Impact of a novel community-based lifestyle intervention program on type 2 diabetes and cardiovascular risk in a resource-poor setting in the Dominican Republic.
BACKGROUND
The prevalence of type 2 diabetes is increasing at an alarming rate in Latin America and in the Caribbean. We present evidence that a cost-effective and sustainable approach to lifestyle modification in underdeveloped countries can be implemented using community members as healthcare champions.


METHODS
Of 222 community members screened in the impoverished community of Villa Juana, Santo Domingo, 69% had prediabetes or diabetes and 79 of these were enrolled. In a 1-day session, trained lifestyle educators from the USA trained ten lay community members to lead groups oriented to lifestyle change. Community leaders met with assigned patient groups monthly for 1 year. Glycated hemoglobin (HbA1c; average plasma glucose concentration), blood pressure, weight and waist circumference were measured at baseline, 6 months and 1 year.


RESULTS
59 individuals completed follow-up. Patients showed significant improvements after 6 months in systolic blood pressure (p=0.001), diastolic blood pressure (p=0.000002) and HbA1c (p=0.015). HbA1c improved further at 1 year (p=0.005).


CONCLUSIONS
Our pilot experience demonstrates the efficacy and feasibility of a novel, low-cost, community-based educational initiative to improve blood glucose control and reduce cardiovascular risk in individuals with type 2 diabetes or prediabetes. Replication of our model in other underserved areas could have a substantial impact on global health.
University of Virginia Health System, 1215 Lane Street, Hospital Expansion Building, Box 800158 Charlottesville, VA, USA, 22908.
Amy
A
West-Pollak
CEDIMAT Plaza de la Salud, Dr Juan Manuel Taveras Rodriguez, Calle Pepillo Salcedo, Ensanche La Fe, Santo Domingo, República Dominicana.
Eddy P
EP
Then
CEDIMAT Plaza de la Salud, Dr Juan Manuel Taveras Rodriguez, Calle Pepillo Salcedo, Ensanche La Fe, Santo Domingo, República Dominicana.
Carlos
C
Podesta
University of Virginia Health System, 1215 Lane Street, Hospital Expansion Building, Box 800158 Charlottesville, VA, USA, 22908.
Anne
A
Hedelt
University of Virginia Health System, 1215 Lane Street, Hospital Expansion Building, Box 800158 Charlottesville, VA, USA, 22908.
Mary Lou
ML
Perry
University of Virginia Health System, 1215 Lane Street, Hospital Expansion Building, Box 800158 Charlottesville, VA, USA, 22908.
Wendy V
WV
Izarnotegui
University of Virginia Health System, 1215 Lane Street, Hospital Expansion Building, Box 800158 Charlottesville, VA, USA, 22908.
Margarita
M
Perez
CEDIMAT Plaza de la Salud, Dr Juan Manuel Taveras Rodriguez, Calle Pepillo Salcedo, Ensanche La Fe, Santo Domingo, República Dominicana.
Antonio
A
Villegas
CEDIMAT Plaza de la Salud, Dr Juan Manuel Taveras Rodriguez, Calle Pepillo Salcedo, Ensanche La Fe, Santo Domingo, República Dominicana.
Nelson I
NI
Baez
CEDIMAT Plaza de la Salud, Dr Juan Manuel Taveras Rodriguez, Calle Pepillo Salcedo, Ensanche La Fe, Santo Domingo, República Dominicana.
Rimsky
R
Bassa
CEDIMAT Plaza de la Salud, Dr Juan Manuel Taveras Rodriguez, Calle Pepillo Salcedo, Ensanche La Fe, Santo Domingo, República Dominicana.
Gabriella
G
Mendez
CEDIMAT Plaza de la Salud, Dr Juan Manuel Taveras Rodriguez, Calle Pepillo Salcedo, Ensanche La Fe, Santo Domingo, República Dominicana.
Karmina
K
Hernandez
University of Virginia Health System, 1215 Lane Street, Hospital Expansion Building, Box 800158 Charlottesville, VA, USA, 22908.
David S
DS
Lim
CEDIMAT Plaza de la Salud, Dr Juan Manuel Taveras Rodriguez, Calle Pepillo Salcedo, Ensanche La Fe, Santo Domingo, República Dominicana.
Pedro
P
Urena
University of Virginia Health System, 1215 Lane Street, Hospital Expansion Building, Box 800158 Charlottesville, VA, USA, 22908 amt6b@virginia.edu.
Angela M
AM
Taylor
D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000517:prevention & control*; D003153:Community Health Services / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology / Q000517:prevention & control*; D004293:Dominican Republic; D005240:Feasibility Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008019:Life Style; D008297:Male; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D011204:Poverty Areas; D015397:Program Evaluation
D006442:Glycated Hemoglobin
Behavior modification; Cardiovascular disease; Community-based participatory research; Hypertension, Lifestyle; Type 2 diabetes mellitus