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Paula Trief Part 3, Diabetes Support Project

In part 3 of this Exclusive Interview, Paula Trief talks with Diabetes in Control Publisher Steve Freed about the results of a couples intervention trial, the Diabetes Support Project.

Paula Trief, PhD is a Patrick A. Lehan Professor of Physiology and Biophysics and Chairman of the Department of Medicine Department at University of Mississippi.


Transcript of this video segment:

Steve Freed: Can you tell us about the work you’ve done with the Diabetes Support Project, what it is and what did you find?

Paula Trief:  So this was a couples intervention trial where we had couples where one person had type 2 diabetes in poor glycemic control, A1c greater than seven point five percent. And we compared diabetes education with the patient only — because we know that diabetes education works — to an individual intervention just the patient, which was education and then ten more sessions of what you see in most behavioral interventions, working on diet and activity and testing your blood sugar and setting goals and action plans and things like that. And then we had a couples intervention. So we did the same intervention but we had the partner there, but they weren’t just there. They were intimately involved, they were working on setting goals themselves, the whole discussion was about how they could support the patient and making changes. We used that Speaker Listener technique, we had the talk about conflict. And what we found — our main outcome was A1c, and what we found was that all of the groups actually improved significantly in A1c, which kind of said that maybe you don’t need to bring in the partner. But then when we looked at it by their baseline A1c, what we found was that the patients that had lowest third — so they had seven point five to eight point two percent [A1c] — they didn’t change in any of the groups. And the patients in the highest third, nine point two percent, they changed in all of the groups; but in that middle group, the eight point two to nine point two percent, it was only the couples intervention that changed, and they improved for a whole year, not just for the intervention. So that just supported the idea of bringing in couples. And working with them in this communal coping way we think can be effective.

And we looked at other things too. Relationship, how happy they were in their relationships. We also just recently looked at the effect on the partners and we found that the ones who were in the couples intervention were more satisfied with their relationships, had less diabetes distress themselves, so they had kind of a psychological benefit from being involved as well.

Steve Freed: And I noticed that you do things a little bit different. Why do you deliver your interventions over the telephone instead of a clinic visit?

Paula Trief:  We did that in another study that we did, which was a translation of the DPP. The issue is, I live in Syracuse. It’s a moderate sized city. People who live even in the suburbs talk about not wanting to drive into the city, even though it’s not like the city like New York. There’s a large rural population and those people just don’t get in. They don’t come in for these kinds of interventions; they might come in to see their doctors every six months or so but we’re talking about like a weekly intervention, and then you know people who are elderly, people who have disabilities, people who work — you know, if you’re doing it during clinic time, if you’re working. And I was looking to bring in couples, so it wasn’t just bringing in one person, you have to bring in two people and coordinate that. So by doing it by phone you get all those, or at least potentially all those people. We had some couples where the one person was in one city and the other person was in another city. One couple where he was a truck driver and she was a homemaker and they’d both be on the phone but they wouldn’t even be in the same environment. So we just thought that that would increase what’s called reach, you know, to give people that you can get to, that clinic visits just don’t.

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