Long-Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa

Mayuree Rao, Judith D DePue, Shira Dunsiger, Mohammad Elsayed, Ofeira Nu'usolia, Stephen T McGarvey, Mayuree Rao, Judith D DePue, Shira Dunsiger, Mohammad Elsayed, Ofeira Nu'usolia, Stephen T McGarvey

Abstract

Introduction: Diabetes Care in American Samoa (DCAS) was a randomized controlled trial of a 12-month intervention facilitated by community health workers (CHWs) that demonstrated improved HbA1c levels compared with usual care at trial completion. We sought to evaluate the long-term impact of this intervention on diabetes control.

Methods: We retrospectively collected HbA1c measurements from medical records of DCAS participants (n = 268). The study group received the intervention during the trial, and the control group received the intervention after the trial. We used mixed-effects longitudinal regression models to assess change in HbA1c within each trial arm during 3 time periods: DCAS (12 months of the study group's intervention), the first year after DCAS (control group's intervention), and the second year after DCAS. Models were adjusted for baseline characteristics that differed significantly for participants with a low number of HbA1c measurements from those with a high number of HbA1c measurements.

Results: After adjustment for confounders, the experiment group experienced a decrease in HbA1c of 0.28 units per year (95% confidence interval [CI], -0.64 to 0.07) during DCAS (intervention). HbA1c decreased by 0.88 units per year (95% CI, -1.31 to -0.45) during the year after the intervention. No significant change was observed the following year. HbA1c of the control group did not significantly change during DCAS (usual care) but decreased by 1.31 units per year (95% CI, -1.72 to -0.91) during its intervention. During the year after the control group's intervention, HbA1c increased by 1.18 units per year (95% CI, 0.42 to 1.93).

Conclusion: Both groups had initial improvements in glycemic control, but HbA1c later plateaued or increased. These results suggest that time-limited CHW programs improve diabetes control in the short term, but ongoing programs are needed for sustained impact.

Trial registration: ClinicalTrials.gov NCT00850824.

Figures

Figure 1
Figure 1
Timeline of study analysis. Change in HbA1c over time was evaluated by trial arm during 3 consecutive 1-year periods: 1) DCAS period; 2) first year after DCAS completion; and 3) second year after DCAS completion. Abbreviation: DCAS, Diabetes Care in American Samoa.
Figure 2
Figure 2
Consolidated Standards of Reporting Trial (CONSORT) diagram of recruitment. In this intent-to-treat analysis, participants who did not complete 12-month follow-up were included in analysis until date of ineligibility. Abbreviations: CHW, community health worker; DCAS, Diabetes Care in American Samoa.

References

    1. Dibello JR, Baylin A, Viali S, Tuitele J, Bausserman L, McGarvey ST. Adiponectin and type 2 diabetes in Samoan adults. Am J Hum Biol 2009;21(3):389–91. 10.1002/ajhb.20858
    1. DiBello JR, McGarvey ST, Kraft P, Goldberg R, Campos H, Quested C, et al. Dietary patterns are associated with metabolic syndrome in adult Samoans. J Nutr 2009;139(10):1933–43. 10.3945/jn.109.107888
    1. Keighly ED, McGarvey ST, Quested C, McCuddin C, Viali S, Maga UA. Nutrition and health in modernizing Samoans: temporal trends and adaptive perspectives. In: Ohtsuka R, Ulijaszek SJ, editors. Health Change in the Asia-Pacific Region. New York (NY): Cambridge University Press; 2007. p. 142-91.
    1. Designated health professional shortage areas. Washington (DC): Health Services and Resource Administration, US Department of Health and Human Services; 2014. . Accessed October 3, 2014.
    1. DePue JD, Dunsiger S, Seiden AD, Blume J, Rosen RK, Goldstein MG, et al. Nurse-community health worker team improves diabetes care in American Samoa: results of a randomized controlled trial. Diabetes Care 2013;36(7):1947–53. 10.2337/dc12-1969
    1. Attridge M, Creamer J, Ramsden M, Cannings-John R, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database Syst Rev 2014;9:CD006424.
    1. Shah M, Kaselitz E, Heisler M. The role of community health workers in diabetes: update on current literature. Curr Diab Rep 2013;13(2):163–71. 10.1007/s11892-012-0359-3
    1. Dale JR, Williams SM, Bowyer V. What is the effect of peer support on diabetes outcomes in adults? A systematic review. Diabet Med 2012;29(11):1361–77. 10.1111/j.1464-5491.2012.03749.x
    1. Gary TL, Batts-Turner M, Yeh HC, Hill-Briggs F, Bone LR, Wang NY, et al. The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med 2009;169(19):1788–94. 10.1001/archinternmed.2009.338
    1. Gary TL, Bone LR, Hill MN, Levine DM, McGuire M, Saudek C, et al. Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans. Prev Med 2003;37(1):23–32. 10.1016/S0091-7435(03)00040-9
    1. American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care 2009;32(Suppl 1):S13–61.
    1. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA 2002;288(15):1909–14. 10.1001/jama.288.15.1909
    1. Goldstein MG, DePue J, Kazura A. Models of provider-patient interaction and shared decision making. In: Shumaker SA, Ockene JK, Riekert KA, editors. Handbook of Health Behavior Change. New York (NY): Springer Publishing Company; 2008. p. 107-26.
    1. American Samoa NCD Risk Factors STEPS Report. Australia: World Health Organization and Monash University; 2007. . Accessed June 7, 2015.
    1. American Association of Diabetes Educators (AADE). AADE7 Self-Care Behaviors. Diabetes Educ 2008;34(3):445–9. 10.1177/0145721708316625
    1. Centers for Disease Control and Prevention. The Road to Health Toolkit. Atlanta (GA); 2010. . Accessed October 3, 2014.
    1. DePue JD, Rosen RK, Batts-Turner M, Bereolos N, House M, Held RF, et al. Cultural translation of interventions: diabetes care in American Samoa. Am J Public Health 2010;100(11):2085–93. 10.2105/AJPH.2009.170134
    1. Educators AAoD. Community Health Workers in Diabetes Management and Prevention: American Association of Diabetes Educators (AADE) Position Paper. Sept. 2011. .
    1. American Association of Diabetes Educators (AADE). A Sustainable Model of Diabetes Self-Management: Education/Training Involves a Multi-Level Team That Can Include Community Health Workers. AADE; 2010. . Accessed June 7, 2015.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe