TY - JOUR
T1 - Racial differences in the effectiveness of a multifactorial telehealth intervention to slow diabetic kidney disease
AU - Kobe, Elizabeth A.
AU - Diamantidis, Clarissa J.
AU - Bosworth, Hayden B.
AU - Davenport, Clemontina A.
AU - Oakes, Megan
AU - Alexopoulos, Anastasia Stefania
AU - Pendergast, Jane
AU - Patel, Uptal D.
AU - Crowley, Matthew J.
N1 - Funding Information:
Supported by funding from the National Institute of Diabetes, Digestive, and Kidney Disease (NIDDK) (1R01DK93938 and P30DK096493). E.A.K. is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (TL1 TR002555). C.J.D. is supported by a grant from NIDDK (K23-DK099385 and R01-DK09398). H.B.B. is supported by a Senior Career Scientist Award VA HSR&D 08-027 and a grant from NIDDK (R34 DK102166). C.A.D. is partially supported by UL1TR001117 from the National Center for Advancing Translational Sciences. A.-S.A. is supported by the National Institutes of Health (T32DK007012). U.D.P. was supported by R01DK093938, R34DK102166, and P30DK096493 before joining Gilead Sciences in 2016. M.J.C. is supported by a Career Development Award (CDA 13-261) from VA Health Services Research & Development.
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Background:African Americans are significantly more likely than non-African Americans to have diabetes, chronic kidney disease, and uncontrolled hypertension, increasing their risk for kidney function decline.Objective:The objective of this study was to compare how African Americans and non-African Americans with diabetes responded to a multifactorial telehealth intervention designed to slow kidney function decline.Research Design:Secondary analysis of a randomized trial. Primary care patients (N=281, 56% African American) were allocated to either: (1) a multifactorial, pharmacist-delivered phone-based telehealth intervention focused on behavioral and medication management of diabetic kidney disease; or (2) an education control.Measures:The primary study outcome was change in estimated glomerular filtration rate (eGFR). Linear mixed models were used to explore the moderating effect of race on the relationship between study arm and eGFR decline over time; the mean annual rate of eGFR decline was estimated by race and study arm.Results:Findings demonstrated a differential intervention effect on kidney function over time by race (Pinteraction=0.005). Among African Americans, the intervention arm had significantly greater preservation of eGFR over time than the control arm (difference in the annual rate of eGFR decline=1.5 mL/min/1.73 m2; 95% confidence interval: 0.04, 3.02). For non-African Americans, the intervention arm had a faster decline in eGFR over time than the control arm (difference in the annual rate of eGFR decline=-1.7 mL/min/1.73 m2; 95% confidence interval: -3.3, -0.02).Conclusion:A multifactorial, pharmacist-delivered telehealth intervention for diabetic kidney disease may be more effective for slowing eGFR decline among African Americans than non-African Americans.
AB - Background:African Americans are significantly more likely than non-African Americans to have diabetes, chronic kidney disease, and uncontrolled hypertension, increasing their risk for kidney function decline.Objective:The objective of this study was to compare how African Americans and non-African Americans with diabetes responded to a multifactorial telehealth intervention designed to slow kidney function decline.Research Design:Secondary analysis of a randomized trial. Primary care patients (N=281, 56% African American) were allocated to either: (1) a multifactorial, pharmacist-delivered phone-based telehealth intervention focused on behavioral and medication management of diabetic kidney disease; or (2) an education control.Measures:The primary study outcome was change in estimated glomerular filtration rate (eGFR). Linear mixed models were used to explore the moderating effect of race on the relationship between study arm and eGFR decline over time; the mean annual rate of eGFR decline was estimated by race and study arm.Results:Findings demonstrated a differential intervention effect on kidney function over time by race (Pinteraction=0.005). Among African Americans, the intervention arm had significantly greater preservation of eGFR over time than the control arm (difference in the annual rate of eGFR decline=1.5 mL/min/1.73 m2; 95% confidence interval: 0.04, 3.02). For non-African Americans, the intervention arm had a faster decline in eGFR over time than the control arm (difference in the annual rate of eGFR decline=-1.7 mL/min/1.73 m2; 95% confidence interval: -3.3, -0.02).Conclusion:A multifactorial, pharmacist-delivered telehealth intervention for diabetic kidney disease may be more effective for slowing eGFR decline among African Americans than non-African Americans.
KW - diabetic kidney disease
KW - racial disparities
KW - telehealth intervention
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UR - http://www.scopus.com/inward/citedby.url?scp=85093539227&partnerID=8YFLogxK
U2 - 10.1097/MLR.0000000000001387
DO - 10.1097/MLR.0000000000001387
M3 - Article
C2 - 32833935
AN - SCOPUS:85093539227
SN - 0025-7079
VL - 58
SP - 968
EP - 973
JO - Medical care
JF - Medical care
IS - 11
ER -