Telephone support ineffective for disadvantaged diabetes patients
MedWire News: Diabetes management programs that include ongoing telephone support may not benefit patients from the most socially and economically disadvantaged backgrounds, report US researchers.
More intensive intervention may be required for these patients, they say.
In an attempt to overcome the structural barriers to effective diabetes self-management training in the US healthcare system, disease management programs that include ongoing telephone support for patients have been implemented.
To investigate the effects of such programs in particularly disadvantaged individuals, Dominick Frosch (Palo Alto Medical Foundation Research Institute, California) and colleagues recruited 201 predominantly poor, uninsured ethnic-minority patients with poorly controlled Type 2 diabetes and randomly assigned them to either an experimental intervention or a control group.
The intervention group received a behavioral support DVD and work book developed by the Foundation for Informed Medical Decision Making as well as five sessions of telephone coaching by a bilingual, trained diabetes nurse.
The control group received a brochure on diabetes self-care developed by the National Institutes of Health National Diabetes Education Program.
All participants completed standardized biometric and survey measures at baseline and at 1-and 6-month follow-ups.
As reported in Archives of Internal Medicine, the authors found that although there was an overall decline in mean glycated hemoglobin (HbA1c) levels during the study period, the reduction was not significantly different between the intervention and control groups.
In the intervention group, the mean HBA1c level decreased from 9.4% at baseline to 8.9% after 6 months while in the control group it fell from 9.8% to 9.2%.
Between-group differences in other clinical measures (low-density lipoprotein cholesterol, blood pressure, and body mass index) were also insignificant, as were measures of diabetes knowledge and self-care behaviors.
"The lack of success of the experimental intervention is contrary to previous telephone intervention studies with different patient populations that showed significant increases in self-care and, in some cases, significant improvement in glycemic control," write Frosch and team.
The researchers say the participants in this trial had considerable deficits in their understanding of diabetes and what successful management of the condition requires. This, combined with the severe economic disadvantage and stress experienced by this population, could not be overcome by the intervention, they explain.
"The need for effective interventions that can reduce the negative health effects and suffering these patients are vulnerable to thus remains urgent," concludes the team.
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By Sally Robertson