Empathy-focused Calls Boost Diabetes Self-Care

TOPLINE:

Empathetic telephone calls by laypeople may improve glycemic control in patients with uncontrolled diabetes and low income, particularly in those with subclinical depressive symptoms.

METHODOLOGY:

• Patients were stratified by baseline depressive symptom scores ≥ 5 (a cutoff that includes subclinical depressive symptoms) and
• Patients in the intervention group chose the frequency and length of calls and discussed their own interests, adding up to an average of 20 calls per patient over 6 months.
• The primary outcome was a change in A1c levels, measured at baseline, 3 months, and 6 months by finger stick on a portable device.

TAKEAWAY:

• The mean within-person change in A1c levels from baseline to 6 months was −0.7% in the intervention group vs 0.02% in the usual care group (95% CI, − 1.0% to 0.4%, and 0.02% (95% CI, −0.4% to 0.4%, respectively); improvements in A1c levels modestly correlated with the total number of calls and total minutes (P = .02 and P = .048, respectively).
• Patients in the intervention group with a baseline depressive score ≥ 5 experienced a greater improvement in A1c levels, with a mean within-person change of −1.1%, compared with 0.1% in the usual care group (P = .004).
• However, those with depressive scores P = .21).
• At 6 months, most of the patients rated the program to be “very” or “extremely” beneficial; self-reported mental health scores did not significantly change.

IN PRACTICE:

“Our exploratory results support the importance of addressing patients’ diabetes-related emotional distress to effectively improve glycemic control,” the authors wrote. “[The trial] raises the intriguing possibility that the critical ingredient for many people with diabetes who want to improve glycemic control could be social support,” wrote experts in an invited commentary. 

SOURCE:

The study was led by Maninder K. Kahlon, PhD, Dell Medical School, The University of Texas at Austin. It was published online in JAMA Network Open. The invited commentary was led by Brett D. Thombs, PhD, Jewish General Hospital, Montreal, Quebec, Canada, and was published online in JAMA Network Open.

LIMITATIONS:

The small sample size may have limited the ability to detect mental health improvements with minor effect sizes. Researchers assessed perceptions of behavior change, but physical activity and diet were not measured objectively. A higher dropout rate was observed in the usual care group than in the intervention group. (The type of diabetes of the study population was not specified in the paper nor the clinical trial record.)

DISCLOSURES:

The study was supported by the Episcopal Health Foundation, Texas. One author reported receiving grants from foundations outside the study. Two authors reported being unpaid founders of a Texas LLC with a Medicaid contract to scale the model in the study, while another author reported receiving personal fees from pharmaceutical and other companies outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.