Adult supporters may help people with type 2 diabetes improve self-management
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Adults with type 2 diabetes experienced more confidence and involvement in self-managing their disease when they had an adult friend or family supporter present, researchers reported.
“Patient activation (engagement and involvement in care) and diabetes self-efficacy (confidence in ability to manage diabetes) both increased significantly for CO-IMPACT patient participants,” Ann-Marie Rosland, MD, MS, associate professor of internal medicine and clinical and translational science, director of the Caring for Complex Chronic Conditions Research Center at the University of Pittsburgh and core investigator at VA Pittsburgh Center for Health Equity Research and Promotion, told Healio. “In general, this means patients had more capacity to successfully manage diabetes, which can help people stay healthy both in the short and longer term. Increases in activation and self-efficacy have been strongly linked with better long-term diabetes management and outcomes.”
Researchers assessed 239 patient-supporter dyads, which were groups of one patient and one adult supporter aged 21 years or older who spoke with the participant about their health at least twice per month and aided the participant with one or more aspects of their health care without pay. Participants were recruited from two VA primary care sites from November 2016 to August 2019. All patient participants were adults aged 30 to 70 years with type 2 diabetes and HbA1c levels greater than 8% or systolic blood pressure higher than 150 mm Hg. These dyads were randomly assigned to the Caring Others Increasing Engagement in Patient Aligned Care Teams (CO-IMPACT) intervention (n = 123) or standard care (n = 116) and were followed for 12 to 15 months.
The CO-IMPACT intervention included a health coaching session focused on information sharing and positive support techniques between the patient-participant and adult supporter. This session was followed by 12 months of biweekly automated monitoring of phone calls to prompt participants and their supporters to take action and meet goals for diabetes, coaching calls to aid dyads in preparing for primary care visits and after-visit summarizations, the researchers wrote. Standard care included general diabetes education materials alone.
The primary outcomes were 12-month changes in Patient Activation Measure-13 and UK Prospective Diabetes Study 5-year diabetes-specific cardiac event risk scores. Secondary outcomes included 12-month changes in HbA1c levels, systolic BP, diabetes self-management behaviors, diabetes distress, diabetes management self-efficacy and satisfaction with health system support for family supporter involvement.
Overall, 95.8% of dyads had complete 12-month outcome data. Intention-to-treat analyses of this randomized clinical trial demonstrated that patients who received the CO-IMPACT intervention experienced greater 12-month improvements in Patient Activation Measure-13 scores compared with patients who received standard care (P = .048). However, researchers did not observe significant differences in UK Prospective Diabetes Study 5-year cardiac risk (P = .26).
In addition, patients who received the CO-IMPACT intervention experienced greater 12-month improvements in healthy eating (P = .007), diabetes self-efficacy (P = .01) and satisfaction with health system support for family supporter involvement (P = .009).
“Health care practitioners often think adults with diabetes operate on their own to care for their diabetes and are surprised to hear that most adults work with and rely on family and friends to successfully manage diabetes,” Rosland said. “If practitioners can help those key supporters get the right information and include them in their lines of communication with patients, their patients will have an easier time managing diabetes well.”
Rosland and colleagues are currently conducting a National Institute of Diabetes and Digestive and Kidney Diseases-funded trial to compare the effectiveness of family-focused vs. individual-focused diabetes education for adults in an urban community health center.
For more information:
Ann-Marie Rosland, MD, MS, can be reached at roslandam@pitt.edu.
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