title: Managing the space between visits: a randomized trial of disease management for diabetes in a community health center.
abstract: BACKGROUND
  Diabetes outcomes are worse for underserved patients from certain ethnic/racial minority populations. Telephonic disease management is a cost-effective strategy to deliver self-management services and possibly improve diabetes outcomes for such patients.
  
  
  OBJECTIVE
  We conducted a trial to test the effectiveness of a supplemental telephonic disease management program compared to usual care alone for patients with diabetes cared for in a community health center.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  All patients had type 2 diabetes, and the majority was Hispanic or African American. Most were urban-dwelling with low socioeconomic status, and nearly all had Medicaid or were uninsured.
  
  
  METHODS
  Clinical measures included glycemic control, blood pressure, lipid levels, and body mass index. Validated surveys were used to measure dietary habits and physical activity.
  
  
  RESULTS
  A total of 146 patients were randomized to the intervention and 149 to the control group. Depressive symptoms were highly prevalent in both groups. Using an intention to treat analysis, there were no significant differences in the primary outcome (HbA1c) between the intervention and control groups at 12 months. There were also no significant differences for secondary clinical or behavioral outcome measures including BMI, systolic or diastolic blood pressure, LDL cholesterol, smoking, or intake of fruits and vegetables, or physical activity.
  
  
  CONCLUSIONS
  A clinic-based telephonic disease management support for underserved patients with diabetes did not improve clinical or behavioral outcomes at 1 year as compared to patients receiving usual care alone.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA. daren.anderson@va.gov
authors.forename: Daren R
authors.initials: DR
authors.lastname: Anderson
authors.forename: Joan
authors.initials: J
authors.lastname: Christison-Lagay
authors.forename: Victor
authors.initials: V
authors.lastname: Villagra
authors.forename: Haibei
authors.initials: H
authors.lastname: Liu
authors.forename: James
authors.initials: J
authors.lastname: Dziura
mesh_terms: D003151:Community Health Centers / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000208:ethnology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D009819:Office Visits / Q000191:economics; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome