Evidence mapPaperPMID 39688288Full record

Trial reportDiabetes care2025

Project ECHO Diabetes Trial Improves Outcomes for Medically Underserved People.

Ashby F Walker, Michael J Haller, Ananta Addala, Stephanie L Filipp, Rayhan A Lal, Matthew J Gurka, Lauren E Figg, Melanie Hechavarria, Dessi P Zaharieva, Keilecia G Malden and 8 more

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in Diabetes care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Ashby F WalkerUniversity of Florida Diabetes Institute, Gainesville, FL.ORCID 0000-0002-7554-2344
Michael J HallerUniversity of Florida Diabetes Institute, Gainesville, FL.ORCID 0000-0002-2803-1824
Ananta AddalaStanford Diabetes Research Center, Stanford, CA.ORCID 0000-0002-0508-4309
Stephanie L FilippDepartment of Pediatrics, University of Florida, Gainesville, FL.
Rayhan A LalStanford Diabetes Research Center, Stanford, CA.ORCID 0000-0002-8055-944X
Matthew J GurkaDepartment of Pediatrics, University of Florida, Gainesville, FL.ORCID 0000-0002-3371-4582
Lauren E FiggDivision of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Melanie HechavarriaDivision of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL.
Dessi P ZaharievaDivision of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.ORCID 0000-0002-9374-8469
Keilecia G MaldenDepartment of Health Services Research, Management and Policy, University of Florida, Gainesville, FL.
Korey K HoodStanford Diabetes Research Center, Stanford, CA.ORCID 0000-0001-5730-7749
Sarah C WestenDepartment of Clinical and Health Psychology, University of Florida, Gainesville, FL.
Jessie J WongStanford Diabetes Research Center, Stanford, CA.ORCID 0000-0003-2093-4647
William T DonahooDivision of Endocrinology, Diabetes, & Metabolism, College of Medicine, University of Florida, Gainesville, FL.
Marina BasinaStanford Diabetes Research Center, Stanford, CA.
Angelina V BernierUniversity of Florida Diabetes Institute, Gainesville, FL.ORCID 0000-0003-1300-8151
David M MaahsStanford Diabetes Research Center, Stanford, CA.
ECHO Diabetes Study Team

Funding

Leona M. and Harry B. Helmsley Charitable Trust AWD06490
6 · The paper itself

Abstract

objectiveThe Project Extension for Community Healthcare Outcomes (ECHO) model is used in 180 countries to address chronic disease care through a provider empowerment, tele-education approach. Few studies have rigorously evaluated the impact of the program on patient outcomes using randomized designs. RESEARCH DESIGN AND

methodsImplementation of an ECHO Diabetes program was evaluated using a stepped-wedge design with recruitment of 20 federally qualified health centers (FQHCs) across California and Florida with randomized, phased-in intervention entry. Participating FQHCs (referred to as "spokes") provided aggregate data, including the Healthcare Effectiveness Data and Information Set (HEDIS) and diabetes technology use. Patients were recruited from spokes, and data collection involved historical and prospective HbA1c measures, HEDIS markers, and pre/post surveys. Linear mixed models were used to generate patient-level monthly HbA1c estimates and evaluate change over time; Poisson regression was used to model clinic-level technology use.

resultsThe spoke-level cohort included 32,796 people with type 1 diabetes (T1D; 3.4%) and type 2 diabetes (T2D; 96.6%), of whom 72.7% were publicly insured or uninsured. The patient-level cohort included 582 adults with diabetes (33.0% with T1D, 67.0% with T2D). Their mean age was 51.1 years, 80.7% were publicly insured or uninsured, 43.7% were non-Hispanic White, 31.6% were Hispanic, 7.9% were non-Hispanic Black, and 16.8% were in other race/ethnicity categories. At the spoke level, there were statistically significant reductions before and after the intervention in the proportion of people with HbA1c >9% (range 31.7% to 26.7%; P = 0.033). At the patient level, there were statistically significant increases in those using continuous glucose monitoring (range 25.1% to 36.8%; P < 0.0001) and pump use (range 15.3% to 18.3%; P < 0.001) before and after the intervention.

conclusionsThe ECHO model demonstrates promise for reducing health disparities in diabetes and contributes to our understanding of program benefits beyond the provider level.

Indexed as

Diabetes Mellitus, Type 1Diabetes Mellitus, Type 2Medically Underserved AreaAdultCaliforniaFemaleFloridaGlycated HemoglobinHumansMaleMiddle AgedTelemedicineGlycated Hemoglobin

Identifiers

PMID39688288
PMCPMC11770159

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.