Telephone Intervention to Improve Diabetes Control: A Randomized Trial in the New York City A1c Registry

• Published in: American journal of preventive medicine Vol. 49; no. 6; pp. 832 - 841
• Main Authors: Chamany, Shadi, Walker, Elizabeth A, Schechter, Clyde B, Gonzalez, Jeffrey S, Davis, Nichola J, Ortega, Felix M, Carrasco, Jeidy, Basch, Charles E, Silver, Lynn D
• Format: Journal Article
• Language: English
• Published: Netherlands 01.12.2015
• Subjects: Aged; Blood Glucose - drug effects; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 2 - drug therapy; Female; Glycated Hemoglobin A - analysis; Humans; Male; Medication Adherence; Middle Aged; New York City; Registries; Self Care; Telephone
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2015.04.016

Scalable self-management interventions are necessary to address suboptimal diabetes control, especially among minority populations. The study tested the effectiveness of a telephone behavioral intervention in improving glycemic control among adults with diabetes in the New York City A1c Registry. RCT comparing a telephone intervention to print-only intervention in the context of the A1c Registry program. Nine hundred forty-one adults with diabetes and hemoglobin A1c (A1c) >7% from a low-income, predominantly Latino population in the South Bronx were recruited from the A1c Registry. All study participants were mailed print diabetes self-management materials at baseline and modest lifestyle incentives quarterly. Only the telephone participants received four calls from health educators evenly spaced over 1 year if baseline A1c was >7%-9%, or eight calls if baseline A1c was >9%. Medication adherence was the main behavioral focus and, secondarily, nutrition and exercise. Primary outcome was difference between two study arms in change in A1c from baseline to 1 year. Secondary outcomes included diabetes self-care activities, including self-reported medication adherence. Data were collected in 2008-2012 and analyzed in 2012-2014. Participants were predominantly Latino (67.7%) or non-Latino black (28%), with 69.7% foreign-born and 55.1% Spanish-speaking. Among 694 (74%) participants with follow-up A1c, mean A1c decreased by 0.9 (SD=0.1) among the telephone group compared with 0.5 (SD=0.1) among the print-only group, a difference of 0.4 (95% CI=0.09, 0.74, p=0.01). The intervention had significant effect when baseline A1c was >9%. Both groups experienced similar improvements in self-care activities, medication adherence, and intensification. A telephone intervention delivered by health educators can be a clinically effective tool to improve diabetes control in diverse populations, specifically for those with worse metabolic control identified using a registry. This public health approach could be adopted by health systems supported by electronic record capabilities. CLINICALTRIALS. NCT00797888.