RecruitingNot ApplicableNCT07196007

Leveraging Community-clinical Linkages to Address Unmet Social Needs for People With Diabetes

Leveraging Community-clinical Linkages to Address Unmet Social Needs for People With Diabetes Living in Rural Settings

Sponsor

Mary Lacy

Enrollment

12,000 participants

Start Date

Mar 10, 2026

Study Type

INTERVENTIONAL

Conditions

Diabetes Mellitus Diabetes

Summary

This study is a hybrid type 2 design to evaluate the effectiveness and implementation of a community-clinical linkage intervention in primary clinics to address unmet social needs for patients with diabetes living in rural communities. The study will take place in two rural communities in Kentucky, one in eastern Kentucky and one in western Kentucky.

Eligibility

Min Age: 18 Years

Inclusion Criteria4

staff at the intervention or comparison clinic
age 18 or older,
is a patient at the intervention or comparison clinic
diagnosed with diabetes

Exclusion Criteria4

staff not at the intervention or comparison clinic
being under the age of 18,
not a patient at the intervention or comparison clinic
not diagnosed with diabetes

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Interventions

BEHAVIORALCommunity-Clinical Intervention

The intervention involves enhancing usual care for screening patients with diabetes for unmet social needs and referring those who screen positive to a Community Health Worker. Patients who screen positive for unmet social needs will work with CHWs to be connected to community organizations.