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Empathy-oriented phone calls from laypersons helped patients with uncontrolled diabetes improve glycemic control, a parallel-arm superiority trial found.

Among 260 participants, those who received calls from community-hired laypeople decreased their HbA1c from 10% to 9.3% by 6 months. Meanwhile, HbA1c in the usual care group held steady from 9.8% to 9.7%, reported Maninder Kahlon, PhD, of the University of Texas at Austin, and colleagues.

The impact of the phone calls was even more pronounced in patients with baseline scores of 5 or higher on the depressive symptoms scale of the 9-item Patient Health Questionnaire (PHQ-9). For this subset, patients who received the phone calls had an HbA1c drop of 1.1% (95% CI -1.8% to -0.5%) compared with a 0.1% (95% CI -0.7% to 0.8%) increase for controls.

These HbA1c reductions were "on the higher end of improvements previously seen" in that used psychological interventions such as cognitive behavioral therapy or motivational interviewing, the researchers wrote in .

While behavioral health support is known to be beneficial for patients managing diabetes and comorbid depressive symptoms, it carries barriers to access, and "when available, is offered only for those who reach a clinical threshold, with an insufficient workforce severely limiting capacity, particularly for patients with low socioeconomic status who lack resources," the researchers said.

The approach in this trial was different from prior models that instead shifted focus back to the needs of the patient on their own terms.

"The goal was not to accomplish tasks but to converse to learn more about the patient," said Kahlon's group. "Patients chose the frequency and length of calls and discussed their own interests."

Throughout the 6-month trial, participants received calls of unlimited duration from a bilingual dedicated caller. Callers didn't have a healthcare background -- just 8 hours of training -- and discussed the participant's life with diabetes. They didn't stick to a script, and instead asked questions about whatever the patient raised themselves, whether it be dinner or frustrations with management blood glucose.

"When they expressed needs, which they were more likely to do because they were being called regularly by someone they trusted, patients were supported in connecting back to the health system," said Kahlon and co-authors. "This reversal of focus, starting with the patients on their own terms, may have increased their sense of autonomy, enabling healthy lifestyle changes aligned with personal preferences."

Participants received three telephone calls in the first week from their assigned caller and then chose one to five calls per week for the next 3 weeks, and subsequently one call every 1 or 2 weeks. On average, 20 calls were completed per participant in the intervention group and call duration was 360.6 minutes total.

In addition to the calls, participants were also mailed two gifts, worth less than $25 each, selected by callers that reflected their understanding of participants' preferences, such as a yoga mat or a cookbook.

In an , Brett Thombs, PhD, of Jewish General Hospital in Montréal, Canada, and colleagues called the program "unique," and said the outcomes indicated that social support is a "critical ingredient" in helping people with diabetes improve glycemic control.

"Indeed, this would be consistent with considerable evidence that links social support, defined as the perception or reality that one is cared for and has assistance available from others, to positive health behaviors and outcomes," they wrote.

Additional studies should try to replicate the findings, Thombs' group suggested, since this simple intervention "could expand our ability to provide needed support in diabetes and other conditions."

Participants were recruited via text messages from a federally qualified health center (FQHCs) in Austin, Texas -- 129 were randomized to the intervention and 131 to the control. FQHCS are federally funded centers that offer primary care to medically underserved populations regardless of patients' ability to pay.

Most participants (78.5%) were Hispanic or Latino, 62.9% were female, and average age was 49.5. Nearly 87% had an annual income under $40,000. All had uncontrolled diabetes defined as at least 1 HbA1c measurement of 8.0% or greater at a clinic appointment in the prior 12 months with an HbA1c measurement of 7.5% or greater at trial enrollment.

After 6 months, 91.7% of participants who received phone calls said the program was "very" or "extremely beneficial."

Even those with baseline PHQ-9 scores less than 5 had a benefit. In this subset, the intervention group had a significant 0.4% drop in HbA1c compared with a nonsignificant 0.02% drop for the control group.

The trial was limited by the somewhat short 6-month follow-up period. Kahlon's group said it would be "useful" to see the benefits of a longer duration program or whether glycemic impacts are sustained long-term.

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