title: Results of a successful telephonic intervention to improve diabetes control in urban adults: a randomized trial.
abstract: OBJECTIVE
  To compare the effectiveness of a telephonic and a print intervention over 1 year to improve diabetes control in low-income urban adults.
  
  
  METHODS
  A randomized trial in Spanish and English comparing a telephonic intervention implemented by health educators with a print intervention. Participants (N = 526) had an A1C ≥7.5% and were prescribed one or more oral agents. All were members of a union/employer jointly sponsored health benefit plan. Health coverage included medications. Primary outcomes were A1C and pharmacy claims data; secondary outcomes included self-report of two medication adherence measures and other self-care behaviors.
  
  
  RESULTS
  Participants were 62% black and 23% Hispanic; 77% were foreign born, and 42% had annual family incomes <$30 thousand. Baseline median A1C was 8.6% (interquartile range 8.0-10.0). Insulin was also prescribed for 24% of participants. The telephone group had mean ± SE decline in A1C of 0.23 ± 0.11% over 1 year compared with a rise of 0.13 ± 0.13% for the print group (P = 0.04). After adjusting for baseline A1C, sex, age, and insulin use, the difference in A1C was 0.40% (95% CI 0.10-0.70, P = 0.009). Change in medication adherence measured by claims data, but not by self-report measures, was significantly associated with change in A1C (P = 0.01). Improvement in medication adherence was associated (P = 0.005) with the telephonic intervention, but only among those not taking insulin. No diabetes self-care activities were significantly correlated with the change in A1C.
  
  
  CONCLUSIONS
  A 1-year tailored telephonic intervention implemented by health educators was successful in significantly, albeit modestly, improving diabetes control compared with a print intervention in a low-income, insured, minority population.
authors.affiliation: Department of Medicine and Endocrinology, Albert Einstein College of Medicine, Bronx, New York, USA. elizabeth.walker@einstein.yu.edu
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Walker
authors.forename: Celia
authors.initials: C
authors.lastname: Shmukler
authors.forename: Ralph
authors.initials: R
authors.lastname: Ullman
authors.forename: Emelinda
authors.initials: E
authors.lastname: Blanco
authors.forename: Melissa
authors.initials: M
authors.lastname: Scollan-Koliopoulus
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic; D013689:Telephone
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin