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

Abstract

IntroductionThis 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 methodsAdults 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.ResultsAt 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.ConclusionsImproved 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 numberNCT04035395.

Individual and Community Social Determinants of Health Associated With Diabetes Management in a Mexican American Population

“…Rather, we aimed to investigate how different SDOH might contribute to the HbA1C reduction, after taking into account the participants' engagement in the program. We found that participants who attended more DSME classes had higher HbA1C reduction, which was consistent with the findings from Reininger et al ( 13 ), where high engagement groups (≥2 visits to service provided by intervention program) showed greater HbA1C reduction over the study period, but low engagement groups (<2 visits) were not able to maintain the reduction in HbA1C. We also included the length of day as a way to account for engagement, and found that a longer stay in the program was also associated with a higher reduction in HbA1C; however, the association had a plateau effect and diminished after 439 days.…”

“…We should note that our analysis is not trying to provide a comprehensive evaluation of the effectiveness of the SyV program, as it has been reported elsewhere ( 13 ). Rather, we aimed to investigate how different SDOH might contribute to the HbA1C reduction, after taking into account the participants' engagement in the program.…”

“…SyV is an ongoing community-based intervention program that offers services such as diabetes self-management education classes (DSME), led by a professional multidisciplinary team and tailored to meet participants' individual needs. Details of the program can be found in Reininger et al ( 13 ). Most participants had uncontrolled diabetes (HbA1C over 9%) at the time of enrollment (i.e., baseline).…”

Prevalence of disease complications and risk factor monitoring amongst diabetes and hypertension patients attending chronic disease management programmes in a South African Township

“… 27 Examples include the use of drawings made by patients to assess their illness perception, 28 extended engagement with patients beyond the clinical setting using interventions that include peer led support groups, psycho-behavioural support, community based lifestyle programmes for patients and their families, and cooking classes. 29 …”

“…27 Examples include the use of drawings made by patients to assess their illness perception, 28 extended engagement with patients beyond the clinical setting using interventions that include peer led support groups, psycho-behavioural support, community based lifestyle programmes for patients and their families, and cooking classes. 29 We recommend a re-orientation of CDMPs to meet actual patient needs whereby the clubs focus on providing individualised self-management support to patients 11 consistent with their illness experience. Risk factors identified during yearly CDMP attendance should be adequately addressed through tailored self-management interventions and subsequent audits to assess effect of the interventions.…”