More than 30 million Americans have type 2 diabetes (T2D). As T2D is associated with a host of deleterious health outcomes, those who have persistently uncontrolled T2D (A1c >8) have the greatest risk for poor health outcomes due to associated comorbid conditions. Effective T2D management heavily relies on the individual initiating changes to diet, exercise, stress management, and medication adherence.
However, initiating and sustaining behavioral change is difficult to achieve and requires intensely skilled and continuous self-management. Research indicates continuous self-management of T2D can lead to a conglomeration of overwhelming emotions called diabetes distress, which may cause an individual to practice unhealthy behaviors. Without sustained behavioral change, the benefits of T2D therapeutics are blunted and the risk for poor outcomes increases.
Current strategies to improve T2D self-management and behavioral engagement involve prescription of T2D management programs. However, these programs generally focus on self-management education and do not deal with the main behavioral drivers of management failure. What is needed are comprehensive approaches that identify an individual’s personal motivations that can lead to sustained health management and provide ongoing support to enable individuals to achieve their health goals.
The Duke Center for Personalized Health Care proposes a novel telehealth group visit care model for individuals with T2D that brings all these factors together for long-term health improvements and disease management. This research will evaluate the efficacy of a 16-week virtual, Personal Health Planning (PHP) T2D Program emphasizing behavioral engagement, utilizing a mixed methods research design (A1c >8: n=30 experimental; n=30 control).
Our primary objectives are to evaluate implementation and determine the effectiveness of the telehealth personal health planning program for patients with uncontrolled type 2 diabetes mellitus. We hypothesize that this research will address a critical need in the care of patients with unmanaged T2D and could lead to new sustainable, lifestyle-based prevention and disease management strategies; establishing effectiveness of the intervention where evidence is lacking in persistently unmanaged T2D.