Controlled trial of nursing interventions to improve health outcomes of older African American women with type 2 diabetes.
BACKGROUND
Type 2 diabetes affects one in five African American women older than 60 years. These women face distinct challenges in managing diabetes self-care. Therefore, tailored self-care interventions for this population need to be developed and tested.


OBJECTIVE
The effectiveness of a tailored, four-visit, in-home symptom-focused diabetes intervention with and without booster telephone calls was compared with an attentional control focused on skills training for weight management and diet.


METHODS
African American women (n = 180; >55 years old, Type 2 diabetes mellitus >1 year, HbA1c >7%) were randomly assigned to the intervention or attentional control condition. Half the intervention participants were assigned to also receive a telephone-delivered booster intervention. Participants were evaluated at baseline and 3, 6, and 9 months.


RESULTS
: Baseline HbA1 was 8.3 in the intervention group (n = 60), 8.29 in the intervention with booster group (n = 55), and 8.44 in the attentional control condition (n = 59). HbA1c declined significantly in the whole sample (0.57%) with no differences between study arms. Participants in the booster arm decreased HbA1c by 0.76%. Symptom distress, perceived quality of life, impact of diabetes, and self-care activities also improved significantly for the whole sample with no significant differences between study arms.


CONCLUSIONS
Parsimonious interventions of four in-person visits yielded clinically significant decreases in HbA1c. Although the weight and diet program was intended as an attentional control, the positive effects suggest it met a need in this population. Because the contents of both the intervention and the attentional control were effective despite different approaches, a revised symptom-focused intervention that incorporates weight and diet skills training may offer even better results.
School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460, USA. askelly@email.unc.edu
Anne H
AH
Skelly
John
J
Carlson
Jennifer
J
Leeman
April
A
Soward
Dorothy
D
Burns
D001741:Black or African American; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000451:nursing*; D004038:Diet, Reducing; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D012648:Self Care; D013689:Telephone; D015431:Weight Loss
D006442:Glycated Hemoglobin