Culturally tailored type 2 diabetes programs may benefit Hispanic patients

Among Hispanic patients with type 2 diabetes, involvement of family members in a culturally targeted intervention program may yield improvements in glycemic control, diabetes knowledge, self-efficacy and physical health-related quality of life.However, additional efforts to maintain these improvements are necessary, researchers wrote.

Jie Hu, PhD, RN, FAAN, professor of community practice nursing at The University of North Carolina Greensboro School of Nursing, and colleagues recruited a convenience sample of 186 Hispanic patients with type 2 diabetes and their family members from community clinics, physician’s offices and ethnic churches in rural counties of North Carolina between June 2012 and May 2015. Participants were assigned to either an intervention group, which participated in an 8-week culturally targeted diabetes education program provided in Spanish, or an attention control group, which participated in 8 weekly sessions on general health and safety and 2 diabetes self-management education sessions.

The study population consisted of 92 Hispanic patients with type 2 diabetes(intervention group, n = 51; control group, n = 41) and 94 family members (intervention group, n = 52; control group, n = 42). Data were collected at baseline, after intervention and at 1 and 6 months post-intervention. Participants with diabetes were assessed for HbA1c, diabetes self-efficacy, family support and diabetes self-care; diabetes knowledge was assessed in all participants. Diabetes knowledge was assessed using the Spoken Knowledge of Diabetes in Low Literacy Patients with Diabetes (SKILLD), which measures knowledge of glucose management, lifestyle changes, recognition and treatment of acute complications, and activities intended for prevention of long-term complications.

The researchers found that in patients with diabetes in the intervention group, there were significant changes in SKILLD diabetes knowledge scores and diabetes self-efficacy scores; however, these changes were not maintained at 6-month follow-up.

In post hoc comparisons, the researchers found that at the post-intervention time point, the intervention group achieved mean diabetes knowledge SKILLD scores of 8.6 out of a possible 10, vs. 6.3 for controls (P < .001). The intervention group continued to have significantly higher SKILLD scores at 1 month post-intervention (P = .016). Moreover, after accounting for baseline differences, the intervention group had higher diabetes self-efficacy scores in the immediate post-intervention period vs. controls (P = .004).

Adjustment for repeated measures and propensity score weighting revealed significant changes over time in HbA1c (P < .001). After adjusting for baseline differences, the mean HbA1c in the intervention group was 7.7% at the post-intervention follow-up and 8.7% in the control group (P = .02). Similar findings were observed at 1-month post-intervention follow up, with a consistently significant difference in HbA1c between intervention group vs. the control group (P = .005). Changes in HbA1c were not sustained at the 6-month follow-up.
KILLD diabetes knowledge scores (P < .001), HbA1c (P = .002) and physical health-related quality of life (P = .001).

“Many factors may have contributed to the lack of sustained improvement in HbA1c in our study,” the researchers wrote. “One factor might have been the improvement in glycemic control in the attentional control group, which is consistent with a previously study findings that participants in control groups demonstrated improvements in HbA1c in clinical trials. Strategies for sustaining glycemic control need to be developed in future intervention studies, including possible reinforcement over time.” – by Jennifer Byrne

Disclosure: The researchers report no relevant financial disclosures.

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