Type 2 diabetes is a chronic condition, the progression of which very much depends on how a person manages it (for example monitors blood sugar levels, adjusts medications and diet) as well as on their overall lifestyle. Supporting people with diabetes through coaching is proving effective for sustaining such self-management attitudes and behaviors, and ultimately well-being. The featured article (Pirbaglou et al., 2018) evaluated the efficacy of personal health coaching on blood sugar management and on psychological wellbeing by conducting a review of selected empirical studies as well as additional analyses of the pooled data from all articles.
While the authors initially found over 600 articles on the topic, when selecting based on strict criteria, they ended up reviewing 22 articles from multiple countries. 

Interestingly, the coaching had been conducted according to different frameworks, and used a variety of modalities for delivery (face-to-face, telephone, internet). The coaches also had different backgrounds and training – nurse educators, medical assistants, social workers, psychologists, and peers. The engagement continued from 3 to 18 months in the different programs (in some cases there was also follow-up after the coaching ended).

The variety of coaching characteristics is very typical of such studies, which is why it can be hard to draw conclusions. However, for patients with Type 2 diabetes there is something that almost all studies have in common: they track hemoglobin A1C (HbA1C), a blood indicator for control of glucose, over several months. Perhaps that is why this has been one of the most researched areas in health coaching, and why this area also has the  most robust findings for coaching effectiveness. In a review conducted by a group of us at the IOC, in collaboration with Ithaca College, we also concluded that coaching in Type2 diabetes is widely researched and shows improvements in control of blood glucose in 78% of the studies we selected (Sforzo et al., 2017). 

The conclusion of the featured review is that coaching can improve control of blood glucose, since the groups which received the coaching significantly improved, compared to the groups without coaching (assignment to groups was random). As a matter of fact, the reduction in HbA1c post-coaching is considered clinically significant. This reduction was evident even for 3 months duration of coaching but was most robust when it continued for 4 to 6 months. It was also evident across the different types of delivery modalities.  

Surprisingly, psychological wellbeing showed improvement only in a few studies. The authors hypothesize that this is because so much emphasis is placed on controlling blood glucose, that other dimensions of wellbeing might be left unaddressed. Research on the psychological benefits of coaching (in different health conditions) is also accumulating, but it is harder to draw conclusions, since studies follow a variety of psychological outcomes. 

A study which was just published (Lee et al., 2019) illustrates that if the person with diabetes perceives that they are receiving support for autonomy from their informal caregiver, this is associated with better self-management and lower blood glucose (also true for autonomy support from health professionals). This is a study about relationships, but the conclusions could be relevant to coaching. The authors recommend conducting studies with training to strengthen autonomy support and following the impact on diabetes management. Through such studies, we are understanding more about how the interventions for diabetes could be achieving their positive health effects. For example, Spence & Niemiec implement “needs-supportive” coaching – i.e. coaching which supports autonomy, competence and relatedness, as informed by Self Determination Theory, and show its impact on well-being in the workplace.  

In summary, based on the featured article we can make the following conclusions for practice: 

• Length of the coaching engagement might not need to be longer than 4-6 months to show significant health benefits. 
• Similarly, coaching could have an impact independent of the coaching approach or way of delivery. Current research is now beginning to study whether different coaching approaches might be more appropriate for different situations. 

Based on other recent research we can make additional conclusions for practice: 

• Coaching in diabetes emphasizes glucose management and physical health; however, it could also be an opportunity to address peoples’ psychosocial wellbeing.  
• Following up with “booster sessions” after the coaching ends could be beneficial for sustaining the effects (Sharma, Willard-Grace, Hessler, Bodenheimer, & Thom, 2016). 
• Relationships  which support people’s autonomy could help the self-management of diabetes and lowering of blood glucose  (Lee, Piette, Heisler, Janevic, & Rosland, 2019); thus, coaching could aim to emphasize autonomy support (Spence &  Niemiec, 2016, IOC Webinar).

Lee, A. A., Piette, J. D., Heisler, M., Janevic, M. R., & Rosland, A.-M. (2019). Diabetes self-management and glycemic control: The role of autonomy support from informal health supporters. Health Psychology, 38(2), 122-132. doi: 10.1037/hea0000710

Pirbaglou, M., Katz, J., Motamed, M., Pludwinski, S., Walker, K., & Ritvo, P. (2018). Personal health coaching as a Type 2 Diabetes Mellitus self-management strategy: A systematic review and meta-analysis of randomized controlled trials. American Journal of Health Promotion, 32(7), 1613-1626. doi: 10.1177/0890117118758234

Sforzo, G. A., Kaye, M. P., Todorova, I., Harenberg, S., Costello, K., Cobus-Kuo, L., . . . Moore, M. (2017). Compendium of the health and wellness coaching literature. American Journal Of Lifestyle Medicine. doi: doi.org/10.1177/1559827617708562

Sharma, A. E., Willard-Grace, R., Hessler, D., Bodenheimer, T., & Thom, D. H. (2016). What happens after health coaching? Observational study 1 year following a randomized controlled trial. Annals of Family Medicine, 14(3), 200-207. doi: 10.1370/afm.1924

Relevant resources from the IOC:

Through the Harnisch grant program we are supporting several studies on coaching in diabetes; The authors will present webinars on their research when it is completed. You can find more information here on our Featured Research page.  

• Coaching for Parents of Children with Type 1 Diabetes, Brenden Hursh.
• Coaching and Education for Diabetes Distress (CEDD) A Randomized Controlled Trial; Charles Chima and Jason Salemi.
• Coaching for employee engagement: Using self-determination theory to predict engagement, turnover intention, and well-being among employees. Spence &  Niemiec. Though this study was about coaching in the workplace, it can be relevant.  It implemented “needs-supportive” coaching – i.e. coaching which supports autonomy, competence and relatedness, as informed by Self Determination Theory.
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