Neediest Diabetes Patients Can Benefit Most From Health Coaching Initiatives

Health coaching for diabetes patients increased diabetes knowledge in all participants, but the most significant clinical improvements were seen in those who had been faring poorly at baseline, accordingto the newly published results of a chronic disease management program in Australia.

Chronic disease management programs have been shown to help patients, including those with diabetes, become more engaged in their healthcare. These programs can also incorporate health coaching, an educational approach that focuses on individual problem solving. This study, published in Preventing Chronic Disease, examined the effects of a diabetes health coaching program that consisted of an in-person education session followed by a year of phone calls from a health coach; patients unable to attend the session received the lesson over the phone instead.

Before the program’s initiation, researchers gathered a number of baseline measures from the 238 patients. Tests were administered to assess diabetes knowledge, self-reported health status, and diabetes distress, and repeated at 3, 6, and 12 months after enrollment. Researchers also recorded patients’ glycated hemoglobin (A1C) levels, body mass index, and diabetes complication status at baseline and 12 months after enrollment.

The initial sessions were guided by a conversation map where nurse educators assessed the patient’s current level of disease management and provided guidance on a healthy diet, recommended exercise, and tips on how to prevent complications. They also helped the patients set goals for their diabetes-specific health targets and offered strategies to achieve those goals. In the follow-up calls, the patients would discuss their progress and how they could adjust their strategies.

In accordance with the program’s goals, patients’ diabetes knowledge scores increased after just 3 months and remained stable at 1 year after enrollment. However, improvements in diabetes knowledge were only significant among the participants who attended the in-person education session, not those who received the coaching lesson over the phone.

Among participants with poor baseline health status of 4 or higher on the self-reported scale, those who completed the follow-up assessments at 3 and 6 months saw an improvement in health status from 4.4 at baseline to 3.6 at the 6-month mark. Similar results were found among the patients who had moderate to high diabetes distress at baseline; their distress levels fell from 3.8 at baseline to 3.2 after 6 months and 3.0 after 1 year. Additionally, there were significant improvements in A1C levels after 12 months among the participants with poor glycemic control at baseline.

The study authors concluded that because “patients with high levels of diabetes distress or poor glycemic control at entry into health coaching were the ones who benefitted most from taking part in the program,” this specific population should “be routinely offered additional health coaching or more specialized chronic disease management” instead of expending these resources on patients who are effectively managing their diabetes on their own.