NCT07599852Not yet recruiting
MEDBRIDGE-Guided NCM/CHW Post-Discharge Support for High-Risk T2D Patients
MEDBRIDGE: AI-Driven Risk Stratification and Care Transition Intervention to Improve Diabetes Medication Management
Source: ClinicalTrials.gov · Last updated 20 May 2026
Brief summary (registry, in English)
This study tests whether a support program led by a nurse case manager and community health worker can help patients with type 2 diabetes manage their medications after leaving the hospital. Many patients with diabetes take multiple medications, and changes to these medications during hospital stays can cause confusion and lead to missed doses or incorrect use. This is especially common in communities with limited access to healthcare. The study uses a computer-based tool called MEDBRIDGE (MEDication BRIDGE) to identify patients who may be at higher risk for problems after discharge, such as worsening blood sugar control or return visits to the emergency department. Patients identified as high-risk will receive 3 months of support from a nurse case manager and community health worker team, who will help with medication questions, coordinate with their doctor, and provide follow-up check-ins. The main goal is to find out whether this type of support program is practical to deliver and acceptable to patients. The study will also track changes in blood sugar levels and emergency department visits. Forty-five patients will be enrolled over 6 months at the University of Alabama at Birmingham and Cooper Green Mercy Health Services in Jefferson County, Alabama.
- Status (registry)
- Not yet recruiting
- Study type
- Interventional
- Enrollment
- 45 (estimated)
- First submitted
- 14 May 2026
- Start date
- May 2029
- Primary completion date
- Apr 2030
- Lead sponsor
- University of Alabama at Birmingham
- Diseases
- Type 2 diabetes
- NCT number
- NCT07599852
What you commit to
- Study type: Interventional
- Planned participants: 45
- From May 2029 to the primary completion date, Apr 2030
- 2 sites in 1 country
- Visits and tests: ask the trial team, the registry does not list them
Built from the registry fields of ClinicalTrials.gov. It describes the study, not your situation.
Who cannot take part
Copied verbatim from ClinicalTrials.gov and grouped by topic. Only the trial team decides who can take part.
Other illness
- No indication of type 2 diabetes
Age
- Under age 18
Other
- Not affiliated with Cooper Green Mercy Health Services or UAB Post Discharge Clinic for primary care
- Unable to provide informed consent
- Currently enrolled in another post-discharge intervention study
Who the study is looking for
- Adults aged 18 years or older
- Diagnosis of type 2 diabetes (HbA1c of 6.5% or higher or relevant ICD-10 codes including E11, E13, E14, R73, L97.509, K31.84)
- Discharged from UAB Hospital or its emergency departments
- Receiving primary care at Cooper Green Mercy Health Services or UAB Post Discharge Clinic
- Identified as high risk by the MEDBRIDGE prediction tool based on elevated risk of HbA1c elevation, diabetes-related emergency department visits, or diabetes-related hospitalizations within 3 months post-discharge
Age in the registry: 18 years to - · Sex: All · Does not accept healthy volunteers
Sites (2)
Sites in registry order. Pick your city on the disease page to sort them by distance.
| Site | City | Country | Site status |
|---|---|---|---|
| University of Alabama at Birmingham Coordinator of this site? Confirm its status | Birmingham | United States | Unknown status |
| Cooper Green Mercy Health Services Coordinator of this site? Confirm its status | Birmingham | United States | Unknown status |
This page is information, not medical advice. Discuss any trial with your doctor.