Outcomes of Project Dulce: a culturally specific diabetes management program.
BACKGROUND
Diabetes mellitus is a common and costly chronic disease that increasingly affects minority populations; however, there is little evidence regarding the clinical effectiveness and costs of culturally appropriate disease management programs.


OBJECTIVE
To determine the clinical outcomes and costs of Project Dulce, a combined stepped-care diabetes nurse case management program and culturally oriented peer-led self-empowerment training program.


METHODS
Pre-post clinical outcome and cost analysis of Project Dulce participants were compared with a cohort of historical controls over a one-year period. Subjects included 348 persons with diabetes with coverage under County Medical Services who were receiving services in community health centers in San Diego, CA. Generalized regression models were used to estimate changes in clinical outcomes (hemoglobin [Hb] A1c, blood pressure, cholesterol level) and costs associated with participation in Project Dulce.


RESULTS
Project Dulce participants had significant reductions in HbA1c (0.8%; p < 0.001), systolic (5.4 mm Hg; p = 0.001) and diastolic (8.0 mm Hg; p < 0.001) blood pressure, total cholesterol (28.1 mg/dL; p < 0.001), and low-density-lipoprotein cholesterol (15.6 mg/dL; p < 0.001). Expenditures for pharmacy ($3157 Dulce vs $1618 control) and disease management ($507 Dulce) increased. Total costs were higher during the first year of disease management ($5711 Dulce vs $4365 control; p < 0.001).


CONCLUSIONS
Project Dulce was effective in improving clinical outcomes for control of diabetes and related conditions in a medically indigent, culturally diverse population. Our finding of reduced hospital expenditures, although statistically insignificant, is clinically and economically important and suggests that intervention might provide an immediate benefit to a high-risk population.
Gilmer
Todd P
TP
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093-0622, USA. tgilmer@ucsd.edu
Philis-Tsimikas
Athena
A
Walker
Chris
C
D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D002140:California; D002784:Cholesterol / Q000097:blood; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin; D006630:Hispanic or Latino; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008489:Medical Indigency; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care
D000959:Antihypertensive Agents; D002784:Cholesterol; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents