Chronic Disease

Self-management support results in better diabetes outcomes

Patients with type 2 diabetes who receive support to manage their own disease through a multilingual health information technology tool do better than patients who receive either usual medical care or support through group visits. The finding comes from a study conducted by researchers at the University of California, San Francisco Center for Vulnerable Populations, who compared two types of self-management support interventions with standard diabetes care.

The study took place in the publicly run, safety net health care delivery system affiliated with San Francisco General Hospital. The 339 patients participating in the study were divided into 3 groups. One group received automated telephone self-management support (ATSM) in the form of weekly prerecorded calls over 39 weeks. During the call, patients were able to enter responses to questions about their diabetes, which were followed by a nurse calling them back, if necessary. The second group participated in group medical visits (GMV). These were 90-minute sessions held each month for 9 months and facilitated by a primary care physician and health educator. A third group was randomized to usual care. More than half of the participants spoke a language other than English, and half had less than a high school education and limited literacy skills. Half also lacked health insurance.

Compared with usual care participants, both ATSM and GMV participants had significant improvements in goal setting, problem solving, and self-management behaviors. For example, both of these groups improved in home monitoring of their own blood glucose levels. The ATSM intervention was more effective at improving interpersonal processes of care (e.g., communication), physical activity, foot care, and functional status/quality of life.

Compared with usual care and GMV participants, the ATSM participants increased their physical activity by 2 hours per week. They were also less likely to report that diabetes prevented them from carrying out daily living activities. Improvements in health behavior and functional status among patients who received the ATSM support appeared to be mediated, in part, by better interpersonal processes of care. This makes it an ideal self-management support technique for vulnerable populations with communication barriers, such as those participating in this study.

The study was supported in part by the Agency for Healthcare Research and Quality (HS14864 and HS17261).

See "Effects of self-management support on structure, process, and outcomes among vulnerable patients with diabetes," by Dean Schillinger, M.D., Margaret Handley, Ph.D., Frances Wang, M.S., and Hali Hammer, M.D., in the April 2009 Diabetes Care 32(4), pp. 559-566.

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