Health Coaching Patients with Type 2 Diabetes With and Without Smartphone Support in a Lower Socioeconomic Strata Community

Background: Although the adoption of self-management behaviors is crucial for maintaining good health after a type 2 diabetes diagnosis, many individuals with T2DM fail to meet target blood glucose levels. Adherence to gluco-regulating behaviors like regular exercise and balanced diet can be challenging, especially for individuals of lower socioeconomic status (SES). Providing cost effective interventions that improve adherence to self-management behaviours is important for improving quality of life for patients and the sustainability of health care systems.

Objective: To design and test a health coaching protocol administered by trained health coaches in a lower SES community aimed at improving the health profile of patients with poorly controlled T2DM, with and without smartphone connectivity.

Methods: Dissertation methodology is described in two studies. The first study describes the pilot trial run at the Black Creek Community Health Centre (BCCHC) between February 2010 and March 2011which recruited a total of n=21 participants intervened with by n=1 health coach. The second study describes the randomized controlled trial conducted primarily at BCCHC from March 2012 to March 2014 and intervened with n=131 participants with n=6 health coaches. The primary outcome is change in glycated hemoglobin (HbA1c) from baseline to 6-month follow-up for each study. Secondary outcomes include changes in weight, waist circumference, and BMI, as well as within group changes of HbA1c. Psychometric measures collected pre/post for the RCT include the Satisfaction with Life Scale, Positive and Negative Affect Schedule, Hospital Anxiety and Depression Scale, and the 12-item Short Form Health Survey (SF-12v2).

Hypothesis: Patients who receive health coaching with electronic support will exhibit greater reductions in HbA1c than the health coach only group. There will also be greater improvements in anthropometric and psychometric outcomes favouring the group who receives electronic support.

Results: In the pilot study, a total of 21 individuals consented to participate, of whom 19 (90.4%) completed the 6 month trial; 12 had baseline glycated hemoglobin (HbA1c) levels >7.0% and these participants demonstrated a mean reduction of 0.43 (0.63) (p<.05) with minimal changes in medication. In the RCT, a total of 131 patients were randomized, with n=67 and n=64 in the intervention and control groups, respectively. Primary outcome data were available for n=97 participants (74%). While both groups reduced their HbA1c, there were no significant between-group differences in change of HbA1c at 6 months using intention to treat (LOCF) (p=.481) or per protocol (p=.825) principles. However, the intervention group demonstrated an accelerated reduction in HbA1c, leading to a significant between groups difference at 3 months (p=.032). This difference was reduced at the 6 month follow up as the control group continued to improve, achieving an HbA1c reduction of 0.81% (8.9 mmol/mol) (p=.001) compared with a reduction of 0.84% (9.2 mmol/mol)(p=.001) in the intervention group. Intervention group participants also had significant decreases in weight (p=.006) and waist circumference (p=.011) while controls did not. Both groups reported improvements in mood, satisfaction with life and quality of life.

Discussion: Health coaching with and without access to mobile technology appeared to improve gluco-regulation and mental health in a lower SES, T2DM population. The accelerated improvement in the smartphone group suggests the connectivity provided may more quickly improve adoption and adherence to health behaviors within a clinical diabetes management program. Overall, health coaching in primary care appears to deliver significant benefits for patients from lower SES with poorly controlled type 2 diabetes.