title: Comprehensive diabetes management program for poorly controlled Hispanic type 2 patients at a community health center.
abstract: Technology and improved care coordination models can help diabetes educators and providers meet national care standards and provide culturally sensitive diabetes education that may improve diabetes outcomes. The purpose of the study was to evaluate the clinical usefulness of a nurse-led diabetes care program (Comprehensive Diabetes Management Program, CDMP) for poorly controlled Hispanic type 2 diabetes (T2DM) patients in an urban community health center setting. Patients were randomized to the intervention condition (IC; n = 21) or an attention control condition (AC; n = 18). IC and AC conditions were compared on rates of adherence to national clinical practice guidelines (blood glucose, blood pressure, foot exam, eye exam), and levels of diabetes distress, depression, and treatment satisfaction. IC patients had a significant improvement in A1C from baseline to 12-month follow-up compared with AC (-1.6% ± 1.4% versus -0.6% ± 1.1%; P = .01). The proportion of IC patients meeting clinical goals at follow-up tended to be higher than AC for A1c (IC = 45%; AC = 28%), systolic blood pressure (IC = 55%; AC = 28%), eye screening (IC = 91%; AC = 78%), and foot screening, (IC = 86%; AC = 72%). Diabetes distress and treatment satisfaction also showed greater improvement for IC than AC (P = .05 and P = .06, respectively), with no differences for depression. The CDMP intervention was more effective than an attention control condition in helping patients meet evidence-based guidelines for diabetes care.
authors.affiliation: The Department of Behavioral Medicine Research, Baystate Health Systems, Springfield, Massachusetts (Dr Welch, Dr Zagarins)
authors.forename: Garry
authors.initials: G
authors.lastname: Welch
authors.affiliation: William F Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts (Dr Allen, Dr Stamp)
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Allen
authors.affiliation: The Department of Behavioral Medicine Research, Baystate Health Systems, Springfield, Massachusetts (Dr Welch, Dr Zagarins)
authors.forename: Sofija E
authors.initials: SE
authors.lastname: Zagarins
authors.affiliation: William F Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts (Dr Allen, Dr Stamp)
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Stamp
authors.affiliation: Telehealth Research Institute, John A. BurnsSchool of Medicine, University of Hawaii at Manoa (Dr Bursell)
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Bursell
authors.affiliation: Estenda Solutions Inc., Conshohocken, Pennsylvania (Mr Kedziora)
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kedziora
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003151:Community Health Centers; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000451:nursing*; D003930:Diabetic Retinopathy / Q000517:prevention & control; D019468:Disease Management; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008403:Mass Screening; D008404:Massachusetts; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology* / Q000523:psychology; D011203:Poverty; D012648:Self Care / Q000523:psychology; D055817:Telenursing; D013813:Therapy, Computer-Assisted; D014505:Urban Population