Glucose Intolerance Clinical Trial
Official title:
Remote Care Model for Supporting Prediabetes Patients
The purpose of this study is to determine whether a multi-component remote care model (telephone-based) is effective to achieve the modification of unhealthy eating practices and increase physical activity in adults who have prediabetes and over-weight/obesity. The effectiveness of the remote care model will be determined with respect to the mentioned practices as well as anthropometric parameters (Waist circumference and Weight) and clinical parameters (Fasting Glucose, Triglycerides, Total Cholesterol) which are sensitive to changes in these habits. The counseling intervention is the core of the multi-component tele-care model, which also includes counseling-through text messages, supply of Educational material and self-monitoring equipment (pedometers and measuring tape for patients to check their waist circumference).
International data report that the population with prediabetes is approximately twice the
population with Diabetes Mellitus type 2 (DM2) both in the U.S. and Latin America. Given
prediabetes estimated prevalence in Chile (8 to 15%) and considering the high risk for
developing DM2 that prediabetic people present, as well as the high cost associated with
treating this disease and its consequences, it is essential to look for strategies to
prevent and/or delay this process. People under 45 years who are overweight and have altered
glucose tolerance test constitute a population who is at high risk for developing DM2
(MINSAL, 2009). It has been shown that weight loss and increase of moderate physical
activity reduces by 58% the risk of developing DM2 (The Diabetes Prevention Program Research
Group, 2002), however, at primary care, people who are informed of having prediabetes
usually present no access to the available services to support them in the process of
changing behaviors that are at the core of this condition.
This study aims to design, implement and evaluate a multi-component remote care model to
support people with prediabetes who are overweight or obese, at self-management of their
risk behaviors of unhealthy diet and physical inactivity. This study seeks to determine
whether remote care interventions aimed at overweight or obese people with prediabetes,
carried out by professionals trained in motivational interviewing, behavior change theories
and support health decision-making, with knowledge of prediabetes and effective
interventions for coping are effective for: a) Increase participants knowledge about the
risks of this condition and how to prevent them b) Provide effective support that results in
an increase in daily physical activity c) Provide effective support to ensure change in
their eating habits d) Achieve reduction in clinical parameters values of glucose,
cholesterol and triglycerides e) Attain decrease in the anthropometric parameters body
weight and waist circumference (associated with the modification of the unwanted habits).
The counseling intervention is the core of the multi-component remote care model, which also
includes counseling through text messages, the purveyance of educational material, and
self-monitoring equipment (pedometers and measuring tape for patients to check their waist
circumference). The calls are made by professionals working at health centers who have been
trained to apply theories on behavioral change and decision-making. Phone counseling are
conducted at least once a month. Three different types of counseling are included: (a)
Welcome: aimed at exploring the factors that promote behavioral change and the goals that
the patient must reach to deal with prediabetes; (b) Follow-up: aimed at accompanying the
patient and/or monitoring the attainment of goals associated with the desired behavioral
change, (c) Completion: for closing the intervention process, reinforcing achievements, and
inviting the patient to maintain the behavioral changes made. Short Message Service (SMS)
counseling is aimed at providing information and encouraging the patient to change his/her
behavior in terms of nutrition and physical activity. Messages are sent weekly and are
related to the topics referred to in counseling sessions. The educational material and
equipment --respectively-- seek to provide additional information and foster the habit of
self-monitoring progress and/or reversions in the change process.
A randomized clinical study was designed, including a sample of 70 (both groups) people
diagnosed with prediabetes and altered BMI, registered in 5 primary care centers in the La
Florida commune, Santiago, Chile. The intervention will last 6 months. The control group
will receive usual care from health centers consisting of an indication of physical activity
and healthy eating recommendations, as well as referral to Dietitian if appropriate, an
invitation to participate in educational activities at health centers and periodic
inspection appointments. Apart from the usual care provided in health centers, the
intervention group will also receive the four components of the remote care model. Pre and
post intervention measurements will be applied. At the end of the intervention (after
post-measurement) control group participants will be invited to participate in an
educational workshop to improve eating practices and physical activity, and will receive
educational materials generated by this project, thus ensuring the principle of equity in
the project's development. For the intervention group, the program is expected to lead to
increased knowledge on prediabetes, increment in physical activity, improvement of clinical
and anthropometric parameters as well as of eating habits, all of these are non expected
results for the control group.
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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