July 30, 2015
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Telephone counseling improves diabetes management among urban adults

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Urban-area adults with diabetes improved both their HbA1c and diabetes self-management routines following telephone counseling with community-based health educators, according to research in American Journal of Preventive Medicine.

In a study of predominantly Latino residents of the South Bronx in New York City, researchers found that participants randomly assigned to telephone calls from Spanish-speaking individuals trained in diabetes management saw a greater HbA1c improvement compared with participants who received only printed diabetes self-management materials.

Elizabeth Walker

Elizabeth A. Walker

“The study’s take-home message is that medications and printed self-management materials are necessary, but not sufficient to improve diabetes control,” Elizabeth A. Walker, PhD, RN, of Albert Einstein College of Medicine, said in a press release. “People with diabetes need ongoing counseling about problem-solving and goal-setting for behavior change.”

Shadi Chamany, MD , MPH, of the New York City Department of Health and Mental Hygiene, and colleagues analyzed data from 941 adults with diabetes and an HbA1c greater than 7% (68% Latino; 28% black; 70% foreign-born; 55% Spanish-speaking) participating in an HbA1c registry maintained by the health department between 2008 and 2012. Researchers mailed all participants diabetes self-management materials at baseline, as well as quarterly lifestyle incentives, such as pedometers. Within the cohort, 443 participants also received telephone calls from health educators: four calls (evenly spaced over 1 year) if their baseline HbA1c was between 7% and 9%; eight calls if their HbA1c was greater than 9%. The main behavioral focus was medication adherence, followed by nutrition and exercise.

Researchers found that among 694 participants with follow-up HbA1c records, mean HbA1c decreased by 0.9% in the telephone group vs. a 0.5% decrease in the print-only group (P = .01). Researchers noted a significant effect in participants with a baseline HbA1c greater than 9%.

Both the telephone and print-only groups experienced improvements in self-care activities and medication adherence, according to researchers.

Walker noted that the success of the program was affected by choosing nonclinical, community-based volunteers.

“We chose women and men from the community with warm, caring voices and who spoke the language of the people they called,” Walker said.

The findings, Chamany said, demonstrate that a culturally sensitive intervention can affect a non-English speaking population.

“Meeting people where they are and working on a long-term plan together is the best way to make gains in chronic disease,” Chamany said in a press release. “An intervention like this can be adopted by health systems and other organizations looking to improve diabetes outcomes through diabetes self-management interventions.” by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.