title: A randomized, controlled trial of a stress management intervention for Latinos with type 2 diabetes delivered by community health workers: Outcomes for psychological wellbeing, glycemic control, and cortisol.
abstract: OBJECTIVE
  To test the efficacy of a community health worker (CHW) delivered stress management (SM) intervention on psychosocial, glycemic, and cortisol outcomes among U.S. Latinos with type 2 diabetes.
  
  
  METHODS
  A randomized, controlled trial compared CHW-delivered diabetes education (DE; one group session) to DE plus CHW-delivered SM (DE+SM; 8 group sessions). Psychosocial variables and urinary cortisol were measured at baseline and posttreatment. HbA1c was measured at baseline, posttreatment, and 3-month follow-up.
  
  
  RESULTS
  In intent to treat analysis, compared to DE (n=46), DE+SM (n=61) showed significantly improved symptoms of depression, anxiety, and self-reported health status. There were no significant group effects for HbA1c, diabetes distress, or urinary cortisol. However, there was a dose response effect for HbA1c and diabetes distress; increasing attendance at SM sessions was associated with greater improvements in HbA1c and diabetes distress.
  
  
  CONCLUSIONS
  This is the first randomized, controlled trial demonstrating that CHWs can improve psychological symptoms and self-reported health among Latinos with type 2 diabetes. Efforts to increase intervention attendance may improve HbA1c and diabetes distress.
authors: UConn Health, Farmington, CT, USA. Electronic address: juwagner@uchc.edu.
authors: Julie Ann
authors: JA
authors: Wagner
authors: UConn Health, Farmington, CT, USA.
authors: Angela
authors: A
authors: Bermudez-Millan
authors: Hispanic Health Council, Hartford, CT, USA.
authors: Grace
authors: G
authors: Damio
authors: Hispanic Health Council, Hartford, CT, USA.
authors: Sofia
authors: S
authors: Segura-Perez
authors: Hartford Hospital, Hartford, CT, USA.
authors: Jyoti
authors: J
authors: Chhabra
authors: Hartford Hospital, Hartford, CT, USA.
authors: Cunegundo
authors: C
authors: Vergara
authors: Quinnipiac University School of Medicine, Hamden, CT, USA.
authors: Richard
authors: R
authors: Feinn
authors: Yale School of Public Health, New Haven, CT, USA.
authors: Rafael
authors: R
authors: Perez-Escamilla
mesh_terms: D000368:Aged; D001007:Anxiety / Q000628:therapy; D001786:Blood Glucose; D003150:Community Health Workers; D003376:Counseling; D003863:Depression / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006630:Hispanic or Latino; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000097:blood / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D006854:Hydrocortisone; C517652:hemoglobin A1c protein, human
keywords: Anxiety; Community health workers; Depression; Diabetes; Latinos