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Researchers found that telephone-based layperson-delivered interventions may improve glycemic control for patients with diabetes who have low income.

New research published in JAMA Network Open showed that a telephone-based layperson-delivered empathetic engagement may improve glycemic control for patients with diabetes who have low income.

Maninder K. Kahlon, PhD, and colleagues conducted a parallel-arm randomized study of 260 adults aged 21 years and older with uncontrolled diabetes who were receiving care at a federally qualified health center in Austin, Texas, to compare an intervention, empathy-focused emotional support (n=129), with usual care (n=131). Uncontrolled diabetes was defined as having had at least one HbA1c of 8.0% or greater at a clinic appointment in the prior 12 months with an HbA1c of 7.5% at study enrollment. Patients were stratified by baseline score (≥5 vs <5) on the depressive symptom scale of the 9-item Patient Health Questionnaire (PHQ-9).

Patients in the intervention group received layperson-delivered telephone calls for 6 months, including 3 calls in the first week, 1 to 5 calls per week for the next 3 weeks, and 1 call every 1 to 2 weeks subsequently. The primary end point was HbA1c at baseline, 3 months, and 6 months. Secondary end points included symptoms of depression and anxiety.

Overall, the researchers found that patients in the intervention arm (difference, −0.7%; 95% CI, −1.0% to −0.4%) had statistically greater reductions in HbA1c compared with those in the usual care arm (difference, 0.0%; 95% CI, −0.4% to 0.4%). In addition, from baseline to 6 months, patients in the intervention group had statistically significant mean decreases in HbA1c level (from 10.0% to 9.3%) compared with the control group (from 9.8% to 9.7%).

The effect was larger when only patients with PHQ-9 scores of 5 or higher at study enrollment were evaluated (n=99). For these patients, the within-person change in HbA1c was −1.1% (95% CI, −1.8% to −0.5%) for the intervention group and 0.1% (95% CI, −0.7% to 0.8%; P= 0.004) for the control group; whereas in the subgroup with a PHQ-9 score less than 5, the corresponding changes in HbA1c were −0.4% (95% CI, −0.8% to −0.1%) for the intervention group and −0.02% (95% CI, −0.5% to 0.5%; P=0.21) for the control group. At 6 months, the majority (91.7%) of patients reported that the program was “very” or “extremely” beneficial.

The authors concluded, “Identifying how such a workforce might accompany and be coordinated with clinical care could accelerate achieving meaningful outcomes for patients and the health system.”