Coaching may improve diabetes clinical outcomes in real-world primary care settings
A primary care program with health coaching by medical assistants resulted in significantly greater improvements in HbA1c levels than usual care in a trial of high-risk type 2 diabetes patients at two U.S. centers.
Coaching by a medical assistant (MA) was more effective than usual care for improving glycemic control in adults with type 2 diabetes, according to a pragmatic trial.
The randomized controlled trial compared MA health coaching with usual care in two diverse real-world primary care environments: a federally qualified health center (FQHC) and a large nonprofit private insurance-based health system. Two primary care clinics with similar characteristics in each health system were selected and one randomly allocated to MA coaching. Researchers enrolled 600 adults with type 2 diabetes who had met one or more criteria in the past 90 days: HbA1c level of 8% or greater, low-density lipoprotein (LDL) cholesterol level of 100 mg/dL or greater, and/or systolic blood pressure (SBP) of 140 mm Hg or greater. Coached patients received in-person and telephone self-management support from a specially trained health coach for 12 months. Results were published May 16 by Diabetes Care.
All clinical outcomes improved significantly over one year in both groups. Although both groups achieved clinically significant improvements in HbA1c level over time, the coached group had twice the rate of improvement (−0.12% vs. −0.06% per month) and a 0.34% greater absolute change in HbA1c level over 12 months (−1.08% vs. −0.74%) compared to the usual care group. Coaching also resulted in greater improvements in LDL cholesterol level than usual care at the FQHC site.
The study authors wrote that this was the first large-scale pragmatic trial supporting the real-world effectiveness of MA coaching for type 2 diabetes in U.S. primary care settings. "The implementation and evaluation of this model in two unique health care environments, an FQHC and a large primarily private insurance–based health care system, and among patients undergoing standard care processes (vs. a consent-requiring research trial) enhance the generalizability of findings to other primary care settings and populations," they wrote.