Spanish Diabetes Self-Management With and Without Automated Telephone Reinforcement

Abstract

OBJECTIVE -To determine 1) whether participants in the Spanish Diabetes SelfManagement 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 (Ϫ0.4%), health distress, symptoms of hypo-and hyperglycemia, and self-efficacy (P Ͻ 0.05). At 18 months all improvements persisted (P Ͻ 0.05). SDSMP participants also demonstrated improvements in self-rated health and communication with physicians, had fewer emergency room visits (Ϫ0.18 visits in 6 months, P Ͻ 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 Spanishspeaking population, the SDSMP deserves consideration for implementation. Diabetes Care 31:408-414, 2008

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

“…The strength of the evidence for short-term mortality was graded as moderate, given that results were precise, direct, and had low risk of bias (Table 2). Table 7), 4,21,49,61,62,69,[72][73][74][75][76][77][78][79][80][81][82][83] showing no clear differences between groups in hypoglycemia. The strength of evidence was graded as low, given the inconsistency and imprecision of the results (Table 2).…”

“…Most studies reported hypoglycemia as total hypoglycemic events [75][76][77] (N=5) or p a r t i c i p a n t s e x p e r i e n c i n g h y p o g l y c e m i a ( N = 8). 61,62,69,73,74,78,80,82 Hypoglycemic outcomes were defined heterogeneously, with some studies based on self report 4,21,62,72,73,77,82 and others on glucose readings. 74,76,78 Twelve of the 18 studies reported measures of variability.…”

“…74,76,78 Twelve of the 18 studies reported measures of variability. 4,49,61,62,69,72,73,74,76,78,80,82 Most (66 %) of these studies showed no statistically significant differences between groups (N=8) 49,61,69,73,74,78,80,82 ; however, studies had limited power due to small numbers of events. Three of the remaining four studies showed significantly less hypoglycemia in the intervention groups, 4,72,76 while one study showed significantly less hypoglycemia in the usual care group.…”

“…1, 2 Behavioral interventions are one important way to improve patient outcomes, 3 yet less is known about a subset of novel behavioral interventions focused on engaging patients in care [4][5][6] (often termed "patient activation" 7,8 ). Hibbard et al 7,9 have described patient activation interventions as those that promote motivation, knowledge, and disease self-management skills.…”

“…Hibbard et al 7,9 have described patient activation interventions as those that promote motivation, knowledge, and disease self-management skills. 7,9 Despite the growing evidence suggesting improved patient outcomes by engaging patients, [4][5][6]10 these interventions are often not integrated into practice due to uncertainty about benefit, lack of resources Electronic supplementary material The online version of this article (doi:10.1007/s11606-014-2855-4) contains supplementary material, which is available to authorized users. needed for integration, lack of health insurance coverage across insurers, and lack of clarity on the best strategies to incorporate.…”