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NCT07729501

Multilingual Voice Calls to Adjust Long-Acting Insulin for Adults With Type 2 Diabetes and Low Health Literacy in Pakistan

Sponsor: Shifa International Hospital

View on ClinicalTrials.gov

Summary

This study will evaluate whether a multilingual, feature-phone interactive voice response (IVR) system with human-verified basal insulin titration improves glycemic control compared with standard clinic-based insulin titration among adults with type 2 diabetes and low health literacy in Pakistan. Approximately 220 participants will be randomly assigned to either the IVR-supported titration strategy or usual clinic-based care. Participants will be followed for 12 weeks, with the primary outcome being change in glycated hemoglobin (HbA1c) from baseline to Week 12. Secondary outcomes include fasting plasma glucose, insulin dose adjustment, hypoglycemia, treatment adherence, patient satisfaction, health literacy-related outcomes, and implementation measures.

Official title: Multilingual Voice-Based Insulin Titration for Adults With Type 2 Diabetes and Low Health Literacy in Pakistan: A Randomized Trial

Key Details

Gender

All

Age Range

18 Years - Any

Study Type

INTERVENTIONAL

Enrollment

220

Start Date

2026-09-25

Completion Date

2027-03-01

Last Updated

2026-07-27

Healthy Volunteers

Conditions

Type 2 Diabetes Mellitus (T2DM)Hyperglycemia Due to Type 2 Diabetes Mellitus

Interventions

BEHAVIORAL

Multilingual IVR-Supported Basal Insulin Titration

Participants will receive basal insulin titration using a multilingual interactive voice response (IVR) system with human verification. Automated voice calls collect fasting blood glucose values and generate algorithm-guided insulin dose recommendations that are reviewed by trained clinical staff before implementation. Participants continue standard diabetes care throughout the study.

OTHER

Standard Clinic-Based Basal Insulin Titration

Participants will receive basal insulin titration according to routine clinic-based practice. Insulin dose adjustments will be made during scheduled clinical care using institutional protocols. Participants will continue to receive standard diabetes management throughout the study.

Inclusion Criteria: * Age 18 years or older. * Diagnosed with type 2 diabetes mellitus. * Currently receiving basal insulin or considered by the treating clinician to require initiation or adjustment of basal insulin. * Glycemic control considered inadequate and requiring basal insulin titration according to the study protocol. * Low health literacy as determined using the study-approved screening method. * Able to communicate in one of the languages supported by the study intervention. * Has access to a functioning feature phone or mobile telephone and is able to receive automated voice calls. * Able and willing to perform fasting blood glucose monitoring according to the study procedures. * Willing and able to provide informed consent. * Willing to comply with study procedures and complete the 12-week follow-up. Exclusion Criteria: * Type 1 diabetes mellitus, gestational diabetes, or another specific form of diabetes other than type 2 diabetes mellitus. * Pregnancy, current breastfeeding, or planned pregnancy during the study period. * Current use of an insulin pump. * Severe hypoglycemia requiring assistance from another person within the period specified in the protocol before enrollment. * Recurrent hypoglycemia or another clinical condition that, in the investigator's judgment, makes protocol-directed insulin titration unsafe. * Acute metabolic decompensation, including diabetic ketoacidosis or hyperosmolar hyperglycemic state, at screening or within the period specified in the protocol. * Severe renal, hepatic, cardiac, psychiatric, cognitive, hearing, or other medical impairment that would prevent safe participation or completion of the voice-call intervention. * Inability to understand or respond to the study's supported voice-call languages. * Inability to use the telephone or glucose-monitoring procedures, with or without assistance permitted by the protocol. * Current participation in another interventional clinical trial that could interfere with the study outcomes. * Any other condition that, in the investigator's judgment, would make participation unsafe or compromise adherence to the study procedures.

Locations (1)

Shifa Hospital

Lahore, Pakistan