Managing the Space between Visits: A Randomized Trial of Disease Management for Diabetes in a Community Health Center

• Published in: Journal of general internal medicine : JGIM Vol. 25; no. 10; pp. 1116 - 1122
• Main Authors: Anderson, Daren R., Christison-Lagay, Joan, Villagra, Victor, Liu, Haibei, Dziura, James
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-10-2010; Springer; Springer Nature B.V
• Subjects: Biological and medical sciences; Clinical outcomes; Community health care; Community Health Centers - economics; Diabetes; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - ethnology; Diabetes Mellitus, Type 2 - therapy; Diabetes. Impaired glucose tolerance; Disease Management; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General aspects; Humans; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Miscellaneous; Office Visits - economics; Original Research; Public health. Hygiene; Public health. Hygiene-occupational medicine; Socioeconomic Factors; Telemedicine; Telemedicine - economics; Telemedicine - methods; Treatment Outcome; United States; North America; America; diabetes; self-management; telehealth; Hispanic Americans; disease management; community health centers; Endocrinopathy; Space; American; Disease; Diabetes mellitus; Management; Latinamerican; Medicine; Randomization; Health center; Selfcare; Telemedicine; Clinical trial; Community health; Hispanic; Public health
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-010-1419-5

Background
Diabetes outcomes are worse for underserved patients from certain ethnic/racial minority populations. Telephonic disease management is a cost-effective strategy to deliver self-management services and possibly improve diabetes outcomes for such patients.
Objective
We conducted a trial to test the effectiveness of a supplemental telephonic disease management program compared to usual care alone for patients with diabetes cared for in a community health center.
Design
Randomized controlled trial.
Participants
All patients had type 2 diabetes, and the majority was Hispanic or African American. Most were urban-dwelling with low socioeconomic status, and nearly all had Medicaid or were uninsured.
Measurements
Clinical measures included glycemic control, blood pressure, lipid levels, and body mass index. Validated surveys were used to measure dietary habits and physical activity.
Results
A total of 146 patients were randomized to the intervention and 149 to the control group. Depressive symptoms were highly prevalent in both groups. Using an intention to treat analysis, there were no significant differences in the primary outcome (HbA1c) between the intervention and control groups at 12 months. There were also no significant differences for secondary clinical or behavioral outcome measures including BMI, systolic or diastolic blood pressure, LDL cholesterol, smoking, or intake of fruits and vegetables, or physical activity.
Conclusions
A clinic-based telephonic disease management support for underserved patients with diabetes did not improve clinical or behavioral outcomes at 1 year as compared to patients receiving usual care alone.