A Direct-to-Patient Alert for Glycated Hemoglobin Screening Using Prediction Modeling and Mobile Health (mHealth) (North Carolina)

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Type 2 diabetes (T2D) is a pervasive public health issue in the United States. Studies have shown that 36.5 percent of adults have pre-diabetes, and 12.3 percent of adults have T2D diabetes. Of those adults with T2D, approximately a quarter of cases are undiagnosed. Onset can be difficult to predict due to a lack of symptoms early in the disease course. Hyperglycemia--elevated blood sugar--is the defining characteristic of T2D and can be present for years before a diagnosis. Screening, diagnosis, and management of T2D may be done via hemoglobin A1c (HbA1c), a blood test that is reflective of an individual’s average blood sugar over 3 months. It is thus an easy and accurate method for determining if a patient has experienced hyperglycemia regularly, possibly indicating T2D.

In a previous study, the researchers created a clinical decision support (CDS) tool to identify patients at risk of elevated HbA1c. In the current study, the researchers will implement this existing CDS tool in the electronic health record (EHR) of the Department of Family Medicine at Wake Forest University Health Systems to identify patients at high risk for elevated HbA1c levels. High-risk patients will be contacted via text message and offered HbA1c testing. Patients will then have the ability to accept or decline the testing. If a patient accepts, an order for testing will automatically be placed. Feedback from focus groups will initially guide message content and features. For this pilot study, the CDS will be applied to 500 high-risk patients. Surveys will determine potential factors influencing a patient’s decision to accept or decline HbA1c testing.

The specific aims of the research are as follows:

  • Develop a mobile (mHealth) text message intervention to improve the early identification of patients with hyperglycemia. 
  • Evaluate the impact of a text message mHealth HbA1c screening program in the Department of Family Medicine. 
  • Perform telephonic surveys on 100 patients: 50 who completed screening and 50 who did not complete screening. 

This targeted screening has the potential to improve the cost-effectiveness and efficiency of screening for abnormal HbA1c. Recognizing provider alert fatigue, the HbA1c screening offer will bypass the provider, removing steps to screening, and empower patients to take ownership of their health. Results from this and future studies may demonstrate the viability of texting as a tool for preventive medicine and encourage more studies to leverage direct patient interventions based on personalized recommendations. Results from this project will inform the development of a larger trial.

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