Impact of a Community Health Workers–Led Structured Program on Blood Glucose Control Among Latinos With Type 2 Diabetes: The DIALBEST Trial

Abstract

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.

Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes: A Systematic Review and Meta-Analysis

“…Participant attrition rates were high in some studies, reaching 50 % in the usual care (control) group of the trial performed by Babamoto et al 14 Only nine trials had a clinically meaningful follow-up of at least 12 months. [10][11][12][13][20][21][22][23][24] Of note, those nine studies also exhibited higher quality, and substantially lower risk of bias, than shorter-term studies. For example, all of them described the standardized method applied to measure A1c, and they all followed the intention to treat principle to analyze A1c changes.…”

“…We identified 13 completed randomized clinical trials. [8][9][10][11][12][13][14][19][20][21][22][23][24] Table 1 describes the basic characteristics of those thirteen trials, including the setting for participant recruitment, duration of the study, and ethnicity of the study populations. Most of them studied minority populations, either AfricanAmerican, 13 Hispanics, 9,10,12,14,19,21,23,24 or both.…”

“…In addition, those longer-term studies tended to have larger samples that enhanced their statistical power, and either achieved a balanced distribution of baseline characteristics across the randomized groups, or adjusted appropriately for them in the analysis. [10][11][12][13][20][21][22][23][24] …”

Psychological Distress Mediates the Association between Food Insecurity and Suboptimal Sleep Quality in Latinos with Type 2 Diabetes Mellitus

“…Community health workers meet important needs of individuals with T2DM that are not addressed by private or public health care and social assistance systems (61). The Patient Protection and Affordable Care Act (Public Law 111-148) may represent an opportunity to formalize the role of community health workers as members of a multidisciplinary T2DM health care team.…”

The Role of Patient Navigators in Improving Caregiver Management of Childhood Asthma

“…Despite research documenting the benefits of patient navigators for chronic disease management, we know little about how these benefits are actually realized, including assisting caregivers with asthma management in children (Crocker et al, 2011;Krieger, Song, & Philby, 2015;Krieger, Takaro, Song, Beaudet, & Edwards, 2009;Perez-Escamilla et al, 2015;Rodday et al, 2015). In this study we aim to help explore this issue by complementing MCAN evaluation findings with caregivers' perceptions of the factors and conditions by which patient navigators support their effective management of their child's asthma.…”