Outcomes at 18 months from a community health worker and peer leader diabetes self-management program for Latino adults.
Open accessAbstract
OBJECTIVE: This study evaluated the effectiveness of a community health worker (CHW) diabetes self-management education (DSME) program, followed by two different approaches to maintain improvements in HbA1c and other clinical and patient-centered outcomes over 18 months. RESEARCH DESIGN AND METHODS: The study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1) a CHW-led, 6-month DSME program or 2) enhanced usual care (EUC). After the 6-month program, participants randomized to the CHW-led DSME were further randomized to 1) 12 months of CHW-delivered monthly telephone outreach (CHW-only) or 2) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL). The primary outcome was HbA1c. Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self-management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months. RESULTS: Participants in the CHW intervention at the 6-month follow-up had greater decreases in HbA1c (−0.45% [95% CI −0.87, −0.03]; P < 0.05) and in diabetes distress (−0.3 points [95% CI −0.6, −0.03]; P < 0.05) compared with EUC. CHW+PL participants maintained HbA1c improvements at 12 and 18 months, and CHW-only participants maintained improvements in diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC (−2.2 points [95% CI −4.1, −0.3]; P < 0.05). Participants in CHW-led DSME had significant improvements in diabetes social support and in understanding of diabetes self-management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months. CONCLUSIONS: This study demonstrates the effectiveness of a 6-month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low-resource settings for achieving and maintaining improvements in key diabetes outcomes.
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The finding of durable improvement in HbA1c at 24 months was similar to the improvement observed in an 18-month trial including peer leaders who provided frequent contact for self-management support.
“This finding was similar to the improvement observed in an 18-month trial including peer leaders who provided frequent contact for self-management support.18”
From Mobile Health Intervention in Patients With Type 2 Diabetes: A Randomized Clinical Trial (2023) · cites this paper as [18]
There is growing evidence for the role of community health workers, peer leaders, and lay leaders in providing ongoing support.
“Additionally, there is growing evidence for the role of community health workers (71,72), as well as peer (71)(72)(73)(74)(75)(76) and lay leaders (77), in providing ongoing support.”
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 [72]
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- Authors
- Spencer, M. S., Kieffer, E. C., Sinco, B., Piatt, G., Palmisano, G., Hawkins, J., Lebron, A., Espitia, N., Tang, T., Funnell, M., & Heisler, M.
- Affiliations
- University of Michigan (US)
- Community Health and Social Services (CHASS), Detroit, MI
- Michigan State University (US)
- University of California at Irvine, Irvine, CA
- University of British Columbia (CA)
- Corresponding author
- Spencer, Michael S.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2018-04-27
- Volume
- 41
- Issue
- 7
- Pages
- 1414-1422
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC6014532
- OpenAlex
- W2799449764
- Cited by
- 153
- References
- 40
- Citations by year
- 2026: 13 · 2025: 14 · 2024: 17 · 2023: 15 · 2022: 25 · 2021: 31 · 2020: 22 · 2019: 12 · 2018: 4
- FWCI
- 13.72
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- American Association of Family Physicians Foundation (P30-DK-09292)
- National Institute of Diabetes and Digestive and Kidney Diseases (R18-DK-0785501A1)
- Centers for Disease Control and Prevention (U50/CCU417409)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Health Professions › General Health Professions › Community Health and Development
- Keywords
- community health workers, peer leaders, diabetes self-management education, type 2 diabetes, Latino adults, HbA1c, glycemic control, diabetes distress, depressive symptoms, telephone outreach, peer support groups, resource-limited settings, federally qualified health centers, intervention sustainability
- MeSH terms
- Self-Management, Adult, Aged, Community Health Workers, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Health Education, Glycated Hemoglobin, Hispanic or Latino, Humans, Leadership, Male, Middle Aged, Patient Participation, Peer Group, Self Care, Treatment Outcome, Outcome Assessment, Health Care
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