An automated telephone nutrition support system for Spanish-speaking patients with diabetes

Abstract

In the United States, Spanish-speaking patients with diabetes often receive inadequate dietary counseling. Providing language and culture-concordant dietary counseling on an ongoing basis is critical to diabetes self-care. To determine if automated telephone nutrition support (ATNS) counseling could help patients improve glycemic control by duplicating a successful pilot in Mexico in a Spanish-speaking population in Oakland, California. A prospective randomized open-label trial with blinded endpoint assessment (PROBE) was performed. The participants were seventy-five adult patients with diabetes receiving care at a federally qualified health center in Oakland, California. ATNS, a computerized system that dialed patients on their phones, prompted them in Spanish to enter (via keypad) portions consumed in the prior 24 hours of various cultural-specific dietary items, and then provided dietary feedback based on proportion of high versus low glycemic index foods consumed. The control group received the same ATNS phone calls 14 weeks after enrollment. The primary outcome was hemoglobin A1c % (A1c) 12 weeks following enrollment. Participants had no significant improvement in A1c (-0.3% in the control arm, -0.1% in the intervention arm, P = .41 for any difference) or any secondary parameters. In our study, an ATNS system did not improve diabetes control in a Spanish-speaking population in Oakland.

Keywords: Spanish; diabetes care; self-care; telephone nutrition support; vulnerable populations.

Figure 1.

The glycemic index card. Given in Spanish, this card provided both a list of foods high in glycemic index and potential substitutes immediately adjacent to it. During the phone calls patients received, they were asked about portions consumed of each of these foods (including a description of a portion if they had forgotten). The sum was tallied by the machine, and if the result was 0-1 portions of high glycemic index foods, they received a message of congratulations and encouragement to continue the same; for 2-3 portions, they received a message advising them to try to eat fewer portions and a reminder of what effective substitutes might be; and for 4 or more portions, they received a slightly more strongly worded message that also gave information about end-organ damage when diabetes remains uncontrolled.