Spanish Diabetes Self-Management With and Without Automated Telephone Reinforcement: Two randomized trials

• Published in: Diabetes care Vol. 31; no. 3; pp. 408 - 414
• Main Authors: Lorig, Kate, Ritter, Philip L, Villa, Frank, Piette, John D
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.03.2008
• Subjects: Adult; adults; Aged; Aged, 80 and over; Biological and medical sciences; Care and treatment; Clinical trials; Costs; Data collection; Diabetes; Diabetes Mellitus, Type 2; Diabetes Mellitus, Type 2 - ethnology; Diabetes Mellitus, Type 2 - therapy; Diabetes. Impaired glucose tolerance; Diabetics; Disease Management; distress; Effectiveness; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; ethnology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; glucose; Health aspects; Health Behavior; Health care expenditures; health status; Hispanic Americans - statistics & numerical data; Hispanic or Latino; Humans; hyperglycemia; Male; Medical sciences; Metabolic diseases; methods; Middle Aged; Miscellaneous; monitoring; noninsulin-dependent diabetes mellitus; Outcome Assessment (Health Care); physicians; Public health. Hygiene; Public health. Hygiene-occupational medicine; questionnaires; Self Care; Self Care - methods; Self Care - statistics & numerical data; self-efficacy; statistics & numerical data; Studies; Telemedicine; Telephone; therapy; Type 2 diabetes; Wellness programs; Europe; Spain; Endocrinopathy; Human; Randomization; Selfcare; Nutrition; Telephone; Diabetes mellitus; Telephone call; Clinical trial; Metabolic diseases; Spanish; Endocrinology
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc07-1313

OBJECTIVE:--To determine 1) whether participants in the Spanish Diabetes Self-Management Program (SDSMP), when compared at 6 months to randomized control subjects, would demonstrate improvements in health status, health behaviors, and self-efficacy; and 2) whether SDSMP participants receiving monthly automated telephone reinforcement would maintain improvements at 18 months better than those not receiving reinforcement. RESEARCH DESIGN AND METHODS--A total of 567 Spanish-speaking adults with type 2 diabetes were randomized to a usual-care control group or 6-week community-based, peer-led SDSMP. SDSMP participants were re-randomized to receive 15 months of automated telephone messages or no reinforcement. A1C was measured at baseline and 6 and 18 months. All other data were collected by self-administered questionnaires. RESULTS:--At 6 months SDSMP participants compared with control subjects demonstrated improvements in A1C (-0.4%), health distress, symptoms of hypo- and hyperglycemia, and self-efficacy (P < 0.05). At 18 months all improvements persisted (P < 0.05). SDSMP participants also demonstrated improvements in self-rated health and communication with physicians, had fewer emergency room visits (-0.18 visits in 6 months, P < 0.05), and trended toward fewer visits to physicians. At 18 months the only difference between reinforced and nonreinforced participants was increased glucose monitoring for the reinforcement group. CONCLUSIONS:--The SDSMP demonstrated effectiveness in lowering A1C and improving health status. Reinforcement did not add to its effectiveness. Given the high needs of the Spanish-speaking population, the SDSMP deserves consideration for implementation.