Culturally Competent Diabetes Self-Management Education for Mexican Americans

Abstract

OBJECTIVE -To determine the effects of a culturally competent diabetes self-management intervention in Mexican Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS-A prospective, randomized, repeated measures study was conducted on the Texas-Mexico border in Starr County. A total of 256 randomly selected individuals with type 2 diabetes between 35 and 70 years of age, diagnosed with type 2 diabetes after 35 years of age, and accompanied by a family member or friend were included. The intervention consisted of 52 contact hours over 12 months and was provided by bilingual Mexican American nurses, dietitians, and community workers. The intervention involved 3 months of weekly instructional sessions on nutrition, self-monitoring of blood glucose, exercise, and other self-care topics and 6 months of biweekly support group sessions to promote behavior changes. The approach was culturally competent in terms of language, diet, social emphasis, family participation, and incorporation of cultural health beliefs. Outcomes included indicators of metabolic control (HbA 1c and fasting blood glucose), diabetes knowledge, and diabetesrelated health beliefs.

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.…”

“…[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. 8 Allen et al recruited some White participants (21 % of their study sample), but the majority of their participants were AfricanAmerican.…”

“…In two of the studies, participants in the control arm were placed on a waiting list, and received no additional care during the study. 8,10 Lujan et al assigned the control arm participants to receive their usual care at the clinic, 9 whereas in the study by Corkery et al, the control arm participants received care from a certified diabetes educator. 19 The study by Babamoto et al had two control arms: in one control arm, the participants were managed by a diabetes nurse, and in the other control arm, participants continued to receive usual care from their primary care providers.…”

“…Randomized controlled trials have had conflicting results. Some trials showed a significant reduction in A1c, [8][9][10][11][12] while other trials did not. 13,14 Of note, there was methodological variability across studies, including sample size, target population, intervention protocols, and length of follow-up.…”

Self-monitoring of blood glucose in type 2 diabetes: a new look at published trials

“…We analysed 18 relevant RCTs [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], some of which had not been included in previous meta-analyses [20][21][22][23][24][25]. Why do these trials not provide a reliable answer?…”