Pro-Active Call Center Treatment Support (PACCTS) to Improve Glucose Control in Type 2 Diabetes

Abstract

OBJECTIVE— To determine whether Pro-Active Call Center Treatment Support (PACCTS), using trained nonmedical telephonists supported by specially designed software and a diabetes nurse, can effectively improve glycemic control in type 2 diabetes. RESEARCH DESIGN AND METHODS— A randomized controlled implementation trial of 1-year duration was conducted in Salford, U.K. The trial comprised 591 randomly selected individuals with type 2 diabetes. By random allocation, 197 individuals were assigned to the usual care (control) group and 394 to the PACCTS (intervention) group. Lifestyle advice and drug treatment in both groups followed local guidelines. PACCTS patients were telephoned according to a protocol with the frequency of calls proportional to the last HbA1c level. The primary outcome was absolute reduction in HbA1c, and the secondary outcome was the proportion of patients reducing HbA1c by at least 1%. RESULTS— A total of 332 patients (84%) in the PACCTS group and 176 patients (89%) in the control group completed the study. Final HbA1c values were available in 374 patients (95%) in the PACCTS group and 180 patients (92%) in the usual care group. Compared with usual care, HbA1c improved by 0.31% (95% CI 0.11–0.52, P = 0.003) overall in the PACCTS patients. For patients with baseline HbA1c >7%, the improvement increased to 0.49% (0.21–0.77, P < 0.001), whereas in patients with baseline HbA1c <7% there was no change. The difference in the proportions of patients achieving a ≥1% reduction in HbA1c significantly favored the PACCTS intervention: 10% (4–16, P < 0.001) overall and 15% (7–24, P < 0.001) for patients with baseline HbA1c >7%. CONCLUSIONS— In an urban Caucasian trial population with blood glucose HbA1c >7%, PACCTS facilitated significant improvement in glycemic control. Further research should extend the validity of findings to rural communities and other ethnic groups, as well as to smoking and lipid and blood pressure control.