northern California. JAMA Intern Med. 2013 Feb 11;173(3):210-8. doi: 10.1001/jamainternmed.2013.1216. Erratum In: JAMA Intern Med. 2013 May 13;173(9):731. — View Citation

Ray KN, Chari AV, Engberg J, Bertolet M, Mehrotra A. Disparities in Time Spent Seeking Medical Care in the United States. JAMA Intern Med. 2015 Dec;175(12):1983-6. doi: 10.1001/jamainternmed.2015.4468. No abstract available. — View Citation

Reed ME, Huang J, Parikh R, Millman A, Ballard DW, Barr I, Wargon C. Patient-Provider Video Telemedicine Integrated With Clinical Care: Patient Experiences. Ann Intern Med. 2019 Aug 6;171(3):222-224. doi: 10.7326/M18-3081. Epub 2019 Apr 30. No abstract available. — View Citation

Rosal MC, Ockene IS, Restrepo A, White MJ, Borg A, Olendzki B, Scavron J, Candib L, Welch G, Reed G. Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income latinos: latinos en control. Diabetes Care. 2011 Apr;34(4):838-44. doi: 10.2337/dc10-1981. Epub 2011 Mar 4. — View Citation

Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications. Stat Med. 1991 Apr;10(4):585-98. doi: 10.1002/sim.4780100410. — View Citation

Spencer MS, Gunter KE, Palmisano G. Community health workers and their value to social work. Soc Work. 2010 Apr;55(2):169-80. doi: 10.1093/sw/55.2.169. — View Citation

The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial. Diabetes. 1995 Aug;44(8):968-83. — View Citation

Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998 Aug-Sep;1(1):2-4. No abstract available. — View Citation

Wan EYF, Fung CSC, Jiao FF, Yu EYT, Chin WY, Fong DYT, Wong CKH, Chan AKC, Chan KHY, Kwok RLP, Lam CLK. Five-Year Effectiveness of the Multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus (RAMP-DM) on Diabetes-Related Complications and Health Service Uses-A Population-Based and Propensity-Matched Cohort Study. Diabetes Care. 2018 Jan;41(1):49-59. doi: 10.2337/dc17-0426. Epub 2017 Nov 14. — View Citation

White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011 Feb 20;30(4):377-99. doi: 10.1002/sim.4067. Epub 2010 Nov 30. — View Citation

Wilmot E, Idris I. Early onset type 2 diabetes: risk factors, clinical impact and management. Ther Adv Chronic Dis. 2014 Nov;5(6):234-44. doi: 10.1177/2040622314548679. — View Citation

* Note: There are 32 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Differences between study arms in HbA1c change 6-months following enrollment	Change in HbA1c will be assessed using HbA1c values obtained through routine care, with the most recent HbA1c preceding study enrollment and the HbA1c value closest to 6-months following enrollment used to assess HbA1c change.	6-months following enrollment
Secondary	Healthcare contact	Differences in healthcare contact with members of the T2D diabetes care team, including care manager, PCPs, educators.	6-months following enrollment
Secondary	Completion of recommended HbA1c monitoring	Completing HbA1c labs	6-months following enrollment
Secondary	T2D-related medication initiation	Initiation of T2D-related medication	6-months following enrollment
Secondary	T2D-related medication adherence	Adherence to T2D-related medication	6-months following enrollment
Secondary	Use of remote glucose monitoring to measure glucose levels	Use of a remote glucose monitoring to measure glucose levels	6-months following enrollment
Secondary	Participant-reported measures: Confidence in Accessing Care	Assessed at 3-month survey	3-months following enrollment
Secondary	Participant-reported measures: Diet and Exercise	Assessed at 3-month survey	3-months following enrollment
Secondary	Participant-reported measures: Self-efficacy for diabetes	Assessed at 3-month survey	3-months following enrollment
Secondary	Participant-reported measures: Motivation and locus of control	Assessed at 3-month survey	3-months following enrollment
Secondary	Participant-reported measures: Diabetes distress	Assessed at 3-month survey	3-months following enrollment
Secondary	Participant-reported measures: Diabetes stigma	Assessed at 3-month survey	3-months following enrollment