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Community-Based Program Helps Immigrants Control T2D

Community-Based Program Helps Immigrants Control T2D

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Action Points

  • Note that this randomized trial of an educational intervention for Bangladeshi patients with diabetes had a modest beneficial effect on certain hemoglobin A1C metrics.
  • Given the rather unique population studied, broader generalizability is not assured.

A culturally tailored educational program delivered by community health workers helped Bangladeshi immigrants living in New York City to better control their diabetes, a randomized trial found.

At the end of the 6-month program, mean glycated hemoglobin (HbA1c) dropped by 0.2% in the intervention group, but not at all in a control group (P=0.063), said Nadia Islam, PhD, of the New York University School of Medicine in New York City, and colleagues.

Significantly more participants in the intervention group lowered their HbA1c (55.2% versus 42.5%, P=0.035) and achieved a target of 7.0% or less (36.3% versus 24.6%, P=0.034) compared with the control group, Islam’s group reported online in Clinical Diabetes.

In addition, more intervention group participants knew what HbA1c was (75% versus 28%, P<0.01), reported moderate physical activity on a weekly basis (a mean of 163 versus 129 participants, P<0.01), and tested their blood glucose at least once per week (78% versus 66%, P<0.05), the study found.

Previous research has shown that the rate of diabetes among Bangladeshi immigrants living in New York City may be as high as 24%. This population is especially susceptible to the disease and less likely to receive adequate healthcare because of language barriers, lack of education, unhealthy diet, and other factors, the authors said.

“This is the first study of a community-based program to help New York City’s Bangladeshi community control diabetes,” Islam said in a statement. “To the broader issue of disease management, these results add to a growing body of evidence showing that community health worker programs are a low cost and effective strategy for controlling certain chronic diseases.”

What patients value most in working with community health workers is having a trusted person who delivers health coaching and motivation in ways that are culturally meaningful and relevant, Islam told MedPage Today. “Community health workers help connect patients with diabetes to information and community resources to improve their health. Other immigrant populations, such as other Asian subgroups or Latino populations that are at high risk for diabetes, can also benefit from this type of program,” she said.

The Diabetes Research, Education, and Action for Minorities (DREAM) trial enrolled 336 Bangladeshi participants, age 21-75, with type 2 diabetes, defined as an HbA1c of ≥6.5%. All participants lived in the New York City metropolitan area.

Participants were randomized 1:1 to a control group or an intervention group that participated in five, 2-hour monthly educational sessions led by bilingual Bangladeshi health workers. These sessions covered topics including nutrition and healthy eating, physical activity, complications of type 2 diabetes, preventive self-care, and stress management and family support. Intervention group participants also received two one-on-one visits with a community health worker at which they set individual health goals. Participants in the control group were invited only to the first educational session, which gave an overview of diabetes.

The study’s primary outcome was glycemic control, as measured by HbA1c. Secondary outcomes included changes in body weight, BMI, and blood pressure, which were measured by the community health workers. In addition, LDL cholesterol, HDL cholesterol, total cholesterol, and triglycerides were collected from medical records. Finally, the study also assessed self-reported patient outcomes such as type 2 diabetes knowledge, physical activity, and diabetes self-management.

Mean cholesterol decreased by 10.6 mg/dL from baseline in the intervention group (P=0.004), compared with a decrease of 0.6 mg/dL in the control group (P=0.878). The adjusted intervention effect was –8.1 mg/dL (P=0.107). There were no significant differences in LDL cholesterol, HDL cholesterol, or triglycerides.

The intervention effect for systolic blood pressure was -1.7 mmHg (P=0.441), and the intervention effect for diastolic blood pressure was -0.7 mmHg (P=0.619), the authors reported.

One limitation of the study was the behavioral changes were assessed by self-report, and participants may have overestimated these changes in order to please study personnel. “However, data collection was conducted by personnel other than the community health workers where possible to decrease the potential effect of this bias,” Islam’s group said. “As demand for patient-centered approaches in clinical settings expands, community health worker models will have growing clinical and public health relevance in the context of diabetes care for underserved populations.”

The study was funded by the NIH.

Islam and co-authors disclosed no relevant relationships with industry.

  • Reviewed by
    F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2018-01-02T00:00:00-0500

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