Optimizing diabetes control in people with Type 2 diabetes through nurse-led telecoaching

Abstract

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.