title: Impact of a community health workers-led structured program on blood glucose control among latinos with type 2 diabetes: the DIALBEST trial.
abstract: OBJECTIVE
  Latinos with type 2 diabetes (T2D) face major healthcare access and disease management disparities. We examined the impact of the Diabetes Among Latinos Best Practices Trial (DIALBEST), a community health worker (CHW)-led structured intervention for improving glycemic control among Latinos with T2D.
  
  
  METHODS
  A total of 211 adult Latinos with poorly controlled T2D were randomly assigned to a standard of healthcare (n = 106) or CHW (n = 105) group. The CHW intervention comprised 17 individual sessions delivered at home by CHWs over a 12-month period. Sessions addressed T2D complications, healthy lifestyles, nutrition, healthy food choices and diet for diabetes, blood glucose self-monitoring, and medication adherence. Demographic, socioeconomic, lifestyle, anthropometric, and biomarker (HbA1c, fasting blood glucose, and lipid profile) data were collected at baseline and 3, 6, 12, and 18 months (6 months postintervention). Groups were equivalent at baseline.
  
  
  RESULTS
  Participants had high HbA1c at baseline (mean 9.58% [81.2 mmol/mol]). Relative to participants in the control group, CHWs had a positive impact on net HbA1c improvements at 3 months (-0.42% [-4.62 mmol/mol]), 6 months (-0.47% [-5.10 mmol/mol]), 12 months (-0.57% [-6.18 mmol/mol]), and 18 months (-0.55% [-6.01 mmol/mol]). The overall repeated-measures group effect was statistically significant (mean difference -0.51% [-5.57 mmol/mol], 95% CI -0.83, -0.19% [-9.11, -2.03 mmol/mol], P = 0.002). CHWs had an overall significant effect on fasting glucose concentration that was more pronounced at the 12- and 18-month visits. There was no significant effect on blood lipid levels, hypertension, and weight.
  
  
  CONCLUSIONS
  DIALBEST is an effective intervention for improving blood glucose control among Latinos with T2D.
authors.affiliation: Yale School of Public Health, New Haven, CT University of Connecticut, Storrs, CT rafael.perez-escamilla@yale.edu.
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez-Escamilla
authors.affiliation: Hispanic Health Council, Hartford, CT.
authors.forename: Grace
authors.initials: G
authors.lastname: Damio
authors.affiliation: Hartford Hospital, Hartford, CT.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Chhabra
authors.affiliation: University of Connecticut, Storrs, CT.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Fernandez
authors.affiliation: Hispanic Health Council, Hartford, CT.
authors.forename: Sofia
authors.initials: S
authors.lastname: Segura-Pérez
authors.affiliation: Arizona State University, Phoenix, AZ.
authors.forename: Sonia
authors.initials: S
authors.lastname: Vega-López
authors.affiliation: Yale School of Public Health, New Haven, CT.
authors.forename: Grace
authors.initials: G
authors.lastname: Kollannor-Samuel
authors.affiliation: Worcester State University, Worcester, MA.
authors.forename: Mariana
authors.initials: M
authors.lastname: Calle
authors.affiliation: Yale School of Public Health, New Haven, CT.
authors.forename: Fatma M
authors.initials: FM
authors.lastname: Shebl
authors.affiliation: University of North Texas, Denton, TX.
authors.forename: Darrin
authors.initials: D
authors.lastname: D'Agostino
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D003150:Community Health Workers / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000592:standards; D048909:Diabetes Complications / Q000097:blood / Q000208:ethnology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000208:ethnology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic / Q000379:methods*; D018802:Patient-Centered Care; D012648:Self Care / Q000379:methods / Q000592:standards; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids