• Christina R Whitehouse, Molly Knowles, Judith A Long, Nandita Mitra, Kevin G Volpp, Chang Xu, Carolyn Sabini, Norma Gerald, Irene Estrada, Denerale Jones, and Shreya Kangovi.
• M. Louise Fitzpatrick College of Nursing, Villanova University, 800 E. Lancaster Avenue, Villanova, PA, 19085, USA. christina.whitehouse@villanova.edu.
• J Gen Intern Med. 2023 Jan 1; 38 (1): 131137131-137.

ObjectiveThe aim of this study was to evaluate the effectiveness of a digital health intervention plus community health worker (CHW) support on self-monitoring of blood glucose and glycosylated hemoglobin (HbA1c) among adult Medicaid beneficiaries with diabetes.DesignRandomized controlled trial.SettingUrban outpatient clinic.ParticipantsAdult Medicaid beneficiaries living with diabetes and treated with insulin and who had a HbA1c ≥ 9%.InterventionParticipants were randomly assigned to one of three arms. Participants in the usual-care arm received a wireless glucometer if needed. Those in the digital arm received a lottery incentive for daily glucose monitoring. Those in the hybrid arm received the lottery plus support from a CHW if they had low adherence or high blood glucose levels.Main MeasuresThe primary outcome was the difference in adherence to daily glucose self-monitoring at 3 months between the hybrid and usual-care arms. The secondary outcome was difference in HbA1c from baseline at 6 months.Key ResultsA total of 150 participants were enrolled in the study. A total of 102 participants (68%) completed the study. At 3 months, glucose self-monitoring rates in the hybrid versus usual-care arms were 0.72 vs 0.65, p = 0.23. At 6 months, change in HbA1c in the hybrid versus usual-care arms was - 0.74% vs - 0.49%, p = 0.69.ConclusionThere were no statistically significant differences between the hybrid and usual care in glucose self-monitoring adherence or improvements in HbA1C.Trial RegistrationThis trial is registered with clinicaltrials.gov identifier: NCT03939793.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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