Study Suggests Self-Management Intervention for Hypertension has Modest "Spill-Over" Effect on Diabetes Control
Interventions that target self-management skills among patients with chronic diseases have been growing in popularity and have been suggested as an integral part of improving the quality of chronic disease care. This study evaluated the effect of a tailored hypertension self-management intervention that had been shown to have a modest effect on blood pressure control on the unintended targets of diabetes and cholesterol control. Veterans in this study received either a hypertension self-management intervention delivered by a nurse over the telephone or usual care at three primary care clinics within the Durham VAMC between 3/02 and 4/03. In this analysis, the two outcomes assessed over 24 months were glycemic control (HbA1c) and fasting LDL cholesterol (LDL-C).
Findings show a modest difference in glycemic control between Veterans with diabetes who received the intervention compared to usual care: the mean HbA1c decreased by 0.28% among Veterans in the intervention, while increasing 0.18% for those in usual care. LDL-C decreased over the two-year period in both groups, but there was no significant difference between the intervention group and usual care. Similar to results found in the analysis of HbA1c, Veterans with higher LDL-C at baseline had steeper rates of improvement over the study period; however, there was no differential effect between the intervention and usual care groups. Thus, this study shows some evidence that a telephone administered, nurse self-management intervention targeting hypertension may have a modest "spill-over" effect on diabetes control.
Powers B, Olsen M, Oddone E, and Bosworth H. The effect of a hypertension self-management intervention on the unintended targets of diabetes and cholesterol control. American Journal of Medicine July 2009;122(7):639-46.
This study was funded by HSR&D. All authors are part of HSR&D’s Center for Health Services Research in Primary Care in Durham, NC.