Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income latinos: latinos en control

Milagros C Rosal, Ira S Ockene, Angela Restrepo, Mary Jo White, Amy Borg, Barbara Olendzki, Jeffrey Scavron, Lucy Candib, Garry Welch, George Reed, Milagros C Rosal, Ira S Ockene, Angela Restrepo, Mary Jo White, Amy Borg, Barbara Olendzki, Jeffrey Scavron, Lucy Candib, Garry Welch, George Reed

Abstract

Objective: To test whether a theory-based, literacy, and culturally tailored self-management intervention, Latinos en Control, improves glycemic control among low-income Latinos with type 2 diabetes.

Research design and methods: A total of 252 patients recruited from community health centers were randomized to the Latinos en Control intervention or to usual care. The primarily group-based intervention consisted of 12 weekly and 8 monthly sessions and targeted knowledge, attitudes, and self-management behaviors. The primary outcome was HbA(1c). Secondary outcomes included diet, physical activity, blood glucose self-monitoring, diabetes knowledge and self-efficacy, and other physiological factors (e.g., lipids, blood pressure, and weight). Measures were collected at baseline and at 4- and 12-month follow-up. Change in outcomes over time between the groups and the association between HbA(1c) and possible mediators were estimated using mixed-effects models and an intention-to-treat approach.

Results: A significant difference in HbA(1c) change between the groups was observed at 4 months (intervention -0.88 [-1.15 to -0.60] versus control -0.35 [-0.62 to 0.07], P < 0.01), although this difference decreased and lost statistical significance at 12 months (intervention -0.46 [-0.77 to -0.13] versus control -0.20 [-0.53 to 0.13], P = 0.293). The intervention resulted in significant change differences in diabetes knowledge at 12 months (P = 0.001), self-efficacy (P = 0.001), blood glucose self-monitoring (P = 0.02), and diet, including dietary quality (P = 0.01), kilocalories consumed (P < 0.001), percentage of fat (P = 0.003), and percentage of saturated fat (P = 0.04). These changes were in turn significantly associated with HbA(1c) change at 12 months.

Conclusions: Literacy-sensitive, culturally tailored interventions can improve diabetes control among low-income Latinos; however, strategies to sustain improvements are needed.

Figures

Figure 1
Figure 1
Mean differences in HbA1c level at 4- and 12-month follow-ups for the intervention and control conditions of the Latinos en Control study (n = 252). (A high-quality color representation of this figure is available in the online issue.)

References

    1. Centers for Disease Control and Prevention National Diabetes Fact Sheet: General information and National Estimates on Diabetes in the United States, 2007. Atlanta, GA, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008
    1. Office of Minority Health, U.S. Department of Health and Human Services. Diabetes and Hispanic Americans, 2008.
    1. Gale EA, Beattie SD, Hu J, Koivisto V, Tan MH. Recruitment to a clinical trial improves glycemic control in patients with diabetes. Diabetes Care 2007;30:2989–2992 10.2337/dc07-0155
    1. Ismail K, Winkley K, Rabe-Hesketh S. Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. Lancet 2004;363:1589–1597 10.1016/S0140-6736(04)16202-8
    1. Brown SA, Garcia AA, Kouzekanani K, Hanis CL. Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care 2002;25:259–268 10.2337/diacare.25.2.259
    1. Lorig K, Ritter PL, Villa F, Piette JD. Spanish diabetes self-management with and without automated telephone reinforcement: two randomized trials. Diabetes Care 2007;31:408–414 10.2337/dc07-1313
    1. U.S. Census Bureau. Hispanic population of the United States: population estimates July 1, 2000 to July 1, 2006 [article online]. Available from Accessed 20 August 2010
    1. American Diabetes Association. The cost of diabetes [article online]. Available from Accessed 20 August 2010
    1. Rosal MC, White MJ, Restrepo A, et al. Design and methods for a randomized clinical trial of a diabetes self-management intervention for low-income Latinos: Latinos en Control. BMC Med Res Methodol 2009;9:81 10.1186/1471-2288-9-81
    1. Rosal MC, White MJ, Borg A, et al. Translational research at community health centers: challenges and successes in recruiting and retaining low-income Latino patients with type 2 diabetes into a randomized clinical trial. Diabetes Educ 2010;36:733–749 10.1177/0145721710380146
    1. Bandura A. Self-Efficacy: The Exercise of Control. New York, WH Freeman and Company, 1997
    1. von Goeler DS, Rosal MC, Ockene JK, Scavron J, De Torrijos F. Self-management of type 2 diabetes: a survey of low-income urban Puerto Ricans. Diabetes Educ 2003;29:663–672 10.1177/014572170302900412
    1. Rosal MC, Goins KV, Carbone ET, Cortes DE. Views and preferences of low-literate Hispanics regarding diabetes education: results of formative research. Health Educ Behav 2004;31:388–405 10.1177/1090198104263360
    1. Carbone ET, Rosal MC, Torres MI, Goins KV, Bermudez OI. Diabetes self-management: perspectives of Latino patients and their health care providers. Patient Educ Couns 2007;66:202–210 10.1016/j.pec.2006.12.003
    1. Rosal MC, Olendzki B, Reed GW, Gumieniak O, Scavron J, Ockene IS. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med 2005;29:225–235 10.1207/s15324796abm2903_9
    1. Kovatchev BP, Otto E, Cox D, Gonder-Frederick L, Clarke W. Evaluation of a new measure of blood glucose variability in diabetes. Diabetes Care 2006;29:2433–2438 10.2337/dc06-1085
    1. Schakel SF. Maintaining a nutrient database in a changing marketplace: keeping pace with changing food products: a research perspective. J Food Compost Anal 2001;14:315–322 10.1006/jfca.2001.0992
    1. Matthews CE, DuBose KD, LaMonte M, Tudor-Locke C, Ainsworth BE. Evaluation of a computerized 24-hour physical activity recall (24PAR). Med Sci Sports Exerc 2002;34:S41 10.1097/00005768-200205001-00236
    1. Matthews CE, Freedson PS, Hebert JR, Stanek EJ, 3rd, Merriam PA, Ockene IS. Comparing physical activity assessment methods in the Seasonal Variation of Blood Cholesterol Study. Med Sci Sports Exerc 2000;32:976–984 10.1097/00005768-200005000-00015
    1. Speight J, Bradley C. The ADKnowl: identifying knowledge deficits in diabetes care. Diabet Med 2001;18:626–633 10.1046/j.1464-5491.2001.00537.x
    1. Rosal MC, Carbone ET, Goins KV. Use of cognitive interviewing to adapt measurement instruments for low-literate Hispanics. Diabetes Educ 2003;29:1006–1017 10.1177/014572170302900611
    1. Srimanunthiphol J, Beddow R, Arakaki R. A review of the United Kingdom Prospective Diabetes Study (UKPDS) and a discussion of the implications for patient care. Hawaii Med J 2000;59:295–298, 313
    1. International Expert Committee International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009;32:1327–1334 10.2337/dc09-9033
    1. Blonde L, Karter AJ. Current evidence regarding the value of self-monitored blood glucose testing. Am J Med 2005;118(Suppl. 9A):20S–26S 10.1016/j.amjmed.2005.07.053
    1. DeVries JH, Snoek FJ, Kostense PJ, Heine RJ. Improved glycaemic control in type 1 diabetes patients following participation per se in a clinical trial—mechanisms and implications. Diabetes Metab Res Rev 2003;19:357–362 10.1002/dmrr.405

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren