Chronic Disease

Social support did not yield better health results in study of patients with diabetes

Patients with chronic conditions like diabetes often reap health benefits from intense interventions, such as weekly telephone calls, regular meetings, and group sessions with nutritionists or patient educators. However, these interventions can be costly undertakings for primary care practices.

Kevin A. Pearce, M.D., from the University of Kentucky College of Medicine, and colleagues developed a less-intense Cardiovascular Risk Education and Social Support (CaRESS) intervention for patients with type 2 diabetes, for whom cardiovascular disease (CVD) causes two-thirds of all deaths. CaRESS enlisted a support person (SP) of the patient's choosing to partner in his or her care. The SP's job was to accompany the patient to a patient education session and two office visits and receive the same four quarterly newsletters as the patient. The control group received the patient education session and newsletters, but had no SP.

A total of 199 patients and 108 SPs from 18 practices in the Kentucky Ambulatory Network enrolled in the study. During the study period, blood pressure and cholesterol levels (two key risk factors for CVD) fell in both the control and intervention groups. Neither group had significant differences for blood glucose levels or measures of health-related quality of life. Both groups reported slight improvements in satisfaction with their primary care physician, but declines in satisfaction with their overall health care.

The authors suggest that the presence of an SP coupled with one patient education session and regular newsletters may not have been aggressive enough to foster improved health behaviors. Further, because participants' average beginning systolic blood pressure and cholesterol levels were not very high (140 mm Hg and 137 mg/dL, respectively), physicians did not motivate patients to reduce these CVD risk factors. This study was funded in part by the Agency for Healthcare Research and Quality (HS10887).

See "Cardiovascular Risk Education and Social Support (CaRESS): Report of a randomized controlled trial from the Kentucky Ambulatory Network (KAN)," by Dr. Pearce, Margaret M. Love, Ph.D., Brent J. Shelton, Ph.D., and others in the July-August 2008 Journal of the American Board of Family Medicine 21(4), pp. 269-281.

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