JAMA Netw Open: Managing Diabetes, "Is It OK to Be Honest"? Family Support Intervention Really Can!

More than 75% of adults with diabetes in the United States do not meet all blood glucose, blood pressure, and lipid treatment goals
.
These patients often require more intensive monitoring and support
than the health system can provide.
A potentially strong source of support is the patient's family and friends (family supporters).

Family and friend support for diabetes care was associated with better self-management behaviours and risk factor control, and was associated with
a reduced risk of hospitalisation and death.

The investigators designed the Caring for Others to Increase Engagement with Patient-Aligned Care Teams (CO-IMPACT) intervention as a structured approach to provide training and tools
for adult patient supporters.
This analysis aimed to identify major patient health, behavioural and satisfaction outcomes
in randomised clinical trials that identified a 12-month CO-IMPACT intervention versus standard integrated diabetes care.

All patients were diabetic aged 30 to 70 years with glycosylated hemoglobin (HbA1c) higher than 8% of total hemoglobin (converted to total hemoglobin, multiplied by 0.
01) or systolic blood pressure (SBP) higher than 150 mm Hg; Each patient involved has an adult support
.
Of the 1119 patients recruited between November 2016 and May 2018, 239 patient support groups were randomized 1:1 to receive CO-IMPACT interventions or standard care and followed for 12 to 15 months
.

The primary outcomes were change in 12-month patient activation measure-13 (PAM-13) and 5-year diabetes-specific cardiac event risk scores from the UK Prospective Diabetes Study (UKPDS
).
Secondary outcomes included 12-month change
in HbA 1c level, SBP, diabetes self-management behaviour, diabetes distress, diabetes management self-efficacy, and satisfaction with health system support with family supporter participation.

The results showed that a total of 239 collaborators participated in the study; The mean age (SD) of patients was 60 (8.
9) years, of which 231 (96.
7%) were male
.
The mean (SD) baseline HbA1c level was 8.
5% (1.
6%) and the systolic blood pressure was 140.
2 mm Hg (18.
4 mm Hg).

A total of 168 patients (70.
3%) lived with their registered supporters; 229 patients (95.
8%) had complete 12-month outcome data
.
In intention-to-treat analysis, patients with CO-IMPACT had a greater improvement in PAM-13 scores at 12 months compared with standard care (intervention effect, 2.
60 points; 95% CI, 0.
02-5.
18 points; P = .
048), but there was no statistically significant difference in 5-year cardiac risk in UKPDS (intervention effect, 1.
01 points; 95% CI, −0.
74 ~ 2.
77 points; p = .
26）
。 Patients in the CO-IMPACT group had a significant impact on a healthy diet at 12 months (intervention effect, 0.
71 d/wk; 95% CI, 0.
20-1.
22 d/wk; P = .
007), diabetes self-efficacy (intervention effect, 0.
40 points; 95% CI, 0.
09-0.
71 points; P = .
01), satisfaction with health system support for participation of family support participants (intervention effect, 0.
28 points; 95% CI, 0.
07-0.
49 points; p = .
009) has a greater improvement; However, improvements in glycated hemoglobin levels and other indicators were similar
in both groups.

Studies have shown that in this randomized clinical trial, the CO-IMPACT intervention successfully participated in the patient-champion group and increased patient motivation and self-efficacy
.
Physiological outcomes improved similarly
in both groups.
More intensive direct instruction to supporters, or targeting patients with less prior support or fewer resources for diabetes management, may have a greater impact
.

Original source:

Rosland A, Piette JD, Trivedi R, et al.
Effectiveness of a Health Coaching Intervention for Patient-Family Dyads to Improve Outcomes Among Adults With Diabetes: A Randomized Clinical Trial.
JAMA Netw Open.
2022; 5(11):e2237960.
doi:10.
1001/jamanetworkopen.
2022.
37960