You are here

  • Home
  • Archive
  • Volume 8, Issue 1
  • Improved diabetes control among low-income Mexican Americans through community-clinical interventions: results of an RCT

Article Text

Article menu

Download PDFPDF

XML
Clinical Care/Education/Nutrition
Improved diabetes control among low-income Mexican Americans through community-clinical interventions: results of an RCT
  1. Belinda M Reininger1,
  2. MinJae Lee2,3,
  3. Manouchehr Hessabi2,
  4. Lisa A Mitchell-Bennett1,
  5. Maribel R Sifuentes1,
  6. Jose A Guerra1,
  7. Ciara D Ayala1,
  8. Tianlin Xu4,
  9. Valerie Polletta5,
  10. Amy Flynn5,
  11. Mohammad H Rahbar2,3,6
  1. 1Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Brownsville Regional Campus, Brownsville, Texas, USA
  2. 2Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
  3. 3Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas, USA
  4. 4Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
  5. 5Research and Evaluation, Health Resources in Action, Inc, Boston, Massachusetts, USA
  6. 6Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
  1. Correspondence to Dr Belinda M Reininger; Belinda.M.Reininger{at}uth.tmc.edu

Abstract

Introduction This randomized controlled trial investigated community-clinical intervention strategies for a Mexican American population who had not demonstrated control of their diabetes. We tested a control program (Salud y Vida 1.0) supporting diabetes management versus an enhanced version (Salud y Vida 2.0) for reductions in HbA1c at 12 months.

Research design and methods Adults with uncontrolled diabetes (n=353) were enrolled if they had an HbA1c≥9.0% during a program or doctor’s visit between 6 and 36 months of their receipt of SyV 1.0 services, were patients at one of two clinics in local counties, and had an HbA1c≥8.0% at SyV 2.0 baseline enrollment. The control and intervention arms were coordinated by community health workers and the intervention arm included the control program enhanced with medication therapy management; behavioral health services; peer-led support groups; and additional community-based lifestyle programs also open to the family.

Results At 12 months, both study arms improved HbA1c (mean, (CI), Control (−0.47 (-0.74 to –0.20)) and intervention (−0.48 (-0.76 to –0.19)). The intervention group maintained HbA1c levels after month 6, whereas control group HbA1c levels slightly increased (adjusted mean from 9.83% at month 6%–9.90% at month 12). Also, HbA1c was examined by level of participant engagement. The high engagement group showed a decreasing trend over the study period, while control and lower engagement groups failed to maintain HbA1c levels at month 12.

Conclusions Improved HbA1c was found among a population that had not demonstrated diabetes management prior; however, mean HbA1c values were above clinical guideline recommendations. The randomized control trial findings provide additional evidence that extended time and intervention supports may be needed for populations experiencing inequities in social determinants of health.

Trial registration number NCT04035395.

  • randomized controlled trial
  • Mexican Americans
  • community care
  • low income
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2019-000867

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors BMR provided study concept. BMR, MHR, ML and LAM-B conceived the methodology and study design. BMR obtained funding. MH provided database and data management. MRS, JAG and CDA were data curation. MHR reviewed/edited the manuscript. ML, AF and TX analyzed data and wrote the manuscript. BMR, ML, MH, VP, MRS, JAG and LAM-B are writing original draft preparation. BMR, MHR, ML and MH were involved in important intellectual content and read, and approved the final manuscript. BMR and MHR supervised.

    • Funding This material is based on work supported by the Corporation for National and Community Service under Social Innovation Fund Grant Number 14SIHTX001. UTHealth SPH is a proud subgrantee of Methodist Healthcare Ministries’ Sí Texas Project, a Social Innovation Fund (SIF) Program.

    • Disclaimer Opinions or points of view expressed in this document are those of the authors and do not necessarily reflect the official position of, or a position that is endorsed by, the Corporation for National and Community Service.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. Deidentified participant data are available from the first author Belinda.M.Reininger@uth.tmc.edu.