Kate Lorig and her colleagues at Stanford University have reported on a number of excellent self-management studies. Recently, they reported on a study to determine (1) whether participants in a Spanish Diabetes Self-Management Program (SDSMP), when compared at six months to randomized controls, would demonstrate improvements in health status, health behaviors and self-efficacy; and (2) whether SDSMP participants receiving monthly automated-telephone reinforcement would maintain improvements at 18-months better than those not receiving reinforcement. The participants were 567 Spanish-speaking adults with type-2 diabetes who were randomized to a usual-care control group or six week community-based, peer-led SDSMP. SDSMP participants were re-randomized to receive 15 months of automated-telephone messages or no reinforcement. HbA1c was measured at baseline, and at six and 18 months. All other data were collected by self-administered questionnaires. At six months SDSMP participants compared to controls demonstrated improvements in HbA1c, health distress, symptoms of hypo- and hyperglycemia, and self-efficacy. At 18 months all improvements persisted. SDSMP participants also demonstrated improvements in self-rated health, communication with physicians, had fewer ER visits, and a trend toward fewer visits to physicians. At 18 months the only difference between reinforced and non-reinforced participants was increased glucose monitoring for the reinforcement group.

VALUE OF STUDY TO READER: The SDSMP demonstrated effectiveness in lowering HbA1c and improving health status. Reinforcement did not add to its effectiveness. Given the high needs of the Spanish-speaking population, the SDSMP deserves consideration for implementation. These are solid conclusions, particularly as change was maintained for at least 18 months. In addition, the study was important in demonstrating that no additional reinforcement was needed in the study. The study illustrates that an effective self-management program for a chronic illness generates the self-efficacy required for maintenance of the self-management skills.

K Lorig et al. Spanish Diabetes Self-Management with and without Automated Telephone Reinforcement: Two Randomized Trials. Diabetes Care, December 20, 2007.