A structured intervention led by community health workers that focused on healthy lifestyles and self-monitoring of blood glucose improved glycemic control among Latino patients with type 2 diabetes, according to results published in Diabetes Care.
Type 2 diabetes and its complications are highly prevalent in Latino patients. This disproportionate burden of disease is further complicated by certain factors, including socioeconomic status and language barriers. However, some studies suggest that diabetes education delivered in a community setting by well-trained, local, bilingual health workers may be effective in improving glycemic control in this patient population.
In the Diabetes Among Latinos Best Practices Trial (DIALBEST), researchers randomly assigned 211 adult Latino patients with poorly controlled type 2 diabetes to standard care (n=106) or standard care plus a culturally tailored, community health worker-led intervention (n=105).
The intervention was delivered at home by trained, bilingual community health workers during 17 sessions over 12 months. The curriculum included information on type 2 diabetes complications, healthy lifestyles, nutrition, healthy food choices and diet, self-monitoring of blood glucose and medication adherence. The intervention was individualized based on language preference and socioeconomic status and further tailored based on other factors, such as patient’s level of motivation, health literacy and social support.
At baseline, mean HbA1c was 9.58%. Compared with the control group, community health workers appeared to positively affect net HbA1c improvements at 3, 6, 12 and 18 months (–0.42%, –0.47%, –0.57% and –0.55%, respectively), according to study results.
The researchers also found that the overall repeated-measures analyses, which adjusted for baseline HbA1c and age and were limited to post-baseline time points, demonstrated an overall group effect, with lower HbA1c levels in the intervention group vs. the control group (mean difference, –0.51%; 95% CI, –0.83 to –0.19).
Further, the percent change in HbA1c was greater in the intervention group vs. the control group (mean difference, –5.52%; 95% CI, –8.93 to –2.11).
Additionally, community health workers had an overall significant effect on fasting glucose concentration that was more pronounced at the 12- and 18-month visits, the researchers found.
Blood lipid levels, hypertension and weight, however, were not significantly affected by the intervention.
“[Community health workers] proved to be essential not only for delivering education on topics directly relevant to [type 2 diabetes] self-management but also for providing care coordination and social support services to patients,” the researchers wrote.
“Thus, [community health workers] filled huge vacuums of needs that are currently not being addressed by healthcare, public care, and social assistance systems surrounding the target community … [Community health worker] models should take into account needed service intensity of highly impoverished populations,” they added.