In the Journals

Community health workers fill treatment gaps for Latino diabetes population

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February 12, 2015

A structured intervention steered by community health workers effectively improved glycemic control in Latinos with type 2 diabetes, according to research published in Diabetes Care.

“Community health workers filled huge vacuums of needs that are currently not being addressed by health care, public care and social assistance systems surrounding the target community,” the researchers wrote.

Rafael Pérez-Escamilla, PhD, of the Yale School of Public Health, and colleagues from other institutions studied how the DIALBEST intervention affected 211 Latino patients with poorly controlled diabetes.

The researchers randomly assigned patients to standard health care (n = 106) or standard health care plus meetings with a community health worker (n = 105); the intervention included 17 individual sessions, delivered by the workers in patients’ homes, during a 12-month period.

In the sessions, the community health workers addressed type 2 diabetes complications, healthy lifestyles, nutrition, healthy food choices and diet for diabetes, along with blood glucose self-monitoring and medication adherence.

The investigators collected data on demographics, socioeconomics, lifestyle, anthropometrics and biomarkers, including HbA1c, fasting blood glucose and lipid profile, at baseline and 3, 6 and 12 months, then again 18 months after intervention. Group data were comparable at baseline, with patients demonstrating elevated HbA1c levels (mean, 9.58%; 81.2 mmol/mol).

Patients attending community health worker sessions had improved HbA1c levels at 3 months (–0.42%; –4.62 mmol/mol), 6 months (–0.47%; –5.1 mmol/mol), 12 months (–0.57%; –6.18 mmol/mol) and 18 months (–0.55%; –6.01 mmol/mol) vs. standard care.

The group effect with overall repeated measures was statistically significant (mean difference, –0.51%; 95% CI, –0.83 to –0.19; –5.57 mmol/mol; 95% CI, –9.11 to –2.03). 

Community health workers significantly affected fasting glucose concentration overall and more noticeably at 12 and 18 months. No significant effect was seen for blood lipid levels, hypertension and weight.

“DIALBEST is a successfully implemented culturally and health literacy-appropriate intervention that took into account language preferences and socioeconomic circumstances while tailoring the intervention to individual participants,” the researchers wrote. – by Allegra Tiver

Disclosure: The researchers report no relevant financial disclosures.