Although behavioral interventions appear promising, they have generally been evaluated using quasi-experimental designs. Moreover, few are culturally sensitive for African Americans. We, therefore, conducted a randomized controlled trial with 4 parallel arms to determine whether a multifaceted practice-based strategy implemented by a Nurse Case-Manager (NCM) in the clinic, a Community Health Worker (CHW) in the home, or both, could improve metabolic control (vs. usual care alone) over 3 years. The population consisted of 186 African Americans with type 2 diabetes recruited from 2 primary care clinics in East Baltimore. Participants were 76% female, with mean±SD age 59±9 years, education 10±3 years, HbA1c 8.6±2.1%. Interventions focused on diet, exercise, medication and appointment adherence, and glucose self-monitoring. Blinded outcome data were collected at yearly follow-up visits. The 2 year follow-up was completed by 149 individuals (84%). Compared to the usual care group, the NCM group and the CHW group had modest declines in HbA1c over 2 years (0.3 % and 0.3 %, respectively), and the combined NCM+CHW group had a greater decline in HbA1c (0.8 %, p=.137). The combined group also had similar improvements in cholesterol, triglycerides, and diastolic blood pressure. Although these results appear clinically significant, small numbers limited our ability to demonstrate statistical significance. These data suggest that combined NCM/CHW interventions may improve metabolic control in urban African Americans. An interactive clinic and community-based intervention may be essential to address the complex diabetes-related needs in this population.
Learning Objectives: 1.Recognize that the randomized controlled trial is the strongest design to evaluate behavioral interventions 2.Define an innovative clinic and community-based approach to interventions in diabetes care 3.Discuss the effect of interventions on clinical parameters of metabolic control (HbA1c, lipids, blood pressure)
Keywords: Interventions, Diabetes
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.