Voice-activated and touchscreen-controlled smart speaker intervention for adults aged 50 years and older with poorly controlled type 2 diabetes

Adults aged 50 years and older experience a disproportionate burden of diabetes, with nearly double the prevalence, greater risk of complications, and being twice as likely to die, compared to younger adults. Further compounding diabetes burden for older adults are unmet basic needs such as food insecurity, transportation barriers, utility needs, social isolation, and loneliness. These factors, combined with complex treatment regimens, create significant challenges for older adults with type 2 diabetes (T2DM) to complete health promoting self-management activities and to achieve optimal control of hemoglobin A1c (HbA1C), blood pressure, and cholesterol. A promising intervention strategy for improving diabetes outcomes is the integration of social and medical care through non-medical interventions designed to address social needs, however, only a few interventions have begun to address social needs while providing diabetes self-management education (DSME) and skills training. In addition, none of the existing DSME interventions are designed to leverage the technology of artificial intelligence (AI) and personalized DSME and skills training that can be provided using novel voice-activated, touchscreen-controlled (VATC) technologies. VATC smart speakers can help bridge the digital divide and offer a sustainable solution to: 1) deliver DSME and behavioral skills training in the home; 2) discuss unmet social needs; 3) access DSME materials; 4) schedule medication reminders; and 5) support interaction with friends and family. DSME and behavioral skills training delivered using VATC smart speakers can support older adults’ ability to age in place while avoiding institutionalized care and optimizing diabetes outcomes. If smart speakers are efficacious and improve diabetes-related outcomes, these technologies can be used to shift the paradigm and optimize health outcomes, while supporting aging in place for older adults with T2DM. Therefore, the primary objective of this pilot trial is to test the feasibility and acceptability of a health educator-delivered, VATC smart speaker intervention among 30 adults aged 50 years and older with poorly controlled (HbA1C >8%) T2DM using a pre-post clinical trial study design. The VATC intervention will include 12-weekly sessions on DSME and skills training and unmet social needs resolution. The aims of this trial are: Aim 1: To determine the feasibility (measured by recruitment and retention) and acceptability (using qualitative interviews) of the health educator-delivered, VATC smart speaker intervention among adults ≥50 years with poorly controlled T2DM (HbA1c≥8%). Aim 2: To evaluate the change and variability in clinical outcomes (HbA1C, blood pressure, cholesterol) among adults ≥50 years with poorly controlled T2DM (HbA1c≥8%) in the VATC intervention at 3-months follow-up. Aim 3: To evaluate the change and variability in psychosocial outcomes (loneliness, social isolation, depression) among adults ≥50 years with poorly controlled T2DM (HbA1c≥8%) in the VATC intervention at 3-months follow-up. Project Number: 1R21AG098252-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute on Aging (NIA) | Principal Investigator: Aprill Dawson | Institution: MEDICAL COLLEGE OF WISCONSIN, MILWAUKEE, WI | Award Amount: $195,000 | Activity Code: R21 | Study Section: Clinical Management in General Care Settings Study Section[CMGC] View on NIH RePORTER: https://reporter.nih.gov/project-details/11282300