Evaluation of a behavior support intervention for patients with poorly controlled diabetes
Open accessAbstract
BACKGROUND: Disease management programs that include ongoing telephone support for patients with diabetes have shown promise, but published studies have enrolled few socially and economically disadvantaged patients. METHODS: We conducted a randomized controlled trial with 201 patients with poorly controlled type 2 diabetes mellitus (72% African American or Latino; 74% with incomes of ≤$15,000). Participants were randomized to an intervention package consisting of a 24-minute video behavior support intervention with a workbook and 5 sessions of telephone coaching by a trained diabetes nurse or a 20-page brochure developed by the National Diabetes Education Program. Study measures were completed at baseline, 1 month, and 6 months. Participants' review of the intervention materials was assessed at 1 month. The primary trial end point was hemoglobin A(1c) value. Secondary end points included lipid levels, blood pressure, diabetes knowledge, and self-care behaviors. Data were analyzed with repeated measures analysis of variance. RESULTS: Most participants in both groups (94%) reviewed the intervention provided, and 73% of participants assigned to the experimental group completed 5 sessions of telephone coaching. There was a significant overall reduction in mean (SD) hemoglobin A(1c) value from baseline (9.6% [2.0%]) to 6 months (9.1% [1.9%]) (P < .001), but differences between groups were nonsignificant. Differences on other clinical measures (lipid levels and blood pressure) and measures of diabetes knowledge and self-care behaviors were also nonsignificant. CONCLUSIONS: There was no significant effect of the experimental intervention compared with the control condition. The dose of intervention provided was less than in previously published studies. More intensive interventions may be necessary for the most disadvantaged patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00668590.
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Diabetes self-management education and support is associated with lower A1C.
“DSMES is associated with improved diabetes knowledge and self-care behaviors (17), lower A1C (17-21), lower selfreported weight (22), improved quality of life (19,23,24), reduced all-cause mortality risk (25), positive coping behaviors (5,26), and reduced health care costs (27)(28)(29).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [18]
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- Authors
- Frosch, D. L.
- Affiliations
- Palo Alto Medical Foundation (US)
- Corresponding author
- Frosch, Dominick L.
- ORCID
- Frosch, Dominick L.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2011-12-12
- Volume
- 171
- Issue
- 22
- Pages
- 2011
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W1983574128
- Cited by
- 129
- References
- 20
- Citations by year
- 2025: 2 · 2024: 10 · 2023: 11 · 2022: 4 · 2021: 10 · 2020: 8 · 2019: 8 · 2018: 10 · 2017: 13 · 2016: 9 · 2015: 11 · 2014: 8 · 2013: 14 · 2012: 7
- FWCI
- 8.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (P30AG021684)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- type 2 diabetes, uncontrolled diabetes, telephone coaching, diabetes nurses, video-based intervention, HbA1c, glycemic control, diabetes self-care, diabetes knowledge, serum lipids, blood pressure, African American patients, Hispanic patients
- MeSH terms
- Behavior, Black or African American, Blood Pressure, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Hispanic or Latino, Humans, Health Knowledge, Attitudes, Practice, Lipids, Male, Middle Aged, Self Care, Social Support, Videotape Recording, Disease Management
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