Randomized Trial of a Literacy-Sensitive, Culturally Tailored Diabetes Self-Management Intervention for Low-Income Latinos

Abstract

OBJECTIVETo test whether a theory-based, literacy, and culturally tailored self-management intervention, Latinos en Control, improves glycemic control among low-income Latinos with type 2 diabetes.RESEARCH DESIGN AND METHODSA total of 252 patients recruited from community health centers were randomized to the Latinos en Control intervention or to usual care. The primarily group-based intervention consisted of 12 weekly and 8 monthly sessions and targeted knowledge, attitudes, and self-management behaviors. The primary outcome was HbA1c. Secondary outcomes included diet, physical activity, blood glucose self-monitoring, diabetes knowledge and self-efficacy, and other physiological factors (e.g., lipids, blood pressure, and weight). Measures were collected at baseline and at 4- and 12-month follow-up. Change in outcomes over time between the groups and the association between HbA1c and possible mediators were estimated using mixed-effects models and an intention-to-treat approach.RESULTSA significant difference in HbA1c change between the groups was observed at 4 months (intervention −0.88 [−1.15 to −0.60] versus control −0.35 [−0.62 to 0.07], P < 0.01), although this difference decreased and lost statistical significance at 12 months (intervention −0.46 [−0.77 to −0.13] versus control −0.20 [−0.53 to 0.13], P = 0.293). The intervention resulted in significant change differences in diabetes knowledge at 12 months (P = 0.001), self-efficacy (P = 0.001), blood glucose self-monitoring (P = 0.02), and diet, including dietary quality (P = 0.01), kilocalories consumed (P < 0.001), percentage of fat (P = 0.003), and percentage of saturated fat (P = 0.04). These changes were in turn significantly associated with HbA1c change at 12 months.CONCLUSIONSLiteracy-sensitive, culturally tailored interventions can improve diabetes control among low-income Latinos; however, strategies to sustain improvements are needed.

Picture Good Health: A Church-Based Self-Management Intervention Among Latino Adults with Diabetes

“…33,49,50,54,55 While we did find that all participants had improvements in A1C at 3 months, this improvement was not sustained at 6 months. Participants may not have maintained the skills they gained after the weekly contact ended.…”

“…Previous studies testing diabetes self-management interventions have had mixed results in impacting diabetes self-care activities. 49,50 Considering that Latinos tend to struggle with lifestyle changes due to competing demands and lack of resources for lifestyle change, our study demonstrated the possibility of a church-based diabetes self-management intervention helping participants overcome their struggles in making behavior change. 12,51 Even though these outcomes are self-reported, these findings are increasingly relevant since recent studies, including LOOK AHEAD, note that improvements in diet and exercise translate to improvements in many patient-centered outcomes, such as functional status and quality of life.…”

“…While some studies have demonstrated no improvements in diabetes outcomes using a lay leader approach, 33,49,50,[54][55][56] several other studies have noted that trained peers can effectively lead self-management education interventions in community settings and improve clinical outcomes. 13,19,20,[22][23][24]26,27,[57][58][59][60] Studies with Mexican Americans with diabetes utilizing peer-led diabetes self-management interventions have found improvements in glucose control.…”

Automated Telephone Calls in the Follow-Up of Self-Care in Outpatients with Type 2 Diabetes: A Feasibility Study

“…Diabetes is a serious public health problem in Mexico, and the prevalence of diabetes has increased from 6.7% in 1993 to 14.42% in 2006 [1]. Approximately 95% of patients exhibit poor or very poor glycemic control due to inconsistent routine treatment [2].…”

“…However, the health service and specialized facility infrastructure requirements of patients are not clear, and it remains unclear whether this strategy is feasible for patients with little formal education, and with limited economical resources [13] [14].…”