A new NIH-funded study led by the Yale School of Public Health shows the effectiveness of a peer-counseling program integrated within the health care management team in helping the Latino community control blood glucose levels and improve diabetes management.
Latinos, the fastest growing ethnic group in the United States, suffer from noticeably higher rates of type 2 diabetes and its related complications than the general population. According to the National Diabetes Education Program, the risk of diagnosed diabetes is 66 percent higher among Latinos than among non-Latino whites.
The Hartford-area study headed by Rafael Pérez-Escamilla, professor in the Department of Chronic Disease Epidemiology and director of the Office of Public Health Practice, examined the impact of DIALBEST (Diabetes among Latinos Best Practices Trial) a structured intervention led by community health workers (CHWs). The objective was to evaluate the effectiveness of home-based, culturally appropriate counseling delivered by CHWs who were fully integrated into the health care management team, and to determine if the education and support provided would continue to have an impact after the intervention ended.
“We know that traditional treatment strategies that focus on medication alone are not enough to achieve diabetes care goals among Latinos,” Pérez-Escamilla said. “Communication barriers, and provider unfamiliarity with Latino cultural values and assumptions can result in treatment noncompliance and delay in seeking medical help.”
In the study, 211 adult Latinos (average age 56, and about 75 percent female) with poorly controlled type 2 diabetes were placed randomly into two groups. Over 12 months, the control group received the customary standard of care offered at the community clinic they were recruited from— blood glucose checks, height, weight, and blood pressure measurements, and foot, urine, and eye exams. Each member of the intervention group received the standard of care, plus 17 home visits from one of the two bilingual/bi-cultural CHWs, who had been extensively trained in the medical and lifestyle aspects of caring for type 2 diabetes, as well as in motivational interviewing and culturally sensitive communications strategies.
Sessions were tailored to each participant’s language preference, socioeconomic circumstances, level of motivation, health literacy, and degree of social support. At each visit, the CHW offered education on such matters as blood glucose self-monitoring, nutrition, physical activity, and medication adherence, worked closely with the patient on creating and implementing an individualized self-management plan, and facilitated care coordination.
The 12-month long intervention was followed by a six-month maintenance period to allow for assessing the program’s ongoing impact. Data from both groups were collected at baseline and at three, six, 12 and 18 months.
The results were notable. At each of the evaluation points, the blood glucose levels of the group working with the CHWs showed significant improvement over those in the control group. That improvement was most pronounced not only at the 12-month mark, but also after the six-month maintenance period, indicating the potential for the long-term sustainability of DIALBEST’s impact.
“To our knowledge, this is the first randomized controlled trial to document the strong impact a CHW home-based model can have when fully integrated within the health care management team for diabetes care among impoverished Latinos, an approach fully consistent with the top priorities of the Affordable Care Act” said Pérez-Escamilla. “Community health workers clearly met needs currently not being addressed by the health care, public care, and social assistance systems surrounding our target community.”
The study is published in the journal Diabetes Care. Fatma Shebl and Grace Kollannor-Samuel of the Yale School of Public Health are co-authors, as are researchers from the University of Connecticut, Hispanic Health Council, Hartford Hospital, Arizona State University, Worcester University and the University of North Texas.