Diabetic Foot Ulcer and Wound Infection

Diabetes Clinical Trial

Official title:

Remote Glycemic Management for Patients With Diabetic Foot Ulcer and Wound Infection

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT03827902
• Other study ID #: STU 042018-008
• Status: Withdrawn
• Start date: July 9, 2019
• Est. completion date: April 2, 2020

Study information

• Verified date: November 2020
• Source: University of Texas Southwestern Medical Center
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The goal of the study is to compare whether an integrated model of care between Foot Wound and Diabetes Clinic with use of remote glucose monitoring technology (Intervention Arm), as compared with usual care without the use of remote glucose monitoring technology (Control Arm), will result in 1) improved glycemic control, 2) improved ulcer and wound healing, 3) improved patient reported outcomes (PROs), 4) reduced long-term healthcare resource utilization, and 5) improved adherence to anti-glycemic therapy for patients with DFUWI and poor glycemic control over the course of a 6-month intervention period.

Description:

This is a two-arm non-randomized convenient pilot trial to assess impact of an active glycemic management model through remote glucose monitoring technology amongst patients with DFUWI and poor glycemic control at the Parkland Diabetes Foot & Wound clinic. The plan is to implement a remote glucose monitoring technology to facilitate improved glycemic management and control. A cellular enabled glucose meter that will upload blood glucose measurements to a cloud server accessible by providers who can remotely review glycemic trends and remotely provide patients with proactive recommendations for treatment adjustments will be used. Patients receiving services in the integrated care model (same day visits in the Foot Wound and Diabetes Clinics at Parkland) will be eligible for inclusion in the intervention arm which includes proactive glucose monitoring guided by remote glucose monitoring technology. Patients receiving usual care services (non-integrated care model clinic days where Foot Wound and Diabetes Clinic visits are on separate days) will be eligible for inclusion in the control arm. The expectation is that patients in the intervention arm will experience greater improvements in glycemic control, compared to the usual care model. The hypothesis is that improved glycemic control in these patients will result in faster healing of diabetic foot wound, infections or ulcers. The effectiveness of the technologically facilitated integrated model of care will be evaluated compared to the usual care using metrics for diabetic foot ulcers and wound healing, glycemic control, patient reported outcomes, health resource utilization and medication adherence after 6 months of intervention. The Telcare 2.0 BGM for remote self-blood glucose monitoring(FDA Cleared) will be used.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: April 2, 2020
• Est. primary completion date: April 1, 2020
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Type 2 Diabetes
• 18 years and older
• A1C greater than or equal to 8.5% within the preceding 6 months
• A1C greater than 8% on day of enrollment
• Active diabetic foot ulcer or wound receiving treatment in the Foot Wound clinic at Parkland (ulcer that meets University of Texas Classification Grade 1 or 2 of any stage)

Exclusion Criteria:

• Chronic osteomyelitis (even if completed active therapy)
• Moderate/severe lower limb infection (per Infectious Diseases Society of America criteria)
• Diabetic Foot Ulcer and Wound Infection on Charcot Foot
• Any serious/unstable medical condition that interferes with treatment assignment
• Ankle Brachial Index less than 0.7 or toe pressures less than 30mmHg
• Unwilling to participate or receive injectable treatment or unable to keep appointments
• Non-English or Non-Spanish speakers
• Pregnant or planning to become pregnant

Related Conditions & MeSH terms

• Communicable Diseases
• Diabetes
• Diabetes Complications
• Diabetes Mellitus
• Diabetic Foot
• Diabetic Foot Ulcer
• Foot Ulcer
• Infection
• Ulcer
• Wound Infection
• Wounds and Injuries

Intervention

Device:
• Telcare 2.0 BGM
Blood glucose meter that uploads blood glucose measurements to a cloud server that providers can access and use to monitor patients' glycemic trends.

Locations

Country	Name	City	State
United States	Parkland Health and Hospital System	Dallas	Texas

Sponsors (2)

Lead Sponsor	Collaborator
University of Texas Southwestern Medical Center	Parkland Health & Hospital System

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Frequency of hypoglycemic events	Comparison of frequency of severe hypoglycemic symptoms for usual care versus intervention arm	6 months
Primary	Change in HbA1c	Mean change in HbA1c from baseline to end of treatment	6 months
Secondary	Glycemic control	Proportion of patients with lower A1C and insulin use	6 months
Secondary	Foot ulcer and/or wound healing	Complete wound healing as defined by University of Texas Health System	6 months
Secondary	Patient reported satisfaction with diabetes treatment	Self-reported outcome assessment questionnaire using the Diabetes Treatment Satisfcation Questionnaire (DTSQ) [Scale range 0-48]; lower scores represent worse outcomes	6 months
Secondary	Patient reported health status	Self-reported outcome assessment questionnaires using the 5 level EQ-5D health status measure (EQ-5D-5L) [Scale range 5-25]; higher scores represent worse outcome	6 months
Secondary	Proportion of patients with emergency department visits	Proportion of patients with emergency department visits following enrollment	6 months
Secondary	Proportion of days covered score	Proportion of days covered score represents an indirect measure of medication adherence and represents the proportion of days medication was dispensed (numerator) over the total potential days the medication should have been dispensed (denominator)	6 months
Secondary	Proportion of patients with hospitalization	Proportion of patients with hospitalization following enrollment	6 months
Secondary	Frequency of invasive procedures	Total number and type of invasive procedures related to diabetic foot ulcer and or wound infection	6 months
Secondary	Number of outpatient visits	Total number of outpatient visits for general or specialized care (including virtual visits) during trial	6 months
Secondary	Number of casts and boots used for treatment	Total number of casts and boots used for treatment related to diabetic foot ulcer and or wound infection	6 months
Secondary	Overall hospital incurred patient-specific cost	Cost (in US $) of overall patient care for Parkland during study enrollment	6 months
Secondary	Cost of glycemic management during study	• Cost of glycemic management during trial, including cost of encounters (including telephone and virtual visits), testing supplies, drug costs, technology costs specifically related to glycemic management	6 months