A randomized controlled trial of an automated telephone intervention to improve glycemic control in Type 2 diabetes.

Abstract

Type 2 diabetes is a condition that affects millions of Americans and often results in serious vascular complications. Studies have found that lowering HbA1c levels in this population plays an essential role in reducing both micro and macro vascular complications. Consequently, medical management of type 2 diabetes has become more intensive; however HbA1c levels remain too high in this population. This study evaluates the effect of an automated telephone intervention aimed at improving HbA1c levels and self monitoring of blood glucose in adults with type 2 diabetes. One-hundred-twenty participants were randomly assigned to a treatment or a control group. The treatment group received a daily, automated telephone message regarding diabetes and was asked to report blood glucose levels. No difference in mean change in HbA1c between treatment groups was seen at the end of the 90-day intervention. Participants in the treatment group demonstrated a significant improvement in frequency of daily self-monitoring of blood glucose (an increase of .66 times per day in the telephone group compared to .05 times per day in the control group, p = <.001). The treatment group also showed favorable trends on improvement in attitudes toward diabetes and perceived monitoring and exercise barriers. This study shows that an automated telephone intervention increases daily frequency of self-monitoring of blood glucose in adults with type 2 diabetes. This finding has important clinical implications because understanding daily fluctuations in blood glucose informs treatment decisions beyond the information provided by HbA1c levels. Future studies are needed to determine whether this effect is long-lasting, whether changes in attitudes and beliefs mediate the behavior change, and whether the behavior change precedes physiological changes.