Improvement in diabetes care of underinsured patients enrolled in project dulce: a community-based, culturally appropriate, nurse case management and peer education diabetes care model.
OBJECTIVE
To improve clinical diabetes care, patient knowledge, and treatment satisfaction and to reduce health-adverse culture-based beliefs in underserved and underinsured populations with diabetes.


METHODS
A total of 153 high-risk patients with diabetes recruited from six community clinic sites in San Diego County, California were enrolled in a nurse case management (NCM) and peer education/empowerment group. Baseline and 1-year levels of HbA(1c), lipid parameters, systolic and diastolic blood pressure, knowledge of diabetes, culture-based beliefs in ineffective remedies, and treatment satisfaction were prospectively measured. The NCM and peer education/empowerment group was compared with 76 individuals in a matched control group (CG) derived from patients referred but not enrolled in Project Dulce.


RESULTS
After 1 year in Project Dulce, the NCM and peer education/empowerment group had significant improvements in HbA(1c) (12.0-8.3%, P < 0.0001), total cholesterol (5.82-4.86 mmol/l, P < 0.0001), LDL cholesterol (3.39-2.79 mmol/l, P < 0.0001), and diastolic blood pressure (80-76 mmHg, P < 0.009), which were significantly better than in the CG, in which no significant changes were noted. Accepted American Diabetes Association standards of diabetes care, knowledge of diabetes (P = 0.024), treatment satisfaction (P = 0.001), and culture-based beliefs (P = 0.001) were also improved.


CONCLUSIONS
A novel, culturally appropriate, community-based, nurse case management/peer education diabetes care model leads to significant improvement in clinical diabetes care, self-awareness, and understanding of diabetes in underinsured populations.
Philis-Tsimikas
Athena
A
Whittier Institute for Diabetes, La Jolla, California 92037, USA. philis-tsimikas.athena@scrippshealth.org
Walker
Chris
C
Rivard
Lisa
L
Talavera
Gregory
G
Reimann
Joachim O F
JO
Salmon
Michelle
M
Araujo
Rachel
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002140:California / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000097:blood / Q000191:economics* / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000191:economics / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D004608:Eligibility Determination; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D017058:Mexican Americans; D008875:Middle Aged; D017060:Patient Satisfaction
D006442:Glycated Hemoglobin