Impact of a community health workers-led structured program on blood glucose control among Latinos with type 2 diabetes: The DIALBEST Trial

Rafael Pérez-Escamilla, Grace Damio, Jyoti Chhabra, Maria L. Fernandez, Sofia Segura-Pérez, Sonia Vega-Lopez, Grace Kollannor-Samuel, Mariana Calle, Fatma M. Shebl, Darrin D'Agostino

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Abstract

OBJECTIVE: Latinos with type 2 diabetes (T2D) face major healthcare access and disease management disparities.We examined the impact of the Diabetes Among Latinos Best Practices Trial (DIALBEST), a community health worker (CHW)-led structured intervention for improving glycemic control among Latinos with T2D. RESEARCH DESIGN AND METHODS: A total of 211 adult Latinos with poorly controlled T2D were randomly assigned to a standard of healthcare (n = 106) or CHW (n = 105) group. The CHW intervention comprised 17 individual sessions delivered at home by CHWs over a 12-month period. Sessions addressed T2D complications, healthy lifestyles, nutrition, healthy food choices and diet for diabetes, blood glucose self-monitoring, and medication adherence. Demographic, socioeconomic, lifestyle, anthropometric, and biomarker (HbA1c, fasting blood glucose, and lipid profile) data were collected at baseline and 3, 6, 12, and 18 months (6 months postintervention). Groups were equivalent at baseline. RESULTS: Participants had high HbA1c at baseline (mean 9.58% [81.2 mmol/mol]). Relative to participants in the control group, CHWs had a positive impact on net HbA1c improvements at 3 months (-0.42% [-4.62 mmol/mol]), 6 months (-0.47% [-5.10 mmol/mol]), 12 months (-0.57% [-6.18 mmol/mol]), and 18 months (-0.55% [-6.01 mmol/mol]). The overall repeated-measures group effect was statistically significant (mean difference -0.51% [-5.57 mmol/mol], 95% CI -0.83, -0.19% [-9.11, -2.03 mmol/mol], P = 0.002). CHWs had an overall significant effect on fasting glucose concentration that was more pronounced at the 12- and 18-month visits. There was no significant effect on blood lipid levels, hypertension, and weight. CONCLUSIONS: DIALBEST is an effective intervention for improving blood glucose control among Latinos with T2D.

Original languageEnglish (US)
Pages (from-to)197-205
Number of pages9
JournalDiabetes Care
Volume38
Issue number2
DOIs
StatePublished - Feb 1 2015

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Practice Guidelines
Hispanic Americans
Type 2 Diabetes Mellitus
Blood Glucose
Fasting
Blood Glucose Self-Monitoring
Delivery of Health Care
Lipids
Medication Adherence
Diabetes Complications
Disease Management
Life Style
Research Design
Biomarkers
Demography
Diet
Hypertension
Weights and Measures
Glucose
Food

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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Impact of a community health workers-led structured program on blood glucose control among Latinos with type 2 diabetes : The DIALBEST Trial. / Pérez-Escamilla, Rafael; Damio, Grace; Chhabra, Jyoti; Fernandez, Maria L.; Segura-Pérez, Sofia; Vega-Lopez, Sonia; Kollannor-Samuel, Grace; Calle, Mariana; Shebl, Fatma M.; D'Agostino, Darrin.

In: Diabetes Care, Vol. 38, No. 2, 01.02.2015, p. 197-205.

Research output: Contribution to journalArticle

Pérez-Escamilla, R, Damio, G, Chhabra, J, Fernandez, ML, Segura-Pérez, S, Vega-Lopez, S, Kollannor-Samuel, G, Calle, M, Shebl, FM & D'Agostino, D 2015, 'Impact of a community health workers-led structured program on blood glucose control among Latinos with type 2 diabetes: The DIALBEST Trial', Diabetes Care, vol. 38, no. 2, pp. 197-205. https://doi.org/10.2337/dc14-0327
Pérez-Escamilla, Rafael ; Damio, Grace ; Chhabra, Jyoti ; Fernandez, Maria L. ; Segura-Pérez, Sofia ; Vega-Lopez, Sonia ; Kollannor-Samuel, Grace ; Calle, Mariana ; Shebl, Fatma M. ; D'Agostino, Darrin. / Impact of a community health workers-led structured program on blood glucose control among Latinos with type 2 diabetes : The DIALBEST Trial. In: Diabetes Care. 2015 ; Vol. 38, No. 2. pp. 197-205.
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abstract = "OBJECTIVE: Latinos with type 2 diabetes (T2D) face major healthcare access and disease management disparities.We examined the impact of the Diabetes Among Latinos Best Practices Trial (DIALBEST), a community health worker (CHW)-led structured intervention for improving glycemic control among Latinos with T2D. RESEARCH DESIGN AND METHODS: A total of 211 adult Latinos with poorly controlled T2D were randomly assigned to a standard of healthcare (n = 106) or CHW (n = 105) group. The CHW intervention comprised 17 individual sessions delivered at home by CHWs over a 12-month period. Sessions addressed T2D complications, healthy lifestyles, nutrition, healthy food choices and diet for diabetes, blood glucose self-monitoring, and medication adherence. Demographic, socioeconomic, lifestyle, anthropometric, and biomarker (HbA1c, fasting blood glucose, and lipid profile) data were collected at baseline and 3, 6, 12, and 18 months (6 months postintervention). Groups were equivalent at baseline. RESULTS: Participants had high HbA1c at baseline (mean 9.58{\%} [81.2 mmol/mol]). Relative to participants in the control group, CHWs had a positive impact on net HbA1c improvements at 3 months (-0.42{\%} [-4.62 mmol/mol]), 6 months (-0.47{\%} [-5.10 mmol/mol]), 12 months (-0.57{\%} [-6.18 mmol/mol]), and 18 months (-0.55{\%} [-6.01 mmol/mol]). The overall repeated-measures group effect was statistically significant (mean difference -0.51{\%} [-5.57 mmol/mol], 95{\%} CI -0.83, -0.19{\%} [-9.11, -2.03 mmol/mol], P = 0.002). CHWs had an overall significant effect on fasting glucose concentration that was more pronounced at the 12- and 18-month visits. There was no significant effect on blood lipid levels, hypertension, and weight. CONCLUSIONS: DIALBEST is an effective intervention for improving blood glucose control among Latinos with T2D.",
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AU - Chhabra, Jyoti

AU - Fernandez, Maria L.

AU - Segura-Pérez, Sofia

AU - Vega-Lopez, Sonia

AU - Kollannor-Samuel, Grace

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AU - Shebl, Fatma M.

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N2 - OBJECTIVE: Latinos with type 2 diabetes (T2D) face major healthcare access and disease management disparities.We examined the impact of the Diabetes Among Latinos Best Practices Trial (DIALBEST), a community health worker (CHW)-led structured intervention for improving glycemic control among Latinos with T2D. RESEARCH DESIGN AND METHODS: A total of 211 adult Latinos with poorly controlled T2D were randomly assigned to a standard of healthcare (n = 106) or CHW (n = 105) group. The CHW intervention comprised 17 individual sessions delivered at home by CHWs over a 12-month period. Sessions addressed T2D complications, healthy lifestyles, nutrition, healthy food choices and diet for diabetes, blood glucose self-monitoring, and medication adherence. Demographic, socioeconomic, lifestyle, anthropometric, and biomarker (HbA1c, fasting blood glucose, and lipid profile) data were collected at baseline and 3, 6, 12, and 18 months (6 months postintervention). Groups were equivalent at baseline. RESULTS: Participants had high HbA1c at baseline (mean 9.58% [81.2 mmol/mol]). Relative to participants in the control group, CHWs had a positive impact on net HbA1c improvements at 3 months (-0.42% [-4.62 mmol/mol]), 6 months (-0.47% [-5.10 mmol/mol]), 12 months (-0.57% [-6.18 mmol/mol]), and 18 months (-0.55% [-6.01 mmol/mol]). The overall repeated-measures group effect was statistically significant (mean difference -0.51% [-5.57 mmol/mol], 95% CI -0.83, -0.19% [-9.11, -2.03 mmol/mol], P = 0.002). CHWs had an overall significant effect on fasting glucose concentration that was more pronounced at the 12- and 18-month visits. There was no significant effect on blood lipid levels, hypertension, and weight. CONCLUSIONS: DIALBEST is an effective intervention for improving blood glucose control among Latinos with T2D.

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