Periodic telephone counseling can be a highly effective, low-cost tool for lowering blood-sugar levels in minority, urban adults with uncontrolled diabetes, according to a study recently published in the American Journal of Preventive Medicine.
Researchers led by Elizabeth A. Walker, PhD, RN, of the Albert Einstein College of Medicine in New York analyzed 941 adults with diabetes living in the South Bronx. Participants were predominantly Latino (68%) or non-Latino black (28%), with 70% foreign born and 55% Spanish speaking, all recruited through the New York City Department of Health and Mental Hygiene (Health Department) A1c Registry.
All 941 adults were mailed printed diabetes self-management materials. Additionally, half (443) were randomized 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 counseling sessions over one year; 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 of 2.1% (from 11.3% to 9.2%) versus an average decrease of 1.3% among print-only group individuals with extremely elevated A1c levels (from 11.0% to 9.7%). Phone calls were less helpful for people in the moderately elevated A1c group—possibly because they completed too few phone-counseling sessions (an average of 3.4 calls). On average, their A1c levels didn’t change over the course of the year, while A1c levels increased by 0.2% (from 7.8% to 8.0%) among print-only participants with moderately elevated A1c levels. Overall, those in the telephone group decreased their A1c by 0.4% more than those in the print-only group.
The authors conclude that “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. They also note 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.