BACKGROUND:Cardiovascular disease (CVD) and diabetes account for one-third of the mortality difference between African American and white patients. We evaluated the effect of a CVD risk reduction intervention in African Americans with diabetes. METHODS: We randomized 359 African Americans with type 2 diabetes to receiveusual care or a nurse telephone intervention. The 12-month intervention provided monthly self-management support and quarterly medication management facilitation. Coprimary outcomes were changes in systolic blood pressure (SBP), hemoglobin A1c (HbA1c), and low-density lipoprotein cholesterol (LDL-C) over 12 months. We estimated between-intervention group differences over time using linear mixed-effects models. The secondary outcome was self-reported medication adherence. RESULTS:The sample was 72% female; 49% had low health literacy, and 37% had annual income <$10,000. Model-based estimates for mean baseline SBP, HbA1c, and LDL-C were 136.8 mm Hg (95% CI 135.0-138.6), 8.0% (95% CI 7.8-8.2), and 99.1 mg/dL (95% CI 94.7-103.5), respectively. Intervention patients received 9.9 (SD 3.0) intervention calls on average. Primary providers replied to 76% of nurse medication management facilitation contacts, 18% of these resulted in medication changes. There were no between-group differences over time for SBP (P = .11), HbA1c (P = .66), or LDL-C (P = .79). Intervention patients were more likely than those receiving usual care to report improved medication adherence (odds ratio 4.4, 95% CI 1.8-10.6, P = .0008), but adherent patients did not exhibit relative improvement in primary outcomes. CONCLUSIONS: This intervention improved self-reported medication adherence but not CVD risk factor control among African Americans with diabetes. Further research is needed to determine how to maximally impact CVD risk factors in African American patients.
RCT Entities:
BACKGROUND:Cardiovascular disease (CVD) and diabetes account for one-third of the mortality difference between African American and white patients. We evaluated the effect of a CVD risk reduction intervention in African Americans with diabetes. METHODS: We randomized 359 African Americans with type 2 diabetes to receive usual care or a nurse telephone intervention. The 12-month intervention provided monthly self-management support and quarterly medication management facilitation. Coprimary outcomes were changes in systolic blood pressure (SBP), hemoglobin A1c (HbA1c), and low-density lipoprotein cholesterol (LDL-C) over 12 months. We estimated between-intervention group differences over time using linear mixed-effects models. The secondary outcome was self-reported medication adherence. RESULTS: The sample was 72% female; 49% had low health literacy, and 37% had annual income <$10,000. Model-based estimates for mean baseline SBP, HbA1c, and LDL-C were 136.8 mm Hg (95% CI 135.0-138.6), 8.0% (95% CI 7.8-8.2), and 99.1 mg/dL (95% CI 94.7-103.5), respectively. Intervention patients received 9.9 (SD 3.0) intervention calls on average. Primary providers replied to 76% of nurse medication management facilitation contacts, 18% of these resulted in medication changes. There were no between-group differences over time for SBP (P = .11), HbA1c (P = .66), or LDL-C (P = .79). Intervention patients were more likely than those receiving usual care to report improved medication adherence (odds ratio 4.4, 95% CI 1.8-10.6, P = .0008), but adherent patients did not exhibit relative improvement in primary outcomes. CONCLUSIONS: This intervention improved self-reported medication adherence but not CVD risk factor control among African Americans with diabetes. Further research is needed to determine how to maximally impact CVD risk factors in African American patients.
Authors: Wei Duan-Porter; Karen M Goldstein; Jennifer R McDuffie; Jaime M Hughes; Megan E B Clowse; Ruth S Klap; Varsha Masilamani; Nancy M Allen LaPointe; Avishek Nagi; Jennifer M Gierisch; John W Williams Journal: Ann Intern Med Date: 2016-04-26 Impact factor: 25.391
Authors: Nouf Sahal Alharbi; Nada Alsubki; Simon Jones; Kamlesh Khunti; Neil Munro; Simon de Lusignan Journal: J Med Internet Res Date: 2016-11-25 Impact factor: 5.428
Authors: Irene D Blackberry; John S Furler; James D Best; Patty Chondros; Margarite Vale; Christine Walker; Trisha Dunning; Leonie Segal; James Dunbar; Ralph Audehm; Danny Liew; Doris Young Journal: BMJ Date: 2013-09-18
Authors: Simon de Lusignan; Freda Mold; Aziz Sheikh; Azeem Majeed; Jeremy C Wyatt; Tom Quinn; Mary Cavill; Toto Anne Gronlund; Christina Franco; Umesh Chauhan; Hannah Blakey; Neha Kataria; Fiona Barker; Beverley Ellis; Phil Koczan; Theodoros N Arvanitis; Mary McCarthy; Simon Jones; Imran Rafi Journal: BMJ Open Date: 2014-09-08 Impact factor: 2.692