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Spanish Diabetes Self-Management With and Without Automated Telephone Reinforcement

Two randomized trials

¹ Stanford University School of Medicine, Palo Alto, California
² Division of General Medicine, University of Michigan, Ann Arbor, Michigan
³ VA Health Services Research and Development Service Center of Excellence, Center for Practice Management and Outcomes Research, Ann Arbor, Michigan

Address correspondence and reprint requests to Philip L. Ritter, PhD, Stanford University School of Medicine, 2000 Welch Rd., Ste. 204, Palo Alto, California 40304. E-mail: philr{at}stanford.edu

OBJECTIVE—To determine 1) whether participants in the Spanish Diabetes Self-Management Program (SDSMP), when compared at 6 months to randomized control subjects, 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—A total of 567 Spanish-speaking adults with type 2 diabetes were randomized to a usual-care control group or 6-week community-based, peer-led SDSMP. SDSMP participants were re-randomized to receive 15 months of automated telephone messages or no reinforcement. A1C was measured at baseline and 6 and 18 months. All other data were collected by self-administered questionnaires.

RESULTS—At 6 months SDSMP participants compared with control subjects demonstrated improvements in A1C (–0.4%), health distress, symptoms of hypo- and hyperglycemia, and self-efficacy (P < 0.05). At 18 months all improvements persisted (P < 0.05). SDSMP participants also demonstrated improvements in self-rated health and communication with physicians, had fewer emergency room visits (–0.18 visits in 6 months, P < 0.05), and trended toward fewer visits to physicians. At 18 months the only difference between reinforced and nonreinforced participants was increased glucose monitoring for the reinforcement group.

CONCLUSIONS—The SDSMP demonstrated effectiveness in lowering A1C 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.

Abbreviations: SDSMP, Spanish Diabetes Self-Management Program

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