Two studies presented at the 73rd Scientific Sessions of the American Diabetes Association, held in Chicago, demonstrate the value of telephone intervention delivered by primary care practices or trained health educators in preventing weight gain in persons at risk for developing diabetes and controlling blood glucose levels in patients with diabetes living in underserved areas.
One study, known as SHINE (Support, Health Information, Nutrition and Exercise), showed that a telephone diabetes prevention program “is not only feasible, but effective,” said Paula Trief, PhD, co-principal investigator and professor of psychiatry and behavioral sciences at the State University of New York (SUNY) Upstate Medical University in Syracuse.
Funded by the National Institute of Diabetes and Digestive and Kidney Disease, SHINE sought to determine whether primary care provider staff could be trained to deliver diabetes prevention programs, the core of which is weight loss through lifestyle intervention, adapted for telephone delivery. Five primary care practices in upstate New York participated in a 2-day training program for lifestyle-based interventions. The interventions were those previously discovered to reduce the risk of incident diabetes in the Diabetes Prevention Program (DPP), namely weight loss achieved through dietary changes and an increase in physical activity.
Some 257 patients with metabolic syndrome (without diabetes) and a body mass index ≥30 kg/m2 were randomized to participate in the DPP lifestyle balance program as a group or individually. Group conference calls included up to 8 patients.
In the first year, educators presented the DPP core curriculum weekly over the phone for 5 weeks and then monthly afterward. Monthly calls were made by coaches to improve adherence to weight-loss strategies. In the second year, an educator made monthly phone calls and a coach was available for up to 6 visits. In the third year, contact was encouraged quarterly but was not arranged.
At 1 year, weight loss averaged 4.6 kg and 5.5 kg in the individual and group sessions, respectively. Waist circumference was reduced by a mean of 5 cm and 4.5 cm in the 2 groups, respectively.
At 2 years, solo participants had regained some weight but still showed a loss of 2.2 kg from baseline. By comparison, with group intervention, weight loss continued, to a total of 6.2 kg from baseline. Mean weight loss from baseline was 3% in the solo participants and 6.6% in the group participants (P =.01).
“Thus, solo participants had overall improvement but some weight regain, group participants had further weight loss. Lipid changes also favored group [intervention] at 2 years,” Dr Trief said.
Some 29% of the solo arm lost at least 5% of their weight versus 52.2% in the group arm (P = .01). Waist circumference reductions were statistically similar in the solo and group arms (–2.4 cm versus –3.1 cm).
In the second study, 941 adult patients with diabetes were recruited from the New York City Health Department’s hemoglobin A1c (HbA1c) registry. Of these patients, 70% were foreign born, 56% were Spanish speaking, and most were of low socioeconomic status, said lead investigator Elizabeth A. Walker, PhD, RN, CDE, director of the Prevention and Control Core for the Diabetes Research and Training Centerat the Albert Einstein College of Medicine in New York City.
All were sent 4 self-management mailings per year, in either English or Spanish, depending on the person’s preferred language. Then, 443 patients were randomized to also receive 4 to 8 phone calls a year from trained educators. Those with an HbA1c level of 7% to 9% were called 4 times annually; those with an HbA1c level >9% received up to 8 calls annually. In total, 75% of the subjects in both groups completed the 1-year study.
“The [reduction] in HbA1c in the telephone intervention group was comparable to that produced by some pharmaceuticals,” said Dr Walker. The intervention is low-cost, can be done simply from any clinic or physician’s office, and need not be performed by a healthcare professional, she emphasized.
The decline in HbA1c level was 0.41% greater in the phone intervention group compared with the control arm (P= .01). On multivariate analysis, the HbA1c level was 0.6% lower in the telephone group than in controls (P= .006).
Almost all of the improvement in HbA1c levels occurred in the group with baseline levels >9%, said Dr Walker. In this cohort, mean HbA1c levels fell from a mean of 11.3% at baseline to 10.8% at 1 year in those who received phone counseling. In the control arm, the decline was only from 11% to 10.9%.
Among the participants with HbA1c of 7% to 9% at baseline, the HbA1c level changed little in the intervention group and increased slightly in the control group.