This study was performed to investigate the effect of a telephone-delivered intervention on glycemic control and body mass index in Korean type 2 diabetic patients. 38 patients were randomly selected, with 20 assigned to a telephone group and 18 to a control group. The goal of the intervention was to keep blood glucose concentrations close to the normal range. The intervention was applied to the telephone group for 12 weeks. It consisted of continuous education and reinforcement of diet, exercise and medication adjustment, as well as frequent self-monitoring of blood glucose levels. Telephone intervention was performed twice per week for the first month, and then weekly for the second and third months. Subjects were requested to write self- management logs, including blood glucose, diet and an exercise diary. The diet diaries were analyzed by a dietitian, and subjects instructed about the results by telephone counseling or mail. All medication adjustments were communicated to the subjects' diabetes specialist. Glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG) and 2-hour postprandial glucose were measured before, and after, the intervention. Patients in the telephone group had a mean decrease of 1.2%, with those in the control group having a mean increase of 0.6%, in HbA1c. There were no significant differences in the body mass index (BMI) between the two groups. These findings indicated that a telephone-delivered intervention would improve HbA1c, but would not affect BMI.
"ers have presented 80 evidence that telephone - based coaching can be superior to clinical visits , especially for 81 supporting weight management ( Gelfand et al . , 2003 ; Goulis et al . , 2004 ) . Conversely , some 82 study findings indicate that the impact of telephone - based coaching on patients ' success in 83 weight management is minimal ( Oh et al . , 2003 ) and that face - to - face clinical encounters are 84 better suited for tailoring the intervention to individuals ' personal needs for effective weight 85 control ( Jeffery et al . , 2004 ) . Still others conclude that the most effective approach involves 86 combining telephone - based coaching and mail - based educational materials ( "
[Show abstract][Hide abstract] ABSTRACT: Many health promotion interventions have been developed and tested in recent years. Practitioners and researchers must continue to explore how various program delivery modalities can be used effectively and efficiently to optimize program outcomes. A sample of 6,055 participants was drawn from 10 large employers. Participants self-selected into a mail or telephone intervention. This study compared the demographics of those who selected each modality and assessed differences in program success relative to the modalities chosen. Telephone participants were more likely to be older, female, and salaried. Telephone participants were also more ready, confident, and motivated to make a behavior change, when compared to those in the mail program. Researchers found both the telephone and mail programs to be effective in reducing participants' health risk status, though the telephone program was slightly more effective. These findings demonstrate the importance of offering a variety of interventions when promoting healthy changes. More research is needed to investigate the role of participant choice and the combinations of learning experiences that best facilitate sustainable behavior change.
"0.20 (–0.88 to 0.48) Medi-Cal, 62 2004 –0.87 (–0.91 to –0.83) O'Connor et al, 55 1996 –0.90 (–1.82 to 0.02) Piette et al, 94 2000 –0.10 (–0.60 to 0.40) Piette et al, 57 2001 –0.10 (–0.50 to 0.30) Sadur et al, 20 1999 –1.15 (–1.69 to –0.61) Shea et al, 85 2006 –0.14 (–0.27 to –0.01) Weinberger et al, 61 1995 –0.60 (–0.68 to –0.52) Subgroup –0.41 (–0.62 to –0.20) Trials in Which Case Managers Could Make Independent Medication Changes Choe et al, 64 2004 –1.30 (–2.19 to –0.41) de Sonnaville et al, 44 1997 Jaber et al, 18 1996 Kim and Oh, 70 2003 Krein et al, 71 2004 Legorreta et al, 51 1996–Comparison 1 Legorreta et al, 51 1996–Comparison 2 Oh et al, 56 2003 Polonsky et al, 78 2003 Rothman et al, 79 2005 –2.90 (–4.88 to –0.92) –1.20 (–1.82 to –0.58) 0.10 (–0.29 to 0.49) –2.20 (–2.95 to –1.45) 0.60 (–0.67 to 1.87) –1.30 (–2.00 to –0.60) –0.80 (–1.46 to –0.14) –0.90 (–1.62 to –0.18) –1.10 (–1.62 to –0.58) Thompson et al, 59 1999 –0.60 (–1.00 to –0.20) –4.0 –3.0 –2.0 –1.0 0 1.0 2.0 Difference in Postintervention Serum HbA 1c , % Subgroup –0.96 (–1.41 to –0.52) Overall –0.59 (–0.77 to –0.41) "
[Show abstract][Hide abstract] ABSTRACT: There have been numerous reports of interventions designed to improve the care of patients with diabetes, but the effectiveness of such interventions is unclear.
To assess the impact on glycemic control of 11 distinct strategies for quality improvement (QI) in adults with type 2 diabetes.
MEDLINE (1966-April 2006) and the Cochrane Collaboration's Effective Practice and Organisation of Care Group database, which covers multiple bibliographic databases. Eligible studies included randomized or quasi-randomized controlled trials and controlled before-after studies that evaluated a QI intervention targeting some aspect of clinician behavior or organizational change and reported changes in glycosylated hemoglobin (HbA1c) values.
Postintervention difference in HbA1c values were estimated using a meta-regression model that included baseline glycemic control and other key intervention and study features as predictors.
Fifty randomized controlled trials, 3 quasi-randomized trials, and 13 controlled before-after trials met all inclusion criteria. Across these 66 trials, interventions reduced HbA(1c) values by a mean of 0.42% (95% confidence interval [CI], 0.29%-0.54%) over a median of 13 months of follow-up. Trials with fewer patients than the median for all included trials reported significantly greater effects than did larger trials (0.61% vs 0.27%, P = .004), strongly suggesting publication bias. Trials with mean baseline HbA1c values of 8.0% or greater also reported significantly larger effects (0.54% vs 0.20%, P = .005). Adjusting for these effects, 2 of the 11 categories of QI strategies were associated with reductions in HbA(1c) values of at least 0.50%: team changes (0.67%; 95% CI, 0.43%-0.91%; n = 26 trials) and case management (0.52%; 95% CI, 0.31%-0.73%; n = 26 trials); these also represented the only 2 strategies conferring significant incremental reductions in HbA1c values. Interventions involving team changes reduced values by 0.33% more (95% CI, 0.12%-0.54%; P = .004) than those without this strategy, and those involving case management reduced values by 0.22% more (95% CI, 0.00%-0.44%; P = .04) than those without case management. Interventions in which nurse or pharmacist case managers could make medication adjustments without awaiting physician authorization reduced values by 0.80% (95% CI, 0.51%-1.10%), vs only 0.32% (95% CI, 0.14%-0.49%) for all other interventions (P = .002).
Most QI strategies produced small to modest improvements in glycemic control. Team changes and case management showed more robust improvements, especially for interventions in which case managers could adjust medications without awaiting physician approval. Estimates of the effectiveness of other specific QI strategies may have been limited by difficulty in classifying complex interventions, insufficient numbers of studies, and publication bias.
JAMA The Journal of the American Medical Association 08/2006; 296(4):427-40. DOI:10.1001/jama.296.4.427 · 35.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This review summarises current evidence relating to the effectiveness of physical activity (PA) interventions for treating overweight and obesity and type 2 diabetes. Interventions to increase PA for the treatment of overweight and obesity in both children and adults have primarily consisted of health education and behaviour modification strategies in clinical settings or with selected families or individuals. Although evidence is limited, strategies to reduce sedentary behaviours appear to have potential for reducing obesity among children and adolescents. Among adults, strategies that combine diet and PA are more effective than PA strategies alone. Combined lifestyle strategies are most successful for maintained weight loss, although most programs are unsuccessful in producing long-term changes. There is little evidence about compliance to prescribed behaviour changes or the factors that promote or hinder compliance to lifestyle changes. Limited evidence suggests that continued professional contact and self-help groups can help sustain weight loss. Most of the interventions for the treatment of type 2 diabetes have been conducted in clinical settings and have typically required the use of extensive resources. Evidence suggests that interventions can lead to small but clinically meaningful improvements in glycaemic control, even in the absence of weight loss. A recent study demonstrated that a multifactorial intervention (diet, PA and pharmaceutical) can reduce the risk of diabetes complications in individuals with type 2 diabetes. Nevertheless, there is little evidence about the effectiveness of community-based interventions in producing long-term changes in glycaemic control and reduced mortality in people with type 2 diabetes.
Journal of Science and Medicine in Sport 05/2004; 7(1 Suppl):52-9. DOI:10.1016/S1440-2440(04)80278-0 · 3.19 Impact Factor
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