NCT07310849

Digital Care for Holistic Health in Older Adults With Diabetes and Multimorbidity

Digital Care Community Common Good Program Enhances Holistic Health Management for Middle Aged and Older Adults With Diabetes Mellitus and Multiple Chronic Conditions

• Status: Enrolling By Invitation
• Phase: N/A
• Study type: Interventional
• Enrollment: 169 (estimated)
• Sponsor: Chang Gung University of Science and Technology · Academic / Other
• Sex: All
• Age: 50 Years
• Healthy volunteers: Not accepted

Summary

The purpose of this study was to explore the effectiveness of the "Digital Care Community Common Good" program in improving disease control indicators, self-management abilities, depression, and quality of life among patients with comorbidities and type 2 diabetes. The study was designed as a two-year experimental study, with a specific area in New Taipei City selected as the research site. In the first year, the main tasks include establishing an integrated intervention team composed of primary healthcare providers and community resources, expanding the functionalities of the mHealth platform, developing digital educational materials for diabetes comorbidities care, and recruiting and training 6 to 8 community care volunteers. Additionally, 169 eligible participants with type 2 diabetes and comorbidities will be recruited from four communities, completing baseline assessments and randomization into groups. In the second year, a 6-month intervention and effectiveness evaluation of the " Digital Care Community Common Good " program will be implemented. The intervention includes online and in-person educational sessions, telephone care, use of the mHealth platform (featuring educational, data monitoring, contextual learning, interactive, and reminders), as well as home visits, case discussions, and individualized care plans for high-risk cases. Disease control indicators, selfmanagement abilities, depression, and quality of life will be tracked immediately post-intervention, at 3 month, and at 6 month to assess outcomes and changes over time. This study expects to enhance health management for diabetes patients with comorbidities through digital care and interdisciplinary collaboration, offering evidence-based insights and recommendations for policy implementation in the integration of community and primary healthcare models.

Conditions

• Type2Diabetes
• Hypertension
• Dyslipidemia
• CKD
• Cardio Vascular Disease
• Gout Arthritis

Interventions

Type	Name	Description
BEHAVIORAL	Digital Care Community Common Good Program	a 6-month Digital Care Community Common Good program (online and in-person educational sessions, telephone care, use of the mHealth platform (featuring educational, data monitoring, contextual learning, interactive, and reminders), as well as home visits, case discussions, and individualized care plans for high-risk cases.)
BEHAVIORAL	Usual Care	receives usual care and the local integrated medical network information, including clinics and healthcare institutes that provide comorbidity care and counseling.

Timeline

• Start date: 2026-03-01
• Primary completion: 2026-06-01
• Completion: 2027-07-01
• First posted: 2025-12-30
• Last updated: 2026-02-27

Locations

1 site across 1 country: Taiwan