Technological support deemed beneficial for glycemic control
The current improvement in communication technology has expanded the opportunity to apply these technologies to reach and treat elderly patients with chronic conditions that require indefinite treatment. When it comes to diabetes mellitus, especially type 2 diabetes, application of these technologies is mainly through patient education individually or as a group and this has been proven to be very successful. This notwithstanding, a need still exists to expand strategies such as telephones, smart phones, Internet, and text messages. Smartphones are the most effective means because a majority of the population own and operate cellular phones.
Smartphones have led to opening of communication channels between health professionals and the elderly patients with diabetes who would otherwise be isolated and hard to reach.
In a study of 26 diabetes participants who were evaluated before and after four follow-up telephone support calls for insulin administration, it was determined that such an intervention helped provide better knowledge on insulin application. In a second study where 26 patients were met face to face for 2 months and also received 4 follow-up telephone calls by a healthcare professional while a second group of patients received calls only without face to face intervention, telephone intervention was equally effective for the treatment of these diabetes patients. Due to their advanced age, these patients should be handled on a case-by-case basis when deciding those patients who would benefit from both face-to-face and telephone counseling or telephone counseling alone. This will subsequently reduce acute and chronic complications as a result of mismanagement of the disease.
The current study is evaluating the effectiveness of telephone support and counselling in blood sugar control of elderly DM patients. Patients were placed into two groups; one group (G1) received 4 months of telephone support where the patient received 4 telephone support calls per month. The other group (G2) received their educational material through mail.
The results showed a reduction of some of the parameters used to control DM in both groups. Among these changes the only significant parameter was the fasting blood glucose levels in the G1 group that received telephone education and support. The baseline HbA1c and fasting blood glucose for G1 group showed poor glycemic control compared to G2. However, there was a distinctive reduction after the phone intervention among G1 participants. G2 reduction was less remarkable and did not show clinical significance. HbA1c was used as the main predictor to evaluate whether the educative intervention via telephone support was actually working over the four months that the study took place.
Use of telephone support seemed to meet therapeutic needs of the participating patients and to even open more opportunities of care and reassessments. Regular follow-up of patients with a chronic health condition especially DM is currently lacking especially due to the complications associated with comorbidities, different equipment such as the blood glucose monitoring equipment, infusion pumps, injection pens, and medications involved. This poses a challenge to the DM patients and to home-care providers, resulting in a high demand for health services dedicated to this chronic condition. The focus of DM treatment is to empower patients and relatives to be in charge of their own healthcare and achieve glycemic control. This is achieved through health education and support through consistent telephone support.
From the results it was concluded that, telephone support by itself is an effective means of educating elderly patients with diabetes and will help achieve glycemic control. If this strategy is augmented with other strategies, it can help drive down HbA1c levels.
- HbA1c should be made frequently as part of the treatment of DM, due to its highly predictive value for the complications inherent to the disease.
- Telephone support by itself is an effective means of educating elderly patients with diabetes and will help achieve glycemic control.
- DM treatment should be geared toward empowering patients and relatives in management of their self-care with the objective to achieve glycemic control.
Becker TAC, Teixeira CRS, Zanetti ML, Pace AE, Almeida FA, Torquato MTCG. Effects of supportive telephone counseling in the metabolic control of elderly people with diabetes mellitus. Rev. Bras. Enferm. [Internet]. 2017;70(4):704-10. [Thematic Edition “Good Practices: Fundamentals of care in Gerontological Nursing”] DOI: http://dx.doi.org/10.1590/0034-7167-2017-0089
Becker TAC, Teixeira CR, Zanetti ML. Nursing intervention in insulin administration: telephone follow-up. Acta Paul Enferm [Internet]. 2012 [cited 2016 Oct 05];25(1):67-73. Available from: http://www.scielo.br/pdf/ape/v25nspe1/11.pdf
Josephat Macharia, PharmD candidate, Lecom School of Pharmacy class of 2018