Articles

Posted Sep 16 , 2016 02:30 AM

Health and Psychosocial Outcomes of a Telephonic Couples Behavior Change Intervention in Patients With Poorly Controlled Type 2 Diabetes: A Randomized Clinical Trial

Trief PA, et al Diabetes Care 2016: Online ahead of print

What were the findings (excerpted from the Abstract)?

Behavior change in many aspects of lifestyle is important in the management of diabetes. The authors of this study looked to compare glycemic control and secondary outcomes of a 4-month telephonic couples behavioral intervention to individual intervention, and to education, for adults with type 2 diabetes. The study is a randomized trial with the following three arms: couples calls (CC); individual calls (IC); and diabetes education (DE).  All arms had self-management education (two calls). CC and IC had 10 additional behavior change calls.  CC addressed collaboration and relationships/communication. Participants consisted of 280 couples, among whom one partner had type 2 diabetes and an A1C level >7.5%. Blinded assessments occurred at 4, 8, and 12 months. The primary outcome was change in A1C; and secondary outcomes were BMI, waist circumference, blood pressure, depressive symptoms, diabetes self-efficacy, and diabetes distress. Patients had a mean age of 56.8 years; 61.6% were male, and 30.4% were minorities, and baseline mean A1C level was 9.1%. Intention-to-treat analyses found significant A1C reductions for all with no differences between arms. Preplanned within-arm analyses were stratified by baseline A1C tertiles: lowest tertile (7.5–8.2%), no change from baseline; middle tertile (8.3–9.2%), only CC led to significantly lower A1C level; and highest tertile (>9.3%), significant improvement for all interventions. For BMI, CC showed significant improvement, and CC and DE led to decreased waist circumference. The IC group showed greater blood pressure improvement. Results for secondary psychosocial outcomes favored the CC group.

Why is this important?

Family members can influence a number of aspects of diabetes self-management.  It has been suggested that including partners might enhance intervention effects, as the partner might serve as the ongoing enforcer of behavior change. Couples counseling, while somewhat more challenging, should improve outcomes in adults with poorly controlled type 2 diabetes.  This study suggests that a collaborative couples intervention resulted in significant, lasting improvement in A1C levels, obesity measures, and some psychosocial outcomes. For those with exceedingly high A1C levels, education alone was beneficial, but additional intervention is needed to achieve glycemic targets. When working with an adult with diabetes do you counsel couples?  Have you found it to result in better outcomes than basic diabetes education? 

Read the Abstract:

http://care.diabetesjournals.org/content/early/2016/07/21/dc16-0035