OBJECTIVELatinos with type 2 diabetes (T2D) face major healthcare access and disease management disparities. We examined the impact of the Diabetes Among Latinos Best Practices Trial (DIALBEST), a community health worker (CHW)–led structured intervention for improving glycemic control among Latinos with T2D.RESEARCH DESIGN AND METHODSA total of 211 adult Latinos with poorly controlled T2D were randomly assigned to a standard of healthcare (n = 106) or CHW (n = 105) group. The CHW intervention comprised 17 individual sessions delivered at home by CHWs over a 12-month period. Sessions addressed T2D complications, healthy lifestyles, nutrition, healthy food choices and diet for diabetes, blood glucose self-monitoring, and medication adherence. Demographic, socioeconomic, lifestyle, anthropometric, and biomarker (HbA1c, fasting blood glucose, and lipid profile) data were collected at baseline and 3, 6, 12, and 18 months (6 months postintervention). Groups were equivalent at baseline.RESULTSParticipants had high HbA1c at baseline (mean 9.58% [81.2 mmol/mol]). Relative to participants in the control group, CHWs had a positive impact on net HbA1c improvements at 3 months (−0.42% [−4.62 mmol/mol]), 6 months (−0.47% [−5.10 mmol/mol]), 12 months (−0.57% [−6.18 mmol/mol]), and 18 months (−0.55% [−6.01 mmol/mol]). The overall repeated-measures group effect was statistically significant (mean difference −0.51% [−5.57 mmol/mol], 95% CI −0.83, −0.19% [−9.11, −2.03 mmol/mol], P = 0.002). CHWs had an overall significant effect on fasting glucose concentration that was more pronounced at the 12- and 18-month visits. There was no significant effect on blood lipid levels, hypertension, and weight.CONCLUSIONSDIALBEST is an effective intervention for improving blood glucose control among Latinos with T2D.

Aims To test the efficacy of a community health worker (CHW) delivered stress management (SM) intervention on psychosocial, glycemic, and cortisol outcomes among U.S. Latinos with type 2 diabetes. Methods A randomized, controlled trial compared CHW-delivered diabetes education (DE; one group session) to DE plus CHW-delivered SM (DE+SM; 8 group sessions). Psychosocial variables and urinary cortisol were measured at baseline and posttreatment. HbA1c was measured at baseline, posttreatment, and 3-month follow-up. Results In intent to treat analysis, compared to DE (n=46), DE+SM (n=61) showed significantly improved symptoms of depression, anxiety, and self-reported health status. There were no significant group effects for HbA1c, diabetes distress, or urinary cortisol. However, there was a dose response effect for HbA1c and diabetes distress; increasing attendance at SM sessions was associated with greater improvements in HbA1c and diabetes distress. Conclusions This is the first randomized, controlled trial demonstrating that CHWs can improve psychological symptoms and self-reported health among Latinos with type 2 diabetes. Efforts to increase intervention attendance may improve HbA1c and diabetes distress.

Prevalence of depression is high among individuals with type 2 diabetes (T2D). The objective of the current study was to identify the socio-demographic, psychosocial, cultural, and clinical risk factors that predispose to depression, and resources that protect from depression among low income Latinos with T2D. Participants (N = 211) were interviewed in their homes upon enrollment. Multivariate logistic regression was used to identify factors associated with depressive symptoms based on a score of ≥21 on the Center for Epidemiological Studies Depression scale. Lower household income, interference of diabetes with daily activities, and more T2D clinical symptoms were associated with depression risk in the multivariate analyses. At each level of food insecurity the risk of depression was lower the higher the level of social support (P < 0.05). Findings suggest that social support buffers against the negative influence of household food insecurity on depression risk. A comprehensive approach is necessary to address the mental health needs of low income Latinos with T2D.

Background: Evidence increasingly indicates that poor sleep quality is a major public health concern. Household food insecurity

Racial/ethnic minorities are disproportionately affected by barriers to health care access and utilization. The primary objective was to test for an independent association between household food insecurity and health care access/utilization. In this cross-sectional survey, 211 Latinos (predominantly, Puerto-Ricans) with type 2 diabetes (T2D) were interviewed at their homes. Factor analyses identified four barriers for health care access/utilization: enabling factor, doctor access, medication access and forgetfulness. Multivariate logistic regression models examined the association between each of the barrier factors and food insecurity controlling for sociodemographic, cultural, psychosocial, and diabetes self-care variables. Higher food insecurity score was a risk factor for experiencing enabling factor (OR = 1.46; 95% CI = 1.17–1.82), medication access (OR = 1.26; 95 CI% = 1.06–1.50), and forgetfulness (OR = 1.22; 95 CI% = 1.04–1.43) barriers. Higher diabetes management self-efficacy was protective against all four barriers. Other variables associated with one or more barriers were health insurance, perceived health, depression, blood glucose, age and education. Findings suggest that addressing barriers such as food insecurity, low self-efficacy, lack of health insurance, and depression could potentially result in better health care access and utilization among low income Puerto-Ricans with T2D.