Nelson Lyndsay A, Spieker Andrew J, Greevy Robert A, Roddy McKenzie K, LeStourgeon Lauren M, Bergner Erin M, El-Rifai Merna, Aikens James E, Wolever Ruth Q, Elasy Tom A, Mayberry Lindsay S
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA.
medRxiv. 2023 Sep 12:2023.09.11.23295374. doi: 10.1101/2023.09.11.23295374.
Family/friends Activation to Motivate Self-care (FAMS) is a self-care support intervention delivered via mobile phones. We evaluated FAMS effects on hemoglobin A1c (HbA1c) and intervention targets among adults with type 2 diabetes in a 15-month RCT.
Persons with diabetes (PWDs) and their support persons (family/friend, optional) were randomized to FAMS or control. FAMS included monthly phone coaching and text messages for PWDs, and text messages for support persons over a 9-month intervention period.
PWDs (N=329) were 52% male, 39% from minoritized racial or ethnic groups, with mean HbA1c 8.6±1.7%. FAMS improved HbA1c among PWDs with a non-cohabitating support person (-0.64%; 95% CI [-1.22%, -0.05%]), but overall effects were not significant. FAMS improved intervention targets including self-efficacy, dietary behavior, and family/friend involvement during the intervention period; these improvements mediated post-intervention HbA1c improvements (total indirect effect -0.27%; 95% CI [-0.49%, -0.09%]) and sustained HbA1c improvements at 12 months (total indirect effect -0.19%; 95% CI [-0.40%, -0.01%]).
Despite improvements in most intervention targets, HbA1c improved only among PWDs engaging non-cohabitating support persons suggesting future family interventions should emphasize inclusion of these relationships. Future work should also seek to identify intervention targets that mediate improvements in HbA1c.
家庭/朋友激活以促进自我护理（FAMS）是一种通过手机提供的自我护理支持干预措施。我们在一项为期15个月的随机对照试验中评估了FAMS对2型糖尿病成年人糖化血红蛋白（HbA1c）及干预目标的影响。
糖尿病患者（PWDs）及其支持人员（家人/朋友，非必需）被随机分为FAMS组或对照组。FAMS包括在为期9个月的干预期内为PWDs提供每月一次的电话指导和短信，以及为支持人员提供短信。
PWDs（N = 329）中52%为男性，39%来自少数种族或族裔群体，平均HbA1c为8.6±1.7%。FAMS使有非同居支持人员的PWDs的HbA1c有所改善（-0.64%；95%置信区间[-1.22%，-0.05%]），但总体效果不显著。FAMS在干预期内改善了包括自我效能、饮食行为和家人/朋友参与度在内的干预目标；这些改善介导了干预后HbA1c的改善（总间接效应-0.27%；95%置信区间[-0.49%，-0.09%]）以及12个月时HbA1c的持续改善（总间接效应-0.19%；95%置信区间[-0.40%，-0.01%]）。
尽管大多数干预目标有所改善，但HbA1c仅在有非同居支持人员的PWDs中得到改善，这表明未来的家庭干预应强调纳入这些关系。未来的工作还应寻求确定介导HbA1c改善的干预目标。
