Improved diabetes control among low-income Mexican Americans through community-clinical interventions: results of an RCT

Belinda M Reininger, MinJae Lee, Manouchehr Hessabi, Lisa A Mitchell-Bennett, Maribel R Sifuentes, Jose A Guerra, Ciara D Ayala, Tianlin Xu, Valerie Polletta, Amy Flynn, Mohammad H Rahbar, Belinda M Reininger, MinJae Lee, Manouchehr Hessabi, Lisa A Mitchell-Bennett, Maribel R Sifuentes, Jose A Guerra, Ciara D Ayala, Tianlin Xu, Valerie Polletta, Amy Flynn, Mohammad H Rahbar

Abstract

Introduction: This randomized controlled trial investigated community-clinical intervention strategies for a Mexican American population who had not demonstrated control of their diabetes. We tested a control program (Salud y Vida 1.0) supporting diabetes management versus an enhanced version (Salud y Vida 2.0) for reductions in HbA1c at 12 months.

Research design and methods: Adults with uncontrolled diabetes (n=353) were enrolled if they had an HbA1c≥9.0% during a program or doctor's visit between 6 and 36 months of their receipt of SyV 1.0 services, were patients at one of two clinics in local counties, and had an HbA1c≥8.0% at SyV 2.0 baseline enrollment. The control and intervention arms were coordinated by community health workers and the intervention arm included the control program enhanced with medication therapy management; behavioral health services; peer-led support groups; and additional community-based lifestyle programs also open to the family.

Results: At 12 months, both study arms improved HbA1c (mean, (CI), Control (-0.47 (-0.74 to -0.20)) and intervention (-0.48 (-0.76 to -0.19)). The intervention group maintained HbA1c levels after month 6, whereas control group HbA1c levels slightly increased (adjusted mean from 9.83% at month 6%-9.90% at month 12). Also, HbA1c was examined by level of participant engagement. The high engagement group showed a decreasing trend over the study period, while control and lower engagement groups failed to maintain HbA1c levels at month 12.

Conclusions: Improved HbA1c was found among a population that had not demonstrated diabetes management prior; however, mean HbA1c values were above clinical guideline recommendations. The randomized control trial findings provide additional evidence that extended time and intervention supports may be needed for populations experiencing inequities in social determinants of health.

Trial registration number: NCT04035395.

Keywords: Mexican Americans; community care; low income; randomized controlled trial.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
CONSORT structure patients’ flow diagram.

References

    1. American Diabetes Association Where do I begin with type 2? American Diabetes Association, 2019.
    1. Centers for Disease Control and Prevention National diabetes statistics report. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services, 2017.
    1. Unwin N, Whiting D, Roglic G. Social determinants of diabetes and challenges of prevention. Lancet 2010;375:2204–5. 10.1016/S0140-6736(10)60840-9
    1. Clark ML, Utz SW. Social determinants of type 2 diabetes and health in the United States. World J Diabetes 2014;5:296–304. 10.4239/wjd.v5.i3.296
    1. Centers for Disease Control and Prevention Diabetes report card 2014. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services, 2015.
    1. Rao Kondapally Seshasai S, Kaptoge S, Thompson A, et al. . Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 2011;364:829–41. 10.1056/NEJMoa1008862
    1. López L, Golden SH. A new era in understanding diabetes disparities among U.S. Latinos--all are not equal. Diabetes Care 2014;37:2081–3. 10.2337/dc14-0923
    1. Gilmer TP, Roze S, Valentine WJ, et al. . Cost-effectiveness of diabetes case management for low-income populations. Health Serv Res 2007;42:1943–59. 10.1111/j.1475-6773.2007.00701.x
    1. Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract 1998;1:2–4.
    1. Nuckols TK, Keeler E, Anderson LJ, et al. . Economic evaluation of quality improvement interventions designed to improve glycemic control in diabetes: a systematic review and weighted regression analysis. Diabetes Care 2018;41:985–93. 10.2337/dc17-1495
    1. Powers MA, Bardsley J, Cypress M, et al. . Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American diabetes association, the American association of diabetes educators, and the Academy of nutrition and dietetics. Diabetes Care 2015;38:1372–82. 10.2337/dc15-0730
    1. Klein HA, Jackson SM, Street K, et al. . Diabetes self-management education: miles to go. Nurs Res Pract 2013;2013:581012. 10.1155/2013/581012
    1. Thompson T, McQueen A, Croston M, et al. . Social needs and health-related outcomes among Medicaid beneficiaries. Health Educ Behav 2019;46:436–44. 10.1177/1090198118822724
    1. Keene DE, Guo M, Murillo S. "That wasn't really a place to worry about diabetes": Housing access and diabetes self-management among low-income adults. Soc Sci Med 2018;197:71–7. 10.1016/j.socscimed.2017.11.051
    1. Gonzalvo JD, Hamm J, Eaves S, et al. . A practical approach to mental health for the diabetes educator. AADE Pract 2019;7:29–44. 10.1177/2325160319826929
    1. Stark Casagrande S, Cowie CC. Health insurance coverage among people with and without diabetes in the U.S. adult population. Diabetes Care 2012;35:2243–9. 10.2337/dc12-0257
    1. Hu J, Amirehsani K, Wallace DC, et al. . Perceptions of barriers in managing diabetes: perspectives of Hispanic immigrant patients and family members. Diabetes Educ 2013;39:494–503. 10.1177/0145721713486200
    1. Testerman J, Chase D. Influences on diabetes self-management education participation in a low-income, Spanish-speaking, Latino population. Diabetes Spectr 2018;31:47–57. 10.2337/ds16-0046
    1. Nam S, Chesla C, Stotts NA, et al. . Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract 2011;93:1–9. 10.1016/j.diabres.2011.02.002
    1. American Diabetes Association Health disparities among patients with diabetes can be improved by new approaches and insights Kirkwood M, 2017.
    1. Witmer A, Seifer SD, Finocchio L, et al. . Community health workers: integral members of the health care work force. Am J Public Health 1995;85:1055–8. 10.2105/AJPH.85.8_Pt_1.1055
    1. Centers for Disease Control and Prevention Diabetes & Mental Health Centers for Disease Control and Prevention. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services, 2018.
    1. Casagrande SS, McEwen LN, Herman WH. Changes in health insurance coverage under the Affordable care act: a national sample of U.S. adults with diabetes, 2009 and 2016. Diabetes Care 2018;41:956–62. 10.2337/dc17-2524
    1. Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev 2007;64(5 Suppl):101S–56. 10.1177/1077558707305409
    1. Division of Diabetes Translation At A Glance Centers for Disease Control and Prevention National center for chronic disease prevention and health promotion (NCCDPHP). Atlanta, GA: Centers for Disease Control and Prevention, US Dept ofHealth and Human Services, 2019.
    1. Olivarez E. Regional healthcare partnership (RHP) plan. Texas HealthcareTransformation and quality improvement program, 2012.
    1. Fisher-Hoch SP, Vatcheva KP, Laing ST, et al. . Missed opportunities for diagnosis and treatment of diabetes, hypertension, and hypercholesterolemia in a Mexican American population, Cameron County Hispanic cohort, 2003-2008. Prev Chronic Dis 2012;9:110298. 10.5888/pcd9.110298
    1. Coleman K, Austin BT, Brach C, et al. . Evidence on the chronic care model in the new millennium. Health Aff 2009;28:75–85. 10.1377/hlthaff.28.1.75
    1. Epping-Jordan JE, Pruitt SD, Bengoa R, et al. . Improving the quality of health care for chronic conditions. Qual Saf Health Care 2004;13:299–305.
    1. Harris PA, Taylor R, Minor BL, et al. . The REDCap Consortium: building an international community of software platform partners. J Biomed Inform 2019;95:103208. 10.1016/j.jbi.2019.103208
    1. Han B, Enas NH, McEntegart D. Randomization by minimization for unbalanced treatment allocation. Stat Med 2009;28:3329–46. 10.1002/sim.3710
    1. R Foundation for statistical Computing R: a language and environment for statistical computing R core team. Vienna, Austria, 2015.
    1. SAS SAS® 9.4 SAS Institute Inc. Cary, NC: SAS Institute Inc, 2013.
    1. American Diabetes Association Standards of Medical Care in Diabetes-2019 Abridged for Primary Care Providers. Clin Diabetes 2019;37:11–34. 10.2337/cd18-0105
    1. Gonzalez-Zacarias AA, Mavarez-Martinez A, Arias-Morales CE, et al. . Impact of demographic, socioeconomic, and psychological factors on glycemic self-management in adults with type 2 diabetes mellitus. Front Public Health 2016;4:195. 10.3389/fpubh.2016.00195
    1. Davies MJ, Heller S, Skinner TC, et al. . Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ 2008;336:491–5. 10.1136/
    1. Association of Diabetes Educators Community health workers in diabetes management and prevention American. American Association of Diabetes Educators, 2015.
    1. Halbesleben JRB, Rathert C. Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Manage Rev 2008;33:29–39. 10.1097/01.HMR.0000304493.87898.72

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться