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. 2024 Aug;38(8):108794.
doi: 10.1016/j.jdiacomp.2024.108794. Epub 2024 Jun 10.

A community health worker led diabetes self-management education program: Reducing patient and system burden

Laura Porterfield  1 , Xiaoying Yu  2 , Victoria Warren  3 , Michael E Bowen  4 , Carolyn Smith-Morris  5 , Elizabeth M Vaughan  6
Affiliations

A community health worker led diabetes self-management education program: Reducing patient and system burden

Laura Porterfield et al. J Diabetes Complications. 2024 Aug.

Abstract

Aims: Conduct a secondary analysis of the TIME (Telehealth-supported, Integrated Community Health Workers (CHWs), Medication access, diabetes Education) made simple trial (SIMPLE) to evaluate healthcare utilization and explore variables that may have influenced HbA1c.

Methods: Participants (N = 134 [67/group]) were low-income, uninsured Hispanics with or at risk for type 2 diabetes mellitus. We included in-person and telehealth clinician visits, other visits, missed visits, orders placed, and guideline-adherence (e.g., vaccinations, quarterly HbA1c for uncontrolled diabetes). Using multivariable models, we explored for associations between HbA1c changes and these measures.

Results: The control arm had higher missed visits rates (intervention: 45 %; control: 56 %; p = 0.007) and missed telehealth appointments (intervention: 10 %; control: 27.4 %; p = 0.04). The intervention group received more COVID vaccinations than the control (p = 0.005). Other health measures were non-significant between groups. Intervention individuals' HbA1c improved with more missed visits (-0.60 %; p < 0.01) and worsened with improved guideline-adherent HbA1c measurements (HbA1c: 1.2 %; p = 0.057). The control group had non-significant HbA1c associations.

Conclusions: Findings suggest that the SIMPLE trial's improved HbA1c levels stemmed from a CHW-driven intervention and not additional healthcare contact. Exploratory outcomes resulted in seemingly counterintuitive HbA1c associations with missed visits and guideline-adherent measurements; these may suggest that an intervention that enhances communication provides support to reduce the amount of follow-up needed by participants without sacrificing clinical improvements.

Keywords: Community health worker; Diabetes; Disparities; Education; Hispanic; Telehealth.

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Conflict of interest statement

Declaration of competing interest The authors declare no conflicts of interest.

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