title: Improving ambulatory diabetes care in high-risk racial minorities: use of culture-specific education and close follow-up.
abstract: OBJECTIVE
  To describe a project aimed at improving diabetes care in the ambulatory setting among 2 high-risk racial minorities (African American and Hispanic patients) by using culture-specific education provided by trained diabetes educators from the same racial groups as the targeted patients.
  
  
  METHODS
  Two nurse educators, 1 Hispanic and 1 African American, completed a standardized chronic disease management program, as did 2 patients with diabetes from each of the aforementioned ethnic groups in preparation for training other patients. The study patients participated in group classes or one-on-one sessions to learn about appropriate management of their diabetes, related complications, and improved lifestyle habits. Close follow-up by telephone and regular appointments ensured that appropriate glucose monitoring and laboratory tests were performed. Outcome measures before and after the intervention were recorded, with final project follow-up at 24 months. A control group was identified during the same period, which received standard care (follow-up with a physician every 3 to 6 months).
  
  
  RESULTS
  An improvement in control of diabetes occurred, as determined by a significant decline in hemoglobin A1c levels in both minority study groups. Emergency department visits also decreased significantly. Lipid profiles and microalbumin showed improvement as well. More than 90% of patients kept appointments and had all laboratory studies performed.
  
  
  CONCLUSIONS
  The project intervention had a notable effect, physically and psychologically, on the 2 ethnic sample populations studied. These results have major implications, both clinically and financially, for public health policy planning for diabetes care in minority populations.
authors.affiliation: Department of Endocrinology, Fredrickson Health Center, Pinnacle Health System, Mechanicsburg, Pennsylvania 17050, USA. rjoshi@pinnaclehealth.org
authors.forename: Renu
authors.initials: R
authors.lastname: Joshi
authors.forename: Nirmal
authors.initials: N
authors.lastname: Joshi
authors.forename: Amy
authors.initials: A
authors.lastname: Helmuth
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000378:metabolism; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006630:Hispanic or Latino; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D008055:Lipids