Limitations
diabetes, depressive symptoms
SECONDARY, RESOLUTION, DIABETES
Several limitations should be acknowledged. First, our sample was relatively small so we may not have been powered to detect changes between groups in secondary outcomes like hair cortisol and c-reactive protein. Our duration of follow-up was only 3 months after post-treatment and 15 months after baseline so the longer-term durability of these effects are unknown.We did not have a sample size sufficient to investigate specific medication changes in the MTM group that might have led to lowered HbA1c. Resolution of drug therapy problems could involve medications being added/deleted, dose increased/decreased, switched to another medication, and/or adherence increased. Moreover, drug therapy problems and their resolution could pertain to any permutation of medications (e.g., statins, anti-retrovirals, steroids, antidepressants, etc.). A larger study with very granular data collection regarding MTM processes is necessary to understand what specific changes lead to a decrease in HbA1c. What is clear, however, is that in this randomized trial, the MTM intervention decreased HbA1c.Because there is no objective measure of depressive symptoms, our assessment of depressive symptoms was per self-report which may be vulnerable to demand characteristics. Due to racial differences in the relationships between weight/BMI and diabetes for east Asians, we did not plan to examine weight or BMI as a primary outcome which may limit comparison to similar trials, though we do report values of weight and BMI at each timepoint. Our sample was geographically centered in New England where weather and neighborhood factors that affect lifestyle may not generalize to, say, southern California where the other large community of Cambodian Americans live.
