Glycemic outcomes of a family-focused intervention for adults with type 2 diabetes: Main, mediated, and subgroup effects from the FAMS 2.0 RCT

Author:

Nelson Lyndsay A.ORCID,Spieker Andrew J.ORCID,Greevy Robert A.ORCID,Roddy McKenzie K.ORCID,LeStourgeon Lauren M.ORCID,Bergner Erin M.ORCID,El-Rifai MernaORCID,Aikens James E.ORCID,Wolever Ruth Q.ORCID,Elasy Tom A.ORCID,Mayberry Lindsay S.ORCID

Abstract

AbstractAimsFamily/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.MethodsPersons 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.ResultsPWDs (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%]).ConclusionsDespite 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.

Publisher

Cold Spring Harbor Laboratory

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