1. In this randomized control trial, providing positive support technique training to patient-supporter dyads was associated with greater patient confidence in managing diabetes.
2. However, increased patient supporter engagement did not lead to significant changes in physiological outcomes.
Evidence Rating Level: 1 (Excellent)
Diabetes is a highly prevalent health condition; however, more than 75% of adults with diabetes in the United States do not meet targets blood pressure, glycemic, or lipid control. Although support from a patient’s family and friends may help facilitate diabetic management, interventions which provided diabetes information to family supporters have not been shown to improve patient outcomes. However, the effectiveness of specific training in positive support techniques has not been tested.
This randomized control trial was conducted at two different United States Veterans Health primary care sites. Patients included in this study were aged 30 to 70 years with type 2 diabetes and hemoglobin A1c (HbA1c) greater than 8%, or systolic blood pressure (SBP) higher than 150mmHg. Patients with a life-limiting illness, serious mental illness, active substance use disorder, or those living in a nursing home were excluded. Each patient had an adult supporter. 239 patient-supporter dyads were randomized 1:1 to intervention or standard care and followed for 12 to 15 months. The intervention group received health coaching sessions focused on positive support techniques, while standard of care included general diabetes education materials. The primary outcome was change in patient confidence in managing diabetes, as measured by the Patient Activation Measure-13 (PAM-13) survey and diabetes-specific cardiac event risk score measured by the UK Prospective Diabetes Study (UKPDS). Secondary outcomes included changes in HbA1c, SBP, and diabetes self-management behavior.
Results demonstrated that dyads in the intervention group had greater improvement in PAM-13 score compared to the control group. However, there were no significant differences in 5-year cardiac event risk score or other physiological outcomes between groups. This study was limited by the generalizability given the demographic of patients within the Veterans Health system. Nonetheless, these results suggest that increasing patient supporters’ engagement in care of adults with diabetes is feasible and can improve key patient behavioral outcomes.
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