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Optimizing diabetes control in people with Type 2 diabetes through nurse‐led telecoaching
Author(s) -
Odnoletkova I.,
Goderis G.,
Nobels F.,
Fieuws S.,
Aertgeerts B.,
Annemans L.,
Ramaekers D.
Publication year - 2016
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13092
Subject(s) - medicine , type 2 diabetes , diabetes mellitus , randomized controlled trial , blood pressure , subgroup analysis , cholesterol , gastroenterology , guideline , endocrinology , confidence interval , pathology
Aims To study the effect of a target‐driven telecoaching intervention on HbA 1c and other modifiable risk factors in people with Type 2 diabetes. Methods We conducted a randomized controlled trial in patients receiving hypoglycaemic agents. The primary outcome was HbA 1c level at 6 months in the entire sample and in a subgroup with HbA 1c levels ≥ 53 mmol/mol (7%) at baseline. Secondary outcomes were HbA 1c at 18 months; total cholesterol, LDL , HDL , triglycerides, blood pressure, BMI and proportion of people who had achieved guideline‐recommended targets at 6 and 18 months. Results A total of 287 participants were randomized to telecoaching and 287 to usual care. The mean ( sd ) baseline HbA 1c level was 53 (11) mmol/mol [7.0 (1.0)%] overall and 63 (10) mmol/mol [7.9 (0.9)%] in the elevated HbA 1c subgroup. At 6 months, the between‐group differences in favour of telecoaching were: HbA 1c ‐2 (95% CI ‐4; ‐1) mmol/mol [‐0.2 (95% CI ‐0.3;‐0.1)%; P =0.003] overall and ‐4 (95% CI ‐7; ‐2) mmol/mol [‐0.4 (95% CI ‐0.7; ‐0.2)%; P =0.001] in the elevated HbA 1c subgroup; BMI ‐0.4 kg/m 2 (95% CI ‐0.6; ‐0.1; P =0.003); total cholesterol ‐6 mg/dl (95% CI ‐11; ‐1, P =0.012). The proportion of participants on target for the composite of HbA 1c , LDL and blood pressure increased by 8.9% in the intervention group and decreased by 1.3% in the control group ( P =0.011). At 18 months, the difference in HbA 1c was: ‐2 (95% CI ‐3;‐0) mmol/mol [‐0.2 (95% CI ‐0.3; ‐0.0)%; P =0.046] overall and ‐4 (‐7; ‐1) mmol/mol [‐0.4 (95% CI ‐0.7; ‐0.1)%; P =0.023] in the elevated HbA 1c subgroup. Conclusion Nurse‐led telecoaching improved glycaemic control, total cholesterol levels and BMI in people with Type 2 diabetes. Twelve months after the intervention completion, there were sustained improvements in glycaemic control.