Spanish Diabetes Self-Management with and without Automated Telephone Reinforcement: Two Randomized Trials

Abstract

Objective: To determine (1) whether participants in a Spanish Diabetes Self-Management Program (SDSMP), when compared at six months to randomized controls, would demonstrate improvements in health status, health behaviors and self-efficacy; and (2) whether SDSMP participants receiving monthly automated-telephone reinforcement would maintain improvements at 18-months better than those not receiving reinforcement.

Research Design and Methods: 567 Spanish-speaking adults with type-2 diabetes were randomized to a usual-care control group or six week community-based, peer-led SDSMP. SDSMP participants were re-randomized to receive 15 months of automated-telephone messages or no reinforcement. HbA1c was measured at baseline, six and 18 months. All other data were collected by self-administered questionnaires.

Results: At six months SDSMP participants compared to controls demonstrated improvements in HbA1c (-.4%), health distress, symptoms of hypo- and hyperglycemia and self-efficacy. (p<.05) At 18 months all improvements persisted (p<.05). SDSMP participants also demonstrated improvements in self-rated health, communication with physicians, had fewer ER visits (-.18 visits in six months) (p<.05) and a trend toward fewer visits to physicians. At 18 months the only difference between reinforced and non-reinforced participants was increased glucose monitoring for the reinforcement group.

Conclusions: The SDSMP demonstrated effectiveness in lowering HbA1c and improving health status. Reinforcement did not add to its effectiveness. Given the high needs of the Spanish-speaking population, the SDSMP deserves consideration for implementation.