Low-cost diabetes education programs that target Mexican Americans are essential to reduce the observed health disparities in this population. A culturally appropriate intervention was developed as the centerpiece of the Community Diabetes Education (CoDE) program. This article describes the structure, patient acceptance, and costs of this one-to-one educational model delivered in 7 patient contact hours by a community health worker over 12 months in a community clinic serving the uninsured. A total of 162 patients-predominantly female, Spanish-speaking Mexican American patients with type 2 diabetes of mean duration of 6.5 years-enrolled in the program, and a dropout rate of 22% was observed during the 12-month period. Preliminary analysis indicated that program capacity was 120 patients per month, and the annual direct medical expenditure per CoDE participant was $461. The hemoglobin A(1c) was significantly reduced in patients who participated in the program for 12 months. Sustainable, low-cost, community-based programs like CoDE and long-term patient participation will help reduce the burden of diabetes in the underserved Hispanic population.
The feasibility of a newly designed Community Diabetes Education (CoDE) intervention was evaluated in preparation for the development of a pilot study of this program. A comparison between CoDE and similar culturally appropriate diabetes management programs developed specifically for Hispanic Americans demonstrates its unique features. Patient insurance status, duration of the intervention, delivery in individual and/or group settings, the characteristics of the diabetes educator(s), the other professional resources involved in these interventions, the associated costs, and the reported health outcomes were used in the comparison. The significant improvement in hemoglobin A1c observed in patients who completed one year of CoDE suggests that a community health worker can serve as the primary patient educator in the absence of more highly educated personnel required by American Diabetes Association–certified diabetes education programs. This low-cost model can be reproduced de novo in community health centers or inserted into existing diabetes management interventions.
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