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:

• Managing diabetes is especially challenging for low-income patients, in part due to associated emotional distress and mental health decline, but limited health care touchpoints exist to support the necessary lifestyle changes to improve disease management.
• Researchers conducted a parallel-arm superiority trial to assess the impact of layperson-delivered empathetic engagement over the telephone in 26src patients with uncontrolled diabetes (mean age, 49.5 years; 62.9% women; 49.3% White individuals, 78.5% Hispanic or Latino individuals; A1c ≥ 8%; 86.7% with income below $4src,srcsrcsrc) recruited from a health center in Texas from February 2src22 to April 2src23.
• Patients were stratified by baseline depressive symptom scores ≥ 5 (a cutoff that includes subclinical depressive symptoms) and <5 and randomly assigned to an intervention group (n=129) or usual care (n=131).
• Patients in the intervention group chose the frequency and length of calls and discussed their own interests, adding up to an average of 2src 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 −src.7% in the intervention group vs src.src2% in the usual care group (95% CI, − 1.src% to src.4%, and src.src2% (95% CI, −src.4% to src.4%, respectively); improvements in A1c levels modestly correlated with the total number of calls and total minutes (P=.src2 and P=.src48, 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 src.1% in the usual care group (P=.srcsrc4).
• However, those with depressive scores <5 did not achieve a statistically significant improvement in glycemic control with the intervention vs usual care (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.