Impact of a community health workers-led structured program on blood glucose control among latinos with type 2 diabetes: the DIALBEST trial

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.

Trial registration: ClinicalTrials.gov NCT01299844.

Figure 1

Study design flowchart. f/up, follow-up.

Figure 2

Participant HbA_1c percent decline compared with baseline. Net reduction difference in HbA_1c between CHW and control groups at 3, 6, 12, and 18 months were −0.42% (P = 0.043), −0.47% (P = 0.050), −0.57% (P = 0.021), and −0.55% (P = 0.009), respectively. Mean differences and P values are from adjusted LMEs.