Improving diabetes self-management skills in Latinx patients: A SMART design study exploring the roles of Community Health Workers, Registered Nurses, and family members in self-management of type 2 diabetes in Latinx patients (Preprint)

Abstract

The rate of Type 2 diabetes mellitus (T2DM) among Mexican Americans is 16.3%, about twice that of non-Hispanic Whites. While a number of education approaches have been developed and shown to improve diabetes self-management behaviors and glycemic control for Spanish-speaking Latinx patients with T2DM, there is little research to guide health practitioners regarding which interventions to apply and when so that resources are used efficiently, and treatment outcomes are maximized.

To describe an adaptive intervention that integrates community mental health workers, diabetes nurse educators, family members, and patients as partners in care while promoting diabetes self-management for Mexican Americans with T2DM. The project incorporates four evidence-based, culturally tailored treatments to determine what sequence of intervention strategies work most efficiently and for whom. Given the increasing prevalence of T2DM, achieving better control of diabetes and lowering the associated medical complications experienced disproportionally by Mexican Americans is a public health priority.

Funded by the National Institute of Nursing Research (NIH grant number R01 NR015809), this project utilized a Sequential Multiple Assignment Randomized Trial (SMART) and included 330 Spanish-speaking Latinx patients with T2DM. In the first phase of the study, subjects were randomly assigned to an evidence-based diabetes self-management education (DSME) called Tomando Control delivered in a group format for six, bi-weekly 1.5-hour sessions, led either by a community health worker or a diabetes nurse educator. In the second phase of the study, those subjects who did not improve their diabetes self-management behaviors were re-randomized to receive either an augmented version of the DSME or a multifamily group treatment focused on problem solving. The primary outcome measure was the “Summary of Diabetes Self-Care Activities.” Evaluations were made at baseline and at three, six, and 12 months.

The results of this study are pending data analysis.

The results of this trial should help practitioners in selecting the optimal approach for improving diabetes self-management in Spanish-speaking, Latinx patients with T2DM.

Clinical Trials ID# NCT03092063