Using an automated interactive telephone programme to improve diabetes management: The TLC Diabetes project

Project Team

Project Overview

The Telephone-Linked Care (TLC) Diabetes system is designed to monitor, educate and coach people with type 2 diabetes to improve their nutrition, physical activity, blood glucose testing and medication taking. It is based on technology developed at Boston University Medical Centre over the past 15 years under the lead of Professor Robert Friedman. TLC complements the care currently provided to people with Type 2 diabetes by general practitioners, endocrinologists, diabetes educators and other health workers.

Participants, who have Type 2 Diabetes, call the TLC system which consists of a computer equipped with sophisticated speech recognition and voice processing software, from a home or mobile phone to engage in weekly “conversations”. Prior to each call, users upload their most recent glucose meter results via a data transmitter connected to a dedicated mobile phone.

Sub-Projects

1. Trial of the TLC system in Australia

This project focused on identifying the key issues required to adapt the original TLC system designed for use within the United States, for application within an Australian setting. A pilot trial TLC system was undertaken using the Physical Activity module. This trial highlighted that language, accent and colloquialisms, socio-cultural/environmental factors, and health guidelines and systems needed to be changed to reflect the Australian context. The acceptability of the system was also investigated, with participants reporting a high level of satisfaction with the program. The results of this pilot study were used to transfer a more complex system aimed at addressing a number of behaviours associated with successful diabetes self-management.

Funder: Diabetes Australia Research Trust (DART)

2. Development and trial of the Australian TLC Diabetes system

This project involved the review of a number of the original system components necessary to transfer the TLC system to an Australian context, specific to diabetes self-management. Initially, over 2000 of the original voice scripts were reviewed by a group of Australian health professionals. Each script was rigorously assessed in terms of currency and existing public health campaigns, and relevant amendments made. In addition, new scripts were developed to account for the fundamental differences in health guidelines and systems between the two countries.

In addition, to the adjustment of the TLC program to meet the needs of an Australian diabetic population, this project also involved the development of a novel device to upload blood glucose readings. Developed in partnership with Alive Technologies, AliveConnect allows the user to automatically upload readings from a blood glucose meter via a Bluetooth connection to the TLC Diabetes system. The AliveConnect system ensures that accurate feedback on blood glucose readings is provided to the user during calls to the TLC system.

3. Implementation of the TLC Diabetes system

Two studies are being underway to evaluate the TLC system among adults with type 2 diabetes.

A randomised controlled-trial based in Brisbane is comparing the blood glucose control, quality of life, medical costs, and a number of other self-management behaviours between those people allocated to the TLC (intervention) group and those allocated to the usual care or control (placebo) group.  The project is supported by funding from the HCF Health and Medical Research Foundation, NHMRC and Queensland Health.

Another study, funded by Queensland Health, is aiming to assess the acceptability and feasibility of the TLC Diabetes system in regional areas of Queensland.

Key Outcomes

Publications:

Bird, D., Oldenburg, B., Cassimatis, M., Russell, A., Ash, S., Courtney, M.D., Scuffham, P.A., Stewart, I., Wootton, R. and Friedman R.H (2010). Randomised controlled trial of an automated, interactive, telephone intervention to improve type 2 diabetes self-management (Telephone-Linked Care Diabetes Project): study protocol.  BMC Public Health 10, 599

Bird, D., Oldenburg, B., Cassimatis, M., Russell, A., and Friedman, R.H. (2010). Implementation trial of an automated telephone system targeting diabetes self-management. Int J Behav Med; 17(Supp1, S239).

Bird, D., Oldenburg, B., Wootton, R., and Friedman, R. (2008). Development and evaluation of an automated telephone system for diabetes self-management. Ann Bevah Med; 35(Supp, S013).

Oldenburg B., Bird D., and Friedman R. (2005) Adaptation of an automated telephone system to promote physical activity in Australia. Ann Behav Med, 29 (Supp), S083.

Oldenburg B, Bird D & Friedman R. et al. (2006) Using an automated telephone system to promote the patient’s central role in diabetes self-management. Annals of Behavioral Medicine, 31 (Supp), S079

For more information on the TLC-Diabetes Research Program, please visit the TLC Diabetes Website.