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Randomized Controlled Trial
. 2010 Oct;25(10):1116-22.
doi: 10.1007/s11606-010-1419-5. Epub 2010 Jun 16.

Managing the space between visits: a randomized trial of disease management for diabetes in a community health center

Daren R Anderson  1 , Joan Christison-Lagay, Victor Villagra, Haibei Liu, James Dziura
Affiliations
Randomized Controlled Trial

Managing the space between visits: a randomized trial of disease management for diabetes in a community health center

Daren R Anderson et al. J Gen Intern Med. 2010 Oct.

Abstract

Background: Diabetes outcomes are worse for underserved patients from certain ethnic/racial minority populations. Telephonic disease management is a cost-effective strategy to deliver self-management services and possibly improve diabetes outcomes for such patients.

Objective: We conducted a trial to test the effectiveness of a supplemental telephonic disease management program compared to usual care alone for patients with diabetes cared for in a community health center.

Design: Randomized controlled trial.

Participants: All patients had type 2 diabetes, and the majority was Hispanic or African American. Most were urban-dwelling with low socioeconomic status, and nearly all had Medicaid or were uninsured.

Measurements: Clinical measures included glycemic control, blood pressure, lipid levels, and body mass index. Validated surveys were used to measure dietary habits and physical activity.

Results: A total of 146 patients were randomized to the intervention and 149 to the control group. Depressive symptoms were highly prevalent in both groups. Using an intention to treat analysis, there were no significant differences in the primary outcome (HbA1c) between the intervention and control groups at 12 months. There were also no significant differences for secondary clinical or behavioral outcome measures including BMI, systolic or diastolic blood pressure, LDL cholesterol, smoking, or intake of fruits and vegetables, or physical activity.

Conclusions: A clinic-based telephonic disease management support for underserved patients with diabetes did not improve clinical or behavioral outcomes at 1 year as compared to patients receiving usual care alone.

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Figures

Figure 1
Figure 1
Call frequency.
Figure 2
Figure 2
Flowchart for enrollment, randomization, and follow-up of study participants.
Figure 3
Figure 3
Overall and baseline HbA1c group-specific treatment differences and 95% confidence intervals for HbA1c. Differences in least squares means between control and intervention at 12 months with 95% confidence intervals for the overall treatment effect and the treatment effect for subgroups of baseline HbA1c. The band represents a clinically important difference in HbA1c of ±0.50%.
See this image and copyright information in PMC

References

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