Research Partnerships with Healthcare Providers in Rural Community Health Centers: Needs and Challenges in Diabetes Research

One-Year Results of a Synthetic Intervention Model for the Primary Prevention of T2D among Elderly Individuals with Prediabetes in Rural China

Objective: The objective of this study was to evaluate the effectiveness of a synthetic intervention model aimed at preventing type 2 diabetes and controlling plasma glucose, body weight and waist circumference in elderly individuals with prediabetes in rural China. Methods: We randomly assigned 434 (180 men and 254 women; mean age, 69 years; mean body mass index, 23.6 kg/m²) with prediabetes to either the intervention group or the control group. Each participant in the intervention group received synthetic intervention for 1 year. Results: The incidence of diabetes was 4.2% in the intervention group, versus 19.7% in the control group at the end of 1 year (p < 0.001). Compared with the control group, the intervention group experienced a great decrease in fasting glucose (−3.9 vs. 2.2 mg/dL, p < 0.001), body weight (−3.2 vs. 1.7 kg, p < 0.001), waist circumference (−2.4 vs. 1.0 cm, p < 0001), total cholesterol (−9.1 vs. −4.6 mg/dL. p = 0.014) and HbA1c (−1.0 vs. 0.1 mg %, p = 0.002) at the end of 1 year. Conclusions: The incidence of diabetes of the control group was higher than that of the intervention group. Besides, the synthetic intervention contributes to weight loss and glucose decrease, and may be effective in reducing the risk of diabetes among elderly individuals with prediabetes in rural China.

Informatics-based Challenges of Building Collaborative Healthcare Research and Analysis Networks from Rural Community Health Centers

We discuss informatics-based challenges of constructing large-scale collaborative networks for healthcare research and analysis from rural community health centers. These types of networks provide data access and analytic insights across multiple heterogeneous health centers for both healthcare professionals and biomedical researchers. Challenges fall into three general categories: data access, data integration, and technical infrastructure. Data access issues arise in balancing patient privacy, security, and utility; data integration issues persist from each site independently operating its desired electronic medical record; technical infrastructure challenges include creating an analysis and reporting hub capable of scaling across a large collaborative network. Other challenges, such as the difficulty of site recruitment, are important to discuss, but cannot be solved directly through informatics alone. We discuss these challenges and their potential solutions in the context of our implementation of the Kentucky Diabetes and Obesity Collaborative (KDOC). KDOC is a network of Federally-Qualified Community Health Centers (FQHCs) that established a collaborative infrastructure for research and analysis of obesity and diabetes in rural and under-served communities.