PMID- 26441467
OWN - NLM
STAT- MEDLINE
DCOM- 20160526
LR  - 20221207
IS  - 1438-8871 (Electronic)
IS  - 1439-4456 (Print)
IS  - 1438-8871 (Linking)
VI  - 17
IP  - 10
DP  - 2015 Oct 5
TI  - Health Coaching Reduces HbA1c in Type 2 Diabetic Patients From a 
      Lower-Socioeconomic Status Community: A Randomized Controlled Trial.
PG  - e224
LID - 10.2196/jmir.4871 [doi]
LID - e224
AB  - BACKGROUND: Adoptions of health behaviors are crucial for maintaining good health 
      after type 2 diabetes mellitus (T2DM) diagnoses. However, adherence to 
      glucoregulating behaviors like regular exercise and balanced diet can be 
      challenging, especially for people living in lower-socioeconomic status (SES) 
      communities. Providing cost-effective interventions that improve self-management 
      is important for improving quality of life and the sustainability of health care 
      systems. OBJECTIVE: To evaluate a health coach intervention with and without the 
      use of mobile phones to support health behavior change in patients with type 2 
      diabetes. METHODS: In this noninferiority, pragmatic randomized controlled trial 
      (RCT), patients from two primary care health centers in Toronto, Canada, with 
      type 2 diabetes and a glycated hemoglobin/hemoglobin A1c (HbA1c) level of >/=7.3% 
      (56.3 mmol/mol) were randomized to receive 6 months of health coaching with or 
      without mobile phone monitoring support. We hypothesized that both approaches 
      would result in significant HbA1c reductions, although health coaching with 
      mobile phone monitoring would result in significantly larger effects. 
      Participants were evaluated at baseline, 3 months, and 6 months. The primary 
      outcome was the change in HbA1c from baseline to 6 months (difference between and 
      within groups). Other outcomes included weight, waist circumference, body mass 
      index (BMI), satisfaction with life, depression and anxiety (Hospital Anxiety and 
      Depression Scale [HADS]), positive and negative affect (Positive and Negative 
      Affect Schedule [PANAS]), and quality of life (Short Form Health Survey-12 
      [SF-12]). RESULTS: A total of 138 patients were randomized and 7 were excluded 
      for a substudy; of the remaining 131, 67 were allocated to the intervention group 
      and 64 to the control group. Primary outcome data were available for 97 
      participants (74.0%). While both groups reduced their HbA1c levels, there were no 
      significant between-group differences in change of HbA1c at 6 months using 
      intention-to-treat (last observation carried forward [LOCF]) (P=.48) or 
      per-protocol (P=.83) principles. However, the intervention group did achieve an 
      accelerated HbA1c reduction, leading to a significant between-group difference at 
      3 months (P=.03). This difference was reduced at the 6-month follow-up as the 
      control group continued to improve, achieving a reduction of 0.81% (8.9 mmol/mol) 
      (P=.001) compared with a reduction of 0.84% (9.2 mmol/mol)(P=.001) in the 
      intervention group. Intervention group participants also had significant 
      decreases in weight (P=.006) and waist circumference (P=.01) while controls did 
      not. Both groups reported improvements in mood, satisfaction with life, and 
      quality of life. CONCLUSIONS: Health coaching with and without access to mobile 
      technology appeared to improve glucoregulation and mental health in a lower-SES, 
      T2DM population. The accelerated improvement in the mobile phone group suggests 
      the connectivity provided may more quickly improve adoption and adherence to 
      health behaviors within a clinical diabetes management program. Overall, health 
      coaching in primary care appears to lead to significant benefits for patients 
      from lower-SES communities with poorly controlled type 2 diabetes. TRIAL 
      REGISTRATION: ClinicalTrials.gov NCT02036892; 
      http://clinicaltrials.gov/ct2/show/NCT02036892 (Archived by WebCite at 
      http://www.webcitation.org/6b3cJYJOD).
FAU - Wayne, Noah
AU  - Wayne N
AUID- ORCID: 0000-0002-8513-3616
AD  - School of Kinesiology & Health Science, Faculty of Health, York University, 
      Toronto, ON, Canada.
FAU - Perez, Daniel F
AU  - Perez DF
AUID- ORCID: 0000-0002-3056-2421
FAU - Kaplan, David M
AU  - Kaplan DM
AUID- ORCID: 0000-0001-9046-1879
FAU - Ritvo, Paul
AU  - Ritvo P
AUID- ORCID: 0000-0003-1141-0083
LA  - eng
SI  - ClinicalTrials.gov/NCT02036892
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20151005
PL  - Canada
TA  - J Med Internet Res
JT  - Journal of medical Internet research
JID - 100959882
RN  - 0 (Glycated Hemoglobin A)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Diabetes Mellitus, Type 2/*therapy
MH  - Female
MH  - Glycated Hemoglobin/analysis/*chemistry
MH  - Health Behavior
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Primary Health Care/*methods
MH  - Quality of Life
MH  - Social Class
MH  - Telemedicine/*methods
PMC - PMC4642794
OTO - NOTNLM
OT  - RCT
OT  - diabetes mellitus, type 2
OT  - health coaching
OT  - mHealth
OT  - randomized controlled trial
OT  - telehealth
COIS- Conflicts of Interest: None Declared.
EDAT- 2015/10/07 06:00
MHDA- 2016/05/27 06:00
PMCR- 2015/10/05
CRDT- 2015/10/07 06:00
PHST- 2015/06/26 00:00 [received]
PHST- 2015/08/12 00:00 [accepted]
PHST- 2015/08/06 00:00 [revised]
PHST- 2015/10/07 06:00 [entrez]
PHST- 2015/10/07 06:00 [pubmed]
PHST- 2016/05/27 06:00 [medline]
PHST- 2015/10/05 00:00 [pmc-release]
AID - v17i10e224 [pii]
AID - 10.2196/jmir.4871 [doi]
PST - epublish
SO  - J Med Internet Res. 2015 Oct 5;17(10):e224. doi: 10.2196/jmir.4871.