Novel, culturally sensitive, shared medical appointment model for Hispanic pediatric type 1 diabetes patients

Abstract

Background/Objective Latino patients with type 1 diabetes (T1D) face cultural and language barriers leading to poor outcomes. Shared medical appointments (SMAs) are recognized as effective models of care. Our aim is to develop a culturally sensitive, cost effective SMA program for Latino T1D. Subjects Spanish speaking Latinos 1 to 20 years with T1D (n = 88) and their families. Methods Routine care alternating with SMAs that included group education was provided. Teens, ages >11 received the SMA separate from parents. Younger children were seen together. Hemoglobin A1c (HbA1c), behavioral questionnaires, and use of diabetes technology were measured at baseline and every 3 to 6 months. Results 57.7% of children and 77.27% of teens completed the 2 years of the Program. There was a significant association between age and change in HbA1c from baseline to year 1 (P = .001) and baseline to year 2 (P = <.0001). For participants <12 years, there was a significant improvement in HbA1c from baseline to year 1 (P = .0146) and from year 1 to year 2 (P = .0069). Participants ≥12 years, had an increase in HbA1c from year 1 to year 2 (P = .0082). Technology use increased significantly from baseline to year 2 for participants <12 years of age (19%‐60%, P = .0455) and for participants who were ≥12 years of age (10%‐23%, P = .0027). Participants reported a 98% satisfaction rate. Conclusions The culturally sensitive SMA proved to be an appreciated, feasible, and effective alternative to care for Latinos with T1D.

Inequities in Health Outcomes in Children and Adults With Type 1 Diabetes: Data From the T1D Exchange Quality Improvement Collaborative

“…Additionally, a shared medical appointment clinical model for Hispanic youths and families has been developed and studied. Participation in this clinical model was associated with improvement in glycemic control and an increase in technology use ( 25 ). More interventions similar to these are needed to close the gap in diabetes care between non-Hispanic Whites and individuals of other racial and ethnic groups.…”

Psychosocial outcomes in young adolescents with type 1 diabetes participating in shared medical appointments

“…[15][16][17] In adults with T1D or T2D, SMA are associated with improved A1C levels, positive attitudes and outlook, and a sense of empowerment. [18][19][20][21] More recently, studies have examined SMA benefits in the adolescent T1D population, [22][23][24][25][26] finding higher caregiver, patient, and staff satisfaction 25 ; increased peer support 25 ; improved glycemic control 26 ; and adherence. 24 However, investigation into whether SMA improve psychosocial factors in youth and adolescents with T1D has been limited.…”

Hispanic Caregivers' experience of pediatric type 1 diabetes: A qualitative study

“…among the child participants and increasing diabetes technology use in both children and adolescents, with further benefits in relationshipbuilding between parents and caregivers who shared cultural and language backgrounds. 59 Our study has several unique strengths. There is a lack of literature surrounding the lived experience of Hispanic caregivers of children with T1D.…”

“…There are limited trials of group‐based interventions and most take place in adult populations with T2D and/or do not address application to Hispanic cultures 55–58 . One recent study found that shared medical appointments for Hispanic patients were effective in decreasing HbA1c among the child participants and increasing diabetes technology use in both children and adolescents, with further benefits in relationship‐building between parents and caregivers who shared cultural and language backgrounds 59 …”