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13-10-2011 | Legal medicine | Article

Tele-support for diabetes patients has no significant effect


Free abstract

MedWire News: Giving diabetes patients behavioral support using a telephone-based intervention does not benefit their clinical outcomes after 6 months any more than those who simply receive a printed brochure, report researchers.

The finding emerges despite evidence that the participants who received the tele-support intervention perceived these materials positively, and high numbers of them completed both study follow-ups.

Although there was no definite improvement in outcomes in this study: "More intensive and therefore more expensive interventions may [still] be a worthwhile investment to lower the high costs associated with poorly managed diabetes in the long term," suggest Dominick Frosch (Palo Alto Medical Foundation Research Institute, California, USA) and co-workers.

Furthermore, the study cohort comprised a "severely disadvantaged population," ie, one that was ethnically diverse and that earned an average income of US $15,000 (€10,867) per year or less, add the researchers. Therefore, the need for effective interventions that can reduce the negative health effects and suffering these patients are vulnerable to "remains urgent," they suggest.

A total of 201 patients with Type 2 diabetes were recruited between 2008 and 2009 and randomly assigned to receive a 20-page brochure with guidance on how to control diabetes "for life" (n=101; control condition), or to an experimental intervention (n=100) in which they were given a 24-minute-long DVD program with accompanying booklet, and were eligible to receive up to five sessions of telephone coaching.

The researchers evaluated patients' hemoglobin (Hb)A1c levels at 6-months postrandomization.

The majority of patients in the experimental intervention group completed both follow-up measures, with completion rates of 90.5% at 1 month postrandomization and 84.1% at 6 months. A total of 98.0% of participants were successfully reached by telephone 1 week after study enrollment, and almost all reported reviewing the assigned brochure (93.5%) or DVD (94.3%).

At the 6-month follow-up, the HbA1c levels of the whole cohort had significantly reduced by 0.5% compared with baseline, however, there was no significant difference between the control and experimental intervention groups.

Similarly, there was a significant increase in diabetes knowledge from baseline to 6-month follow up in both groups of patients, (tested using a questionnaire including such questions as: "On how many of the last seven days have you followed a healthy diet for diabetes?"), but no significant differences between them or over time.

Frosch et al suggest that the global circumstances prevailing at study enrollment - a recession - in addition to the fact that the frequency and duration of telephone contact may have been lacking, could explain the lack of intervention effect on clinical outcome.

Commenting on the research, editorialists Ruth Wolever and David Eisenberg (Duke University Medical Center, Durham, North Carolina, USA) remarked that the most significant finding in the study was the "feasibility" of the intervention.

However, they caution that although telephonic interventions like the one in the current study are promising, "standardization of training requirements, scope of practice, credentialing, licensure, and competency testing for health coaches is now imperative."

By Sarah Guy

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