Telephone Intervention to Improve Diabetes Control

A Randomized Trial in the New York City A1c Registry

Shadi Chamany, Elizabeth A. Walker, Clyde B. Schechter, Jeffrey S. Gonzalez, Nichola J. Davis, Felix M. Ortega, Jeidy Carrasco, Charles E. Basch, Lynn D. Silver

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction 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. Design RCT comparing a telephone intervention to print-only intervention in the context of the A1c Registry program. Setting/participants 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. Intervention 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. Main outcome measures 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. Results 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. Conclusions 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.gov Registration NCT00797888.

Original languageEnglish (US)
Pages (from-to)832-841
Number of pages10
JournalAmerican Journal of Preventive Medicine
Volume49
Issue number6
DOIs
StatePublished - Dec 1 2015

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Telephone
Registries
Self Care
Medication Adherence
Health Educators
Hispanic Americans
Population
Life Style
Motivation
Hemoglobins
Public Health
Outcome Assessment (Health Care)
Exercise
Health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Epidemiology

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

In: American Journal of Preventive Medicine, Vol. 49, No. 6, 01.12.2015, p. 832-841.

Research output: Contribution to journalArticle

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. / Telephone Intervention to Improve Diabetes Control : A Randomized Trial in the New York City A1c Registry. In: American Journal of Preventive Medicine. 2015 ; Vol. 49, No. 6. pp. 832-841.
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