Young, R, Taylor, J, Friede, T, Hollis, S, Mason, J, Lee, P, Burns, E, Long, A, Gambling,
T, New, JP, Gibson, JM
Diabetes Care. 2005;28( 2):278-82.
OBJECTIVE: To determine whether Pro-Active Call Center Treatment Support (PACCTS),
using trained nonmedical telephonists supported by specially designed software and
a diabetes nurse, can effectively improve glycemic control in type 2 diabetes. RESEARCH
DESIGN AND METHODS: A randomized controlled implementation trial of 1-year duration
was conducted in Salford, U.K. The trial comprised 591 randomly selected individuals
with type 2 diabetes. By random allocation, 197 individuals were assigned to the usual
care (control) group and 394 to the PACCTS (intervention) group. Lifestyle advice
and drug treatment in both groups followed local guidelines. PACCTS patients were
telephoned according to a protocol with the frequency of calls proportional to the
last HbA(1c) level. The primary outcome was absolute reduction in HbA(1c), and the
secondary outcome was the proportion of patients reducing HbA(1c) by at least 1%.
RESULTS: A total of 332 patients (84%) in the PACCTS group and 176 patients (89%)
in the control group completed the study. Final HbA(1c) values were available in 374
patients (95%) in the PACCTS group and 180 patients (92%) in the usual care group.
Compared with usual care, HbA(1c) improved by 0.31% (95% CI 0.11-0.52, P = 0.003)
overall in the PACCTS patients. For patients with baseline HbA(1c) >7%, the improvement
increased to 0.49% (0.21-0.77, P < 0.001), whereas in patients with baseline HbA(1c)
<7% there was no change. The difference in the proportions of patients achieving a
>/=1% reduction in HbA(1c) significantly favored the PACCTS intervention: 10% (4-16,
P < 0.001) overall and 15% (7-24, P < 0.001) for patients with baseline HbA(1c) >7%.
CONCLUSIONS: In an urban Caucasian trial population with blood glucose HbA(1c) >7%,
PACCTS facilitated significant improvement in glycemic control. Further research should
extend the validity of findings to rural communities and other ethnic groups, as well
as to smoking and lipid and blood pressure control.