• Minal R Patel, Guanghao Zhang, Michele Heisler, John D Piette, Kenneth Resnicow, Hae-Mi Choe, Xu Shi, and Peter Song.
• Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA. minalrp@umich.edu.
• J Gen Intern Med. 2024 Oct 1; 39 (13): 241524242415-2424.

BackgroundAdults with type 1 or type 2 diabetes often face financial challenges and other unmet social needs to effective diabetes self-management.ObjectiveWhether a digital intervention focused on addressing socioeconomic determinants of health improves diabetes clinical outcomes more than usual care.DesignRandomized trial from 2019 to 2023.ParticipantsA total of 600 adults with diabetes, HbA1c ≥ 7.5%, and self-reported unmet social needs or financial burden from a health system and randomized to the intervention or standard care.InterventionCareAvenue is an automated, e-health intervention with eight videos that address unmet social needs contributing to poor outcomes.MeasuresPrimary outcome was HbA1c, measured at baseline, and 6 and 12 months after randomization. Secondary outcomes included systolic blood pressure and reported met social needs, cost-related non-adherence (CRN), and financial burden. We examined main effects and variation in effects across predefined subgroups.ResultsSeventy-eight percent of CareAvenue participants completed one or more modules of the website. At 12-month follow-up, there were no significant differences in HbA1c changes between CareAvenue and control group (p = 0.24). There were also no significant between-group differences in systolic blood pressure (p = 0.29), met social needs (p = 0.25), CRN (p = 0.18), and perceived financial burden (p = 0.31). In subgroup analyses, participants with household incomes 100-400% FPL (1.93 (SE = 0.76), p < 0.01), 201-400% FPL (1.30 (SE = 0.62), p < 0.04), and > 400% FPL (1.27 (SE = 0.64), p < 0.05) had significantly less A1c decreases compared to the control group.ConclusionsOn average, CareAvenue participants did not achieve better A1c lowering, met needs, CRN, or perceived financial burden compared to control participants. CareAvenue participants with higher incomes achieved significantly less A1c reductions than control. Further research is needed on social needs interventions that consider tailored approaches to population subgroups.Clinical Trials RegistryClinicalTrials.gov ID NCT03950973, May 2019.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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