A telephone-delivered intervention for patients with NIDDM. Effect on coronary risk factors.
OBJECTIVE
To examine whether a telephone-delivered intervention (TDI), designed to improve glycemic control in patients with non-insulin-dependent diabetes mellitus (NIDDM), improved coronary risk factors in high-risk patients.


METHODS
This randomized controlled trial involved 275 veterans with NIDDM followed in a general medical clinic. Intervention (TDI) patients were telephoned at least monthly by a nurse. Calls emphasized compliance with the medical regimen (diet, medications, and exercise), encouraged behavioral changes, and facilitated referrals to a dietitian or smoking cessation clinic. Control patients received no such calls. Baseline and 12-month follow-up measurements included fasting lipid profiles, weight, smoking status (self-reported; cessation verified by measurement of exhaled CO), adherence to diet and exercise (self-reported), appointments, and medications (hospital computerized data base).


RESULTS
After 12 months, equal numbers of obese patients in the two groups reported adhering to a diabetic diet and exercising, although more obese TDI patients had seen a dietitian (30 vs. 7%, P = 0.003). Weight loss was not seen in either group (-0.9 +/- 5.3 vs. -0.1 +/- 3.6 kg, P = 0.202). Hyperlipidemic TDI patients were more likely to see a dietitian (31 vs. 6%, P = 0.003) and receive lipid-lowering medications (22 vs. 9%, P = 0.096), but serum cholesterol reduction was similar between groups (-11.7 +/- 33.4 vs. -4.3 +/- 32.7 mg/dl, P = 0.270); comparable results were seen for high-density lipoprotein, low-density lipoprotein, and triglyceride levels. More TDI group smokers reported quitting (26 vs. 0%, P = 0.033), but the difference was not significant for CO-verified abstention (10 vs. 0%, P = 0.231).


CONCLUSIONS
The TDI improved self-reported adherence to regimens that might reduce coronary risk, but had little effect on objective measures of risk.
Center for Health Services Research in Primary Care, Duke University Medical Center, Durham, North Carolina.
M S
MS
Kirkman
M
M
Weinberger
P B
PB
Landsman
G P
GP
Samsa
E A
EA
Shortliffe
D L
DL
Simel
J R
JR
Feussner
D001786:Blood Glucose / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000453:epidemiology / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology / Q000534:rehabilitation*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology / Q000534:rehabilitation*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000517:prevention & control*; D003927:Diet, Diabetic; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D012307:Risk Factors; D016540:Smoking Cessation; D013689:Telephone; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D002784:Cholesterol; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D014280:Triglycerides