Abstract
Diabetes imposes a greater burden on minority and disadvantaged populations. Tailored interventions are needed to improve self-management outcomes among these populations. Purpose: To determine a) the effect of tailored coaching on patient knowledge, attitudes, and A1c and b) whether patient age, diabetes duration, or education level moderated intervention effect. Methods: A pre-post efficacy analysis of a randomized patient coaching intervention in an urban diabetes clinic was conducted. Eligibility included diagnosed diabetes, A1c ≥ 7.0%, on insulin or high dose oral agents, at least two clinic visits in the prior year and at least four coaching sessions at ∼6-month intervals. Participants received either standard diabetes handouts (N=192) or one-on-one, low literacy tailored coaching (N=161). Coaching included review of home and clinic blood sugars/A1c using a color coded graphical printed progress report, goal setting and formulation of questions for the provider. Outcomes included A1c/blood sugar target knowledge, measured A1c, Diabetes Empowerment Scale scores, and Patient Activation Measure scores. Results: Most participants were female (64%), black (96%), had household incomes < $15,000/year (83%), and had type 2 diabetes (96%). Mean age was 56.5 years and mean baseline A1c was 8.7%. Coaching increased knowledge of target A1c compared to control (OR 3.2, CI 1.6-6.2) but not knowledge of target blood sugar. Coaching improved measured A1c (-1.0% vs. -0.4% p < 0.05). The magnitude of improvement tended to be somewhat greater at higher educational levels (high school -0.97, p<.01; more than high school -1.19, p<.05). Coaching did not significantly increase diabetes self-efficacy or patient activation. Summary: Personalized, multi-component low literacy coaching significantly improves A1c and knowledge of A1c control targets. Repeated coaching sessions can enhance the effectiveness of medical management visits. Disclosure R. Wolf: None. C.S. Barnes: None. C. Wan: None. J. Caudle: None. D.C. Ziemer: None. Funding American Diabetes Association (7-05-CR-03 to C.S.B.)
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