title: Do automated calls with nurse follow-up improve self-care and glycemic control among vulnerable patients with diabetes?
abstract: OBJECTIVE
  We sought to evaluate the effect of automated telephone assessment and self-care education calls with nurse follow-up on the management of diabetes.
  
  
  METHODS
  We enrolled 280 English- or Spanish-speaking adults with diabetes who were using hypoglycemic medications and who were treated in a county health care system. Patients were randomly assigned to usual care or to receive an intervention that consisted of usual care plus bi-weekly automated assessment and self-care education calls with telephone follow-up by a nurse educator. Outcomes measured at 12 months included survey-reported self-care, perceived glycemic control, and symptoms, as well as glycosylated hemoglobin (Hb A1c) and serum glucose levels.
  
  
  RESULTS
  We collected follow-up data for 89% of enrollees (248 patients). Compared with usual care patients, intervention patients reported more frequent glucose monitoring, foot inspection, and weight monitoring, and fewer problems with medication adherence (all P -0.03). Follow-up Hb A,, levels were 0.3% lower in the intervention group (P = 0.1), and about twice as many intervention patients had Hb A1c levels within the normal range (P = 0.04). Serum glucose levels were 41 mg/dL lower among intervention patients than usual care patients (P = 0.002). Intervention patients also reported better glycemic control (P = 0.005) and fewer diabetic symptoms (P <0.0001 ), including fewer symptoms of hyperglycemia and hypoglycemia.
  
  
  CONCLUSIONS
  Automated calls with telephone nurse follow-up may be an effective strategy for improving self-care behavior and glycemic control, and for decreasing symptoms among vulnerable patients with diabetes.
authors.affiliation: Center for Health Care Evaluation/HSR&D Field Program, VA Palo Alto Health Care System, California, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Piette
authors.forename: M
authors.initials: M
authors.lastname: Weinberger
authors.forename: S J
authors.initials: SJ
authors.lastname: McPhee
authors.forename: C A
authors.initials: CA
authors.lastname: Mah
authors.forename: F B
authors.initials: FB
authors.lastname: Kraemer
authors.forename: L M
authors.initials: LM
authors.lastname: Crapo
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010353:Patient Education as Topic; D012648:Self Care; D013689:Telephone; D014177:Translations
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin