Disease self-management programs in the U.S. have the potential to lead to improvements in behavior and outcomes. These programs can reach a vast array of patients, many of whom may not be able to access traditional services. However, implementation of these programs has been a challenge.
Modest increases have been seen in diabetes self-management for intermediate outcomes, such as lowered hemoglobin A1C values and changes in self-monitored behavior. This study measures the effects of self-management programs in disadvantaged populations.
This randomized, controlled trial enrolled poor, uninsured and minority patients with poorly controlled diabetes into a program consisting of behavior support in a 24-minute video and five phone calls with a trained diabetes nurse. Control patients received diabetes management information in a pamphlet, without the additional support activities.
Most participants in the experimental and control groups utilized the resources provided. There were significant decreases in hemoglobin A1C values in both groups; however, there was not a significant difference in outcomes between the experimental and control patients. This study shows the difficulty of diabetes self-management in disadvantaged populations. A more intensive intervention may be necessary to improve management of chronic disease.