Photo Credit: iStock.com/Egoitz Bengoetxea Iguaran

After 6 months of phone calls with empathetic laypeople, patients with low income and uncontrolled diabetes at baseline demonstrated statistically significant and clinically meaningful improvements in glycemic control compared with patients who received usual care, according to a study published in JAMA Network Open.

“Identifying how such a workforce might accompany and be coordinated with clinical care could accelerate achieving meaningful outcomes for patients and the health system,” wrote corresponding author Maninder K. Kahlon, PhD, and colleagues.

The parallel-arm randomized clinical trial assigned 260 patients with uncontrolled diabetes at a federally qualified health center to either usual care, which served as a control, or to an intervention group that received empathy-oriented phone calls from community-hired laypeople for 6 months. The calls were from a dedicated caller with an empathetic orientation and 8 hours of training on conversational practice and basic diabetes education. Healthcare experience was not required.

“Callers asked questions, without scripts, about whatever participants raised themselves (eg, their neighbor, dinner, or frustrations with managing blood glucose),” researchers explained.

Patients received three calls the first week and then chose one to five calls weekly for the next 3 weeks. Afterward, they received one call every 1 to 2 weeks.

Between baseline and 6 months, hemoglobin A_1c (HbA_1c) levels decreased from an average 10.0% to 9.3% in the intervention group compared with 9.8% to 9.7% in the control group, according to the study. Within-person changes in HbA_1c levels were −0.7% for the intervention group and 0.02% for the control group.

The study also found a small dose-response association between call frequency or duration and HbA_1c level improvement.

For patients with mild or greater depressive symptoms at baseline, as gauged by a score of 5 or higher on the depressive symptom scale of the 9-item Patient Health Questionnaire (PHQ-9), within-person HbA_1c level improvements were greater: −1.1% with the intervention compared with 0.1% with usual care.

When asked how beneficial they found the intervention, 91.7% of patients responded “very” or “extremely.”

“In response to the question, ‘how likely are you to recommend the program to a friend or family member?’, the mean (SD) score from 1 (not likely) to 10 (extremely likely) was 8.7 (2.3),” researchers reported, “with 63 of 98 (64.3%) selecting 10.”