title: Telephone Intervention to Improve Diabetes Control: A Randomized Trial in the New York City A1c Registry.
abstract: BACKGROUND
  Scalable self-management interventions are necessary to address suboptimal diabetes control, especially among minority populations. The study tested the effectiveness of a telephone behavioral intervention in improving glycemic control among adults with diabetes in the New York City A1c Registry.
  
  
  METHODS
  RCT comparing a telephone intervention to print-only intervention in the context of the A1c Registry program.
  
  
  METHODS
  Nine hundred forty-one adults with diabetes and hemoglobin A1c (A1c) >7% from a low-income, predominantly Latino population in the South Bronx were recruited from the A1c Registry.
  
  
  METHODS
  All study participants were mailed print diabetes self-management materials at baseline and modest lifestyle incentives quarterly. Only the telephone participants received four calls from health educators evenly spaced over 1 year if baseline A1c was >7%-9%, or eight calls if baseline A1c was >9%. Medication adherence was the main behavioral focus and, secondarily, nutrition and exercise.
  
  
  METHODS
  Primary outcome was difference between two study arms in change in A1c from baseline to 1 year. Secondary outcomes included diabetes self-care activities, including self-reported medication adherence. Data were collected in 2008-2012 and analyzed in 2012-2014.
  
  
  RESULTS
  Participants were predominantly Latino (67.7%) or non-Latino black (28%), with 69.7% foreign-born and 55.1% Spanish-speaking. Among 694 (74%) participants with follow-up A1c, mean A1c decreased by 0.9 (SD=0.1) among the telephone group compared with 0.5 (SD=0.1) among the print-only group, a difference of 0.4 (95% CI=0.09, 0.74, p=0.01). The intervention had significant effect when baseline A1c was >9%. Both groups experienced similar improvements in self-care activities, medication adherence, and intensification.
  
  
  CONCLUSIONS
  A telephone intervention delivered by health educators can be a clinically effective tool to improve diabetes control in diverse populations, specifically for those with worse metabolic control identified using a registry. This public health approach could be adopted by health systems supported by electronic record capabilities. CLINICALTRIALS.
  NCT00797888.
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York.
authors.forename: Shadi
authors.initials: S
authors.lastname: Chamany
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York. Electronic address: Elizabeth.Walker@einstein.yu.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Walker
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York; Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gonzalez
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York; North Bronx Healthcare Network, Bronx, New York.
authors.forename: Nichola J
authors.initials: NJ
authors.lastname: Davis
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York.
authors.forename: Felix M
authors.initials: FM
authors.lastname: Ortega
authors.affiliation: Montefiore Medical Center, Bronx, New York.
authors.forename: Jeidy
authors.initials: J
authors.lastname: Carrasco
authors.affiliation: Teachers College, Columbia University, New York, New York;
authors.forename: Charles E
authors.initials: CE
authors.lastname: Basch
authors.affiliation: Public Health Institute, Oakland, California.
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Silver
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009519:New York City; D012042:Registries; D012648:Self Care; D013689:Telephone
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin