title: Peer-led diabetes education programs in high-risk Mexican Americans improve glycemic control compared with standard approaches: a Project Dulce promotora randomized trial.
abstract: OBJECTIVE
  To evaluate the effect of a culturally sensitive diabetes self-management education program that uses a low-cost, peer-educator format (Project Dulce) on glucose control and metabolic parameters in low-income Mexican Americans with type 2 diabetes.
  
  
  METHODS
  A total of 207 Mexican-American patients recruited from federally funded community health centers in San Diego County with HbA(1c) >8% were randomly assigned to the Project Dulce peer intervention or continuation of standard diabetes care. The primary outcome of interest was HbA(1c).
  
  
  RESULTS
  The majority of subjects were born in Mexico, were female, were middle-aged, had less than an eighth-grade education, and had high baseline HbA(1c) levels. Significant time-by-group interaction effects for HbA(1c) (P = 0.02) and diastolic blood pressure (P = 0.04) indicated that the Project Dulce group exhibited greater improvement (i.e., decreases) across time. Within-group analyses showed that the intervention group exhibited significant improvements from baseline to month 4 in absolute levels of HbA(1c) (-1.7%, P = 0.001) and HDL cholesterol (+1.4 mg/dL, P = 0.01) and from baseline to month 10 in absolute levels of HbA(1c) (-1.5%, P = 0.01), total cholesterol (-7.2 mg/dL, P = 0.04), HDL cholesterol (+1.6 mg/dL, P = 0.01), and LDL cholesterol (-8.1 mg/dL, P = 0.02). No significant changes were noted in the control group.
  
  
  CONCLUSIONS
  This randomized trial, using the Project Dulce model of culturally sensitive, peer-led education, demonstrates improvement in glucose and metabolic control and suggests that this low-cost approach to self-management education for high-risk diabetic populations is effective.
authors.affiliation: Scripps Whittier Diabetes Institute, La Jolla, CA, USA. tsimikas.athena@scrippshealth.org
authors.forename: Athena
authors.initials: A
authors.lastname: Philis-Tsimikas
authors.forename: Adelaide
authors.initials: A
authors.lastname: Fortmann
authors.forename: Leticia
authors.initials: L
authors.lastname: Lleva-Ocana
authors.forename: Chris
authors.initials: C
authors.lastname: Walker
authors.forename: Linda C
authors.initials: LC
authors.lastname: Gallo
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D010353:Patient Education as Topic; D010379:Peer Group; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin