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

详细信息    查看全文

• 作者：Samuel N Forjuoh (25) (26) (27)
  Jane N Bolin (28)
  John C Huber Jr (26)
  Ann M Vuong (26)
  Omolola E Adepoju (28)
  Janet W Helduser (28)
  Dawn S Begaye (25)
  Anne Robertson (25)
  Darcy M Moudouni (28)
  Timethia J Bonner (29)
  Kenneth R McLeroy (27)
  Marcia G Ory (27)
  
• 关键词：Chronic disease ; Glycemic control ; HbA1c ; Self ; management ; Type 2 diabetes
• 刊名：BMC Public Health
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：472 KB
• 作者单位：Samuel N Forjuoh (25) (26) (27)
  Jane N Bolin (28)
  John C Huber Jr (26)
  Ann M Vuong (26)
  Omolola E Adepoju (28)
  Janet W Helduser (28)
  Dawn S Begaye (25)
  Anne Robertson (25)
  Darcy M Moudouni (28)
  Timethia J Bonner (29)
  Kenneth R McLeroy (27)
  Marcia G Ory (27)
  
  25. Department of Family & Community Medicine, Scott & White Healthcare, College of Medicine, Texas A&M Health Science Center, Temple, TX, USA
  26. Department of Epidemiology & Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
  27. Department of Health Promotion & Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
  28. Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
  29. Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
  
• ISSN：1471-2458

文摘

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 ?8?years and whose last measured HbA1c was ?.5% (?8?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.