management

Many people with diabetes need ongoing help with self-management and new research suggests that periodic telephone counselling could be the answer.

A new study in the United States has found that a chat on the telephone can be a highly effective, low cost aid for lowering blood sugar levels in adults with uncontrolled diabetes.

Telephone counselling may help diabetics better manage their condition

Researchers at the Albert Einstein College of Medicine and the New York City Department carried out a study of 941 adults in the South Bronx, of which 68% were Latinos and 28% black. Some 70% were foreign born and 55% were Spanish speaking.

‘The study’s take home message is that medications and printed self-management materials are necessary, but not sufficient to improve diabetes control. People with diabetes need ongoing counselling about problem solving and goal setting for behaviour change,’ said Elizabeth Walker, principal investigator and professor of medicine and of epidemiology and population health at Einstein.

She credits much of the study’s success to its health educators, non-clinical individuals who received specific training in telephone counselling and expert supervision related to diabetes self-management. ‘We chose women and men from the community with warm, caring voices and who spoke the language of the people they called,’ she explained.

All those who took part were recruited through the Health Department’s A1c Registry and provided their consent before participating. A1c is a measure of long term blood sugar levels. For those diagnosed with diabetes, a level of 7% or below is a common treatment target, though this should be individualized. Those with a level of 9% and above are more likely to experience serious complications, such as blindness, kidney disease, and lower-limb amputations.

All 941 adults were sent printed diabetes self-management materials and 443 were randomised to receive telephone calls from the Health Department health educators about the importance and rationale for adhering to their medication regimens, maintaining good nutrition and exercising.

Telephone group participants who had moderately elevated blood A1c levels between 7% and 9% could receive up to four phone counselling sessions over one year while those with extremely elevated A1c levels above 9% could receive up to eight calls. After one year, the researchers assessed participants’ A1c change through the A1c Registry.

The greatest difference in A1c levels involved people who initially had extremely elevated A1c levels. For those getting telephone intervention, completing an average of 6.3 calls, their A1c levels decreased an average from 11.3% to 9.2%, an 18.6% reduction. Those who relied on printed materials with extremely elevated A1c levels saw them fall from 11% to 9.7%, an 11.8% reduction.

Phone calls were less helpful for people in the moderately elevated A1c group, possibly because they completed too few phone counselling sessions with an average of 3.4 calls. On average, their A1c levels didn’t change over the course of the year, while A1c levels increased from 7.8% to 8%, a 2.6% among print only participants with moderately elevated A1c levels.

Overall, those in the telephone group decreased their A1c by 0.4 percentage points more than those in the print only group, which was a statistically significant difference. Such an improvement is comparable to what some diabetes medications achieve.

The researchers believe that the findings are particularly important as they demonstrate the value of an intervention that is culturally sensitive and individually tailored for a low income and non-English speaking population.

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