A Cluster-Randomized Trial Of Personalized Telephone Intervention For Diabetic Patients

ObjectiveThe rapid increase in rates of diabetes poses a significant public health problem globally. And telephone-delivered intervention has been thought to be cost-effective. Our study aims to test whether personalized telephone intervention would change the health-related behaviors and control the weight, blood glucose, blood lipids and blood pressure levels in patients with type2diabetes in communities of Zhejiang Province, China.MethodsA cluster-randomized clinical trial was conduct in a coastal city of Zhejiang province from November2013to September2014.503patients with type2diabetes were randomly selected from10communities and assigned to telephone intervention group (supervised health-related behaviours such as diet, exercise, drugs and self management by telephone, n=251) or a control group (conventional public health care, n=252). A well-structured questionnaire was applied to obtain information, including demographic characteristics (gender, age, marital status, occupation, education, economic income and so on), lifestyle habits (such as cigarette smoking, alcohol consumption and tea drinking), history of diseases (diabetes, hypertention, cardiovascular disease and dyslipidemia etc.) and medicines (e.g. antidiabetic drugs, hypotensive drugs and lipid-lowering drugs) in baseline and after a six months personalized telephone intervention. International Physical Activity Questionnaire (IPAQ), Diabetes Knowledge Test (DKT) and Summary of Diabetes Self-Care Activities (SDSCA) were used to evaluated the physical activity, diabetes knowledge and diabetes self-care activities of study subjects. Physical examinations were performed for each subject and anthropometry parameters (height, weight, waist circumference, hip circumference, systolic blood pressure and diastolic blood pressure) were obtained. Additionally, a5ml peripheral vein blood specimen was collected to test the level of glycated hemoglobin (HbA1C), fasting blood glucose and blood lipids.Results1.After six-months follow up,419among503diabetic patients finished the telephone intervention and were included in the final analysis. Compared with the control group, the intervention group had less alcohol consumption and higher physical activities after intervention. In the aspect of self management, more patients in the intervention group adopt diet control (92.76%vs83.76%, P=0.0039) and took more physical activities (81.90%vs65.48%, P=0.0001) to control their disease. In addition, telephone intervention might be benefit to weight control, especially for waist to hip ratio as telephone intervention was significantly negatively associated with waist to hip ratio (β=-0.02, se=0.01) in study subjects of well glycemic control at baseline. The expected differences were not observed between groups in fasting blood glucose, blood pressure and blood lipid levels (all P>0.05).2.1n addition, diabetes knowledge (DKT score:32.98±24.34vs52.28±17.29, P<0.0001) and diabetes self-care activities (SDSCA score:36.81±11.21vs39.55±1.59, P<0.0001) were poorer in our study subjects compared to similar studies.Conclusion1. Personalized telephone intervention might be benefit to health-related behavioural change and weight control for patients with type2diabetes. Investigations with larger sample size and longer duration of follow-up were needed to confirm our results and test whether telephone intervention affected the blood glucose, blood pressure and blood lipid control of diabetic patients.2. Diabetes knowledge and diabetes self-care activities were poor in diabetic patients and it was important to strengthen the diabetic education in community.