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Objectives. To review the DREAM studies and the role of participatory research using a Home and Community Care model in treating First Nations diabetes. Study Design. Population survey, pilot and prospective randomized trial Methods. Review documented history of these studies since inception. Collation of all data from the DREAM studies from 1998 to the present, including interviews with all providers and many of the participants.Results. The DREAM studies were a participatory process providing a needs assessment and became the foundation for this First Nation's Home and Community Care team involvement in providing community-based chronic-disease management. The findings motivated the community to find a process that would lead to needed changes. This participatory research enabled a culturally tailored algorithm of evidence-based management of hypertension and disease management strategies for people with diabetes. These studies demonstrated that in this community the Home and Community Care team could work together with primary care physicians and specialists to prevent the complications of diabetes. DREAM studies and participatory research involving multidisciplinary home careConclusions. The DREAM studies demonstrated in the first controlled trial that with participatory research a systems change is possible; a chronic-disease management model utilizing a trained multidisciplinary Home and Community Care team and informed patients can lead to lower blood pressure in a Canadian First Nations population with diabetes.

Objectives. To follow blood pressure change over time in participants who had participated in ayear chronic disease management program focused on blood pressure reduction. The expectation was that blood pressure would return back to the baseline once the study was completed. Study design. Prospective, single-arm observational study. Methods. Study participants were Status Indians living on-reserve with type diabetes and persistent hypertension who had participated in the DREAM3 study. Blood pressure was measured with the BpTRU automated device every 6 months for years. The primary endpoint was the change in systolic blood pressure over the follow-up period. Results. Sixty of the original 96 participants agreed to participate in the follow-up. Mean blood pressure at the beginning of the follow-up was 130/76 (SD 18/12) mmHg. Mean blood pressure at the end of the follow-up period was 132/76 (17/9 SD) mmHg. Target blood pressure (<130/80 mmHg) was present in 53%. The 99% confidence limit around change of blood pressure over the months of follow-up was ±.7mmHg. Conclusions. Contrary to expectations, the participants maintained their blood pressure control and did not revert to baseline levels. Community awareness and engagement resulting from the chronic disease management program led to a sustainable improvement in the health parameters of the participants and the community that lasted beyond the duration of the -year DREAM3 project.

Background: The rising prevalence of type 2 diabetes underlines the importance of secondary strategies for the prevention of target organ damage. While access to diabetes education centers and diabetes intensification management has been shown to improve blood glucose control, these services are not available to all that require them, particularly in rural and northern areas. The provision of these services through the Home Care team is an advance that can overcome these barriers. Transfer of blood glucose data electronically from the home to the health care provider may improve diabetes management.