Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial

BMC Public Health

Marcia G Ory³  Kenneth R McLeroy³  Timethia J Bonner¹  Darcy M Moudouni⁵  Anne Robertson⁴  Dawn S Begaye⁴  Janet W Helduser⁵  Omolola E Adepoju⁵  Ann M Vuong²  John C Huber Jr²  Jane N Bolin⁵  Samuel N Forjuoh³ 

[1] Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA;Department of Epidemiology & Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA;Department of Health Promotion & Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA;Department of Family & Community Medicine, Scott & White Healthcare, College of Medicine, Texas A&M Health Science Center, Temple, TX, USA;Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA

关键词: Type 2 diabetes;    Self-management;    HbA1c;    Glycemic control;    Chronic disease;   

Others  :  1161312
DOI  :  10.1186/1471-2458-14-71

 received in 2013-04-17, accepted in 2013-12-09,  发布年份 2014

【 摘 要 】

Background

Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons.

Methods

We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged ≥18 years and whose last measured HbA1c was ≥7.5% (≥58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multi-specialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model.

Results

Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants’ diabetes self-care activities. Exploratory sub-analysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups.

Conclusions

Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control.

Trial registration

Clinicaltrials.gov Identifier: NCT01221090.

【 授权许可】

   
2014 Forjuoh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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