Family Supporters Attending Programs Improve Patients’ Management of Diabetes

Family members who attend low-intensity coaching and monitoring programs help improve a patient’s ability to manage diabetes, though higher-intensity programs could be necessary to further improve outcomes, according to the results of a study published in JAMA Network Open.

In the randomized clinical trial (NCT02328326), investigators found that the CO-IMPACT intervention led to improved patient activation and self-efficacy. Physiological outcomes were similar in both arms.

The study was conducted between November 2016 and August 2019 among individuals who were from 2 Veterans Health Administration primary-care sites. All were aged 30 through 70 years and had diabetes with hemoglobulin A1c (HbA1c) levels greater than 8% of total hemoglobin or systolic blood pressure (BP) higher than 150 mm Hg. All had an adult supporter.

Of the 1119 individuals recruited, 239 patient-supporter dyads were enrolled between November 2016 and May 2018 and were randomized to receive the CO-IMPACT intervention or the standard care. They were also followed up for 12 to 15 months.

The 259 recruited individuals who declined to participate for various reasons cited too much hassle and time as the most common reason of refusal. Just 16 refused, because they did not want increased supporter burden or involvement.

Of the 299 individuals who were interested but ineligible, the most common reason for ineligibility given by 38% of individuals was the inability to identify a supporter to participate with them, investigators said.

Patient-supporter dyads who were part of the CO-IMPACT intervention cohort received a health coaching session that focused on dyadic information sharing and positive support techniques. They also had 12 months of bi-weekly automated monitoring via telephone calls to prompt dyadic actions to meet the goals, coaching calls to help dyads prepare for primary-care visits and after-visit summaries.

Those in the standard care cohort received general diabetes education material only.

Investigators found that the individuals in the CO-IMPACT program had greater 12-month improvements in PAM-13 scores, but there were no significant differences in UKPDS 5-year cardiac risk.

Furthermore, they found that individuals in the CO-IMPACT program also had greater 12-month improvements in diabetes self-efficacy, healthy eating, , and satisfaction with health system support for family supporters. The 2 arms also had similar improvements in HbA1c levels, as well as other measures.

The findings might not be generalizable because of the majority of individuals in the study being non-Latino white men, investigators said.

They also noted that patient-centered medical home teams have been increasing in popularity.

The intervention models show how supporters could also be included in team-based care, according to investigators.

Another limitation could also include limiting detection in changes for outcomes in HbA1c levels and systolic BP by using both measures for eligibility in the study.

Diabetes programs could be more appealing to those who have multiple risks of complications, investigators said.

Reference

Rosland A, Piette JD, Trivedi R, Lee A, et al. Effectiveness of a health coaching intervention for patient-family dyads to improve outcomes among adults with diabetes: a randomized clinical trial. JAMA Netw Open. 2022;5(11):e2237960. doi:10.1001/jamanetworkopen.2022.37960