Improved Clinical Outcomes Using a Culturally Sensitive Diabetes Education Program in a Hispanic Population

Abstract

Purpose-The purpose of this study was to evaluate the effects of a culturally sensitive diabetes education program for Hispanics with type 2 diabetes.Methods-This study is a prospective cohort study to test the impact of a comprehensive diabetes education program on blood glucose control on Hispanics with type 2 diabetes. The educational program focused on maintaining glycemic control and general aspects of managing diabetes and complications. The study participants were recruited by flyers placed in Hispanic markets and in ambulatory care clinics. A total of 34 Hispanic male and female subjects with type 2 diabetes participated in the study. The concentrations of glucose, insulin, hemoglobin A1c (HbA1c), total cholesterol, triglycerides, low-density lipoprotein and high-density lipoprotein (HDL) cholesterol were analyzed at baseline and at 3 months.Results-A significant mean change was observed for HbA1c, fasting plasma glucose, cholesterol/ HDL ratio, and HDL after 3 months of education compared with baseline. There were significant reductions in weight, total fat, percent fat, trunk fat, and waist-to-hip ratio compared with baseline. After 3 months, subjects showed a significant positive correlation between changes in body mass index and insulin and weight, total fat, trunk fat, and fat free mass and insulin.Conclusions-A culturally sensitive program conducted in Spanish had a significant impact on important clinical parameters in Hispanic subjects with diabetes in a relatively short time period. The study demonstrates the importance of designing education intervention studies that are sensitive to cultural diversity, particularly in at-risk diabetic subjects.The incidence of diabetes is increasing in the United States. The data indicate that ethnic disparities are present in diabetes-related morbidity and mortality. 1 The 1993 to 2001 Medicare beneficiaries' data show that the prevalence of diabetes was highest in Hispanics and African Americans for all ages. 2 In addition, the prevalence of diabetes is expected to increase by 149% among Hispanics between 2000 and 2050. 3 The frequency of certain diabetic complications such as end-stage renal disease, amputation, and neuropathy is higher in minority populations such as Hispanics and African Americans. Type 2 diabetes is associated with a 2-to 4-fold increase in coronary heart disease. 9 Although the degree of glycemia in diabetic patients is strongly related to the risk of microvascular disease, the correlation between glycemia and macrovascular disease is not clearly established. However, there has been strong evidence suggesting that lipid intervention in diabetic patients is associated with macrovascular risk reduction, specifically heart disease. 10 Some have therefore suggested a multifactor approach that incorporates lipid management. The 2001 American Diabetes Association's clinical practice guidelines promote the importance of glucose control and lipid management in preventing cardiovascular disease. 10 The most common pattern of dyslipide...

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