Abstract
Introduction
: Despite having a broad range of services available at the Veterans Affairs Healthcare System (VAHS), veterans struggle to control their chronic diseases. At the Miami VAHS, 30% of veterans have diabetes, and of those, 30% are poorly controlled. Women represent a growing number of veterans at the Miami VAHS who face many of the challenges posed by having a diabetes diagnosis.
Objective:
To improve HbA1c measurements in women veterans (WV) with poorly controlled diabetes following a phone encounter with an endocrinologist addressing diabetes management.
Method:
This was a prospective intervention study of WV with HbA1c levels ≥ 9%. An endocrinologist attempted up to three telephone calls to reach WV. The phone intervention involved a chart review of co-morbidities to establish a HbA1c target, and management included lifestyle modification counseling, insulin dose adjustment, introduction and/or discontinuation of diabetes medications, and a plan for follow-up. During the following 3-4 months, results of follow-up HbA1c were collected regardless of having had an initial telephone encounter. WV who did not have follow-up HbA1c were excluded from the study. The remaining WV were further divided into 1) those that answered the phone and participated in the assessment (intervention group) and 2) those who did not answer the phone to have an initial encounter (control group). Other variables included BMI, eGFR, type of diabetes, diabetes medication, presence of hypertension, dyslipidemia, coronary artery disease (CAD), smoking, and psychiatric illness.
Results:
Of 77 WV who were called, 36 WV were assessed by the endocrinologist; 41 did not answer the phone and were regarded as the control. 8 WV from the intervention group and 16 WV from the control group did not have a follow-up HbA1c, and were excluded. 28 intervention and 25 control WV were included in the final analysis. In the intervention group: mean age 55.0 ± 10.3 years, BMI 29.8 ± 5.5, eGFR 57.9 ± 4.5, 86% type 2 diabetes, 61% on basal bolus insulin therapy, 68% HTN, 93% dyslipidemia, 71% smokers, 4% CAD, and 68% psychiatric diagnosis. In the control group: mean age 55.6 ± 9.9 years, BMI 32.5 ± 6.1, eGFR 58.9 ± 4.5, 96% type 2 diabetes, 44% on basal bolus insulin therapy, 80% HTN, 84% dyslipidemia, 16% smokers, 4% CAD, and 68% psychiatric diagnosis. Mean baseline HbA1c was 10.9 ± 1.5 for the intervention and 10.8 ± 1.8 for the control group. After 3-4 months, mean HbA1c was 9.9 ± 2.3 in the intervention group, and 10.6 ± 1.7 in the control group. HbA1c decrease in the intervention group was statistically significant (p = 0.03).
Conclusion:
This preliminary study demonstrates that a telephone intervention from a diabetes specialist has a positive impact on decreasing HbA1c in WV with poorly controlled diabetes. Findings from this study suggest that this approach should be considered in management of other chronic diseases.