Meta Salud Diabetes for cardiovascular disease prevention in Mexico: a cluster-randomized behavioural clinical trial
Open accessAbstract
BACKGROUND: Healthy lifestyle interventions offered at points of care, including support groups, may improve chronic disease management, especially in low-resource populations. We assessed the effectiveness of an educational intervention in type 2 diabetes (T2D) support groups to reduce cardiovascular disease (CVD) risk. METHODS: We recruited 518 participants to a parallel, two-arm, cluster-randomized, behavioural clinical trial across 22 clinics in Sonora, Mexico, between August 2016 and October 2018. We delivered a 13-week secondary prevention intervention, Meta Salud Diabetes (MSD), within the structure of a support group (GAM: Grupo de Ayuda Mutua) in government-run (community) Health Centres (Centros de Salud). The primary study outcomes were difference in Framingham CVD risk scores and hypertension between intervention (GAM+MSD) and control (GAM usual care) arms at 3 and 12 months. RESULTS: CVD risk was 3.17% age-points lower in the MSD arm versus control at 3 months [95% confidence interval (CI): -5.60, -0.75, P = 0.013); at 12 months the difference was 2.13% age-points (95% CI: -4.60, 0.34, P = 0.088). There was no evidence of a difference in hypertension rates between arms. Diabetes distress was also lower at 3 and 12 months in the MSD arm. Post-hoc analyses showed greater CVD risk reduction among men than women and among participants with HbA1c < 8. CONCLUSIONS: MSD contributed to a positive trend in reducing CVD risk in a low-resource setting. This study introduced an evidence-based curriculum that provides T2D self-management strategies for those with controlled T2D (i.e. HbA1c < 8.0) and may improve quality of life.
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Health behavior change strategies may be delivered by mental health professionals, DCES, other trained health care professionals, or qualified community health workers.
“Health behavior change strategies may be delivered by mental health professionals, DCES, or other trained health care professionals (307,312-314) or qualified community health workers (307,308).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [307]
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- McEwen MM, Pasvogel A, Gallegos G, Barrera L. Type 2 diabe- tes self-management social support intervention at the US- Mexico border. Public Health Nurs 2010;27:310-19.
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- Authors
- Rosales, C. B., Denman, C. A., Bell, M. L., Cornejo, E., Ingram, M., del Carmen Castro Vásquez, M., Gonzalez-Fagoaga, J. E., Aceves, B., Nuño, T., Anderson, E. J., & Guernsey de Zapien, J.
- Affiliations
- University of Arizona (US)
- El Colegio de Sonora (MX)
- Centro de Estudios en Salud y Sociedad, El Colegio de Sonora, Hermosillo, SN, México
- Division of Public Health Practice & Translational Research, University of Arizona Mel & Enid Zuckerman College of Public Health, Phoenix, AZ, USA
- Department of Health Promotion Sciences, University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
- Corresponding author
- Nuño, Tomas
- ORCID
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-04-11
- Volume
- 50
- Issue
- 4
- Pages
- 1272-1282
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- PMC
- PMC8633640
- OpenAlex
- W3152516953
- Cited by
- 15
- References
- 35
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 1
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- International Journal of Epidemiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UA Campus Repository (The University of Arizona) (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute of the National Institutes of Health (R01HL125996)
- NIH
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- type 2 diabetes, cardiovascular disease prevention, diabetes support groups, secondary prevention, healthy lifestyle intervention, Framingham risk score, hypertension, diabetes distress, self-management strategies, resource-limited settings, community health centers, Sonora, Mexico
- MeSH terms
- Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Humans, Hypertension, Infant, Male, Mexico, Quality of Life
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