Health effectiveness of community health workers as a diabetes self-management intervention

Abstract

Objective To evaluate the health effectiveness of community health workers among three groups (intervention, attentional control and control groups) of Hispanic adults with uncontrolled (HbA1c >8%) type 2 diabetes mellitus. Methods This was a randomized clinical trial involving 180 English- and Spanish-speaking Hispanic individuals with uncontrolled type 2 diabetes mellitus, 40–74 years of age, who received diabetes care at an outpatient, public, urban hospital. Repeated-measures analysis of variance was used to evaluate the effect of time and group on the primary outcome measure and secondary outcomes. Group differences in the percentage of participants achieving at least 1% reduction in HbA1c levels were assessed using chi-square tests. Results Patients’ ages ranged from 44 to 74 years, 40% were male, 97% preferred Spanish and seven Spanish-speaking countries were identified as country of origin. Relative to the control and attentional control groups, the intervention group showed greater HbA1c reduction from baseline to 12 months and was the group with the highest percentage of participants showing 1% or more HbA1c reduction. Conclusion Integration of community health workers improved disease control for patients with type 2 diabetes mellitus during the intervention phase. Peer-driven/interactive ways to sustain diabetes control need to be explored.

Analysis of Influencing Factors of Community Management of Diabetes based on Adaptive-Lasso Logistic Regression Model

“…Community intervention and intensive management measures can significantly improve blood glucose management among patients with diabetes. In particular, increasing the number of follow-up evaluations, health consultations and free consultations by the family doctor team will significantly affect the blood glucose management effect of diabetic patients, our results were consistent with the results of Aponte (2017) [4]. It seems that practical strategies to improve diabetes self-management based on the community include social support for family members, health cares, and community members, and local free or low-cost diabetes education materials and courses [18].…”

“…The following factors that may affect the management of diabetes were assigned as independent variables (See Table 2). The logistic regression model of adaptive-lasso variable selection was introduced [4], and the coefficients of each selected variable were estimated to analyse the factors affecting diabetes 10 management. The Lasso-logistics regression model of this study is completed by the glmnet package in R. The relationship between the model error and was obtained through crossvalidation.…”

“…Communitybased diabetes management has become a cost-effective strategy for controlling and managing diabetes in primary settings. The community-based intervention positively reduced the HbA1c level of diabetic people [2,3], improved disease control [4], and improved psychosocial outcomes [5].…”

Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial

“…Patients trust CHWs who understand their sociocultural barriers, provide social support, speak the same language, and can increase the relevancy of disease self‐management for individuals who are often struggling to manage competing priorities. Importantly, mounting evidence suggests that CHW involvement can contribute to improvement in diabetes self‐management as well as significant decreases in HbA1C that have ranged from 0.5–0.9% …”

“…Importantly, mounting evidence suggests that CHW involvement can contribute to improvement in diabetes self-management as well as significant decreases in HbA1C that have ranged from 0.5-0.9%. [10][11][12][13][14] A pilot study partnering clinical pharmacists with CHWs to serve minority patients with poorly controlled type 2 diabetes mellitus demonstrated the feasibility of this collaborative approach. 15 In the pilot, nine Latino patients with HbA1C values of 8% or higher were recruited from within a general medicine clinic.…”