• Shadi Chamany, Elizabeth A Walker, Clyde B Schechter, Jeffrey S Gonzalez, Nichola J Davis, Felix M Ortega, Jeidy Carrasco, Charles E Basch, and Lynn D Silver.
• New York City Department of Health and Mental Hygiene, New York, New York.
• Am J Prev Med. 2015 Dec 1; 49 (6): 832841832-41.

IntroductionScalable self-management interventions are necessary to address suboptimal diabetes control, especially among minority populations. The study tested the effectiveness of a telephone behavioral intervention in improving glycemic control among adults with diabetes in the New York City A1c Registry.DesignRCT comparing a telephone intervention to print-only intervention in the context of the A1c Registry program.Setting/ParticipantsNine hundred forty-one adults with diabetes and hemoglobin A1c (A1c) >7% from a low-income, predominantly Latino population in the South Bronx were recruited from the A1c Registry.InterventionAll study participants were mailed print diabetes self-management materials at baseline and modest lifestyle incentives quarterly. Only the telephone participants received four calls from health educators evenly spaced over 1 year if baseline A1c was >7%-9%, or eight calls if baseline A1c was >9%. Medication adherence was the main behavioral focus and, secondarily, nutrition and exercise.Main Outcome MeasuresPrimary outcome was difference between two study arms in change in A1c from baseline to 1 year. Secondary outcomes included diabetes self-care activities, including self-reported medication adherence. Data were collected in 2008-2012 and analyzed in 2012-2014.ResultsParticipants were predominantly Latino (67.7%) or non-Latino black (28%), with 69.7% foreign-born and 55.1% Spanish-speaking. Among 694 (74%) participants with follow-up A1c, mean A1c decreased by 0.9 (SD=0.1) among the telephone group compared with 0.5 (SD=0.1) among the print-only group, a difference of 0.4 (95% CI=0.09, 0.74, p=0.01). The intervention had significant effect when baseline A1c was >9%. Both groups experienced similar improvements in self-care activities, medication adherence, and intensification.ConclusionsA telephone intervention delivered by health educators can be a clinically effective tool to improve diabetes control in diverse populations, specifically for those with worse metabolic control identified using a registry. This public health approach could be adopted by health systems supported by electronic record capabilities. CLINICALTRIALS.Gov RegistrationNCT00797888.Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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