Journal Article

Peer-Led Diabetes Education Programs in High-Risk Mexican Americans Improve Glycemic Control Compared With Standard Approaches: A Project Dulce promotora randomized trial

Gallo, Linda C, Fortmann, Adelaide, Lleva-Ocana, Leticia, Walker, Chris, Philis-Tsimikas, Athena

2011

Overview

OBJECTIVE: To evaluate the effect of a culturally sensitive diabetes self-management education program that uses a low-cost, peer-educator format (Project Dulce) on glucose control and metabolic parameters in low-income Mexican Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 207 Mexican-American patients recruited from federally funded community health centers in San Diego County with HbA1c >8% were randomly assigned to the Project Dulce peer intervention or continuation of standard diabetes care. The primary outcome of interest was HbA1c. RESULTS: The majority of subjects were born in Mexico, were female, were middle-aged, had less than an eighth-grade education, and had high baseline HbA1c levels. Significant time-by-group interaction effects for HbA1c (P = 0.02) and diastolic blood pressure (P = 0.04) indicated that the Project Dulce group exhibited greater improvement (i.e., decreases) across time. Within-group analyses showed that the intervention group exhibited significant improvements from baseline to month 4 in absolute levels of HbA1c (–1.7%, P = 0.001) and HDL cholesterol (+1.4 mg/dL, P = 0.01) and from baseline to month 10 in absolute levels of HbA1c (–1.5%, P = 0.01), total cholesterol (–7.2 mg/dL, P = 0.04), HDL cholesterol (+1.6 mg/dL, P = 0.01), and LDL cholesterol (–8.1 mg/dL, P = 0.02). No significant changes were noted in the control group. CONCLUSIONS: This randomized trial, using the Project Dulce model of culturally sensitive, peer-led education, demonstrates improvement in glucose and metabolic control and suggests that this low-cost approach to self-management education for high-risk diabetic populations is effective.

• Publisher: American Diabetes Association
• Subject: Adult / Aged / Biological and medical sciences / blood / Blood cholesterol / Blood Glucose / Blood Glucose - metabolism / Blood Pressure / Blood Pressure - physiology / Business education / Cholesterol / Cholesterol - blood / Cholesterol, HDL / Cholesterol, HDL - blood / Cholesterol, LDL / Cholesterol, LDL - blood / community health / Comparative analysis / Design / Dextrose / Diabetes / Diabetes Mellitus, Type 2 / Diabetes Mellitus, Type 2 - blood / Diabetes Mellitus, Type 2 - metabolism / Diabetes therapy / Diabetes. Impaired glucose tolerance / Diabetics / diastolic blood pressure / Education / education programs / Endocrine pancreas. Apud cells (diseases) / Endocrinopathies / Etiopathogenesis. Screening. Investigations. Target tissue resistance / Female / Glucose / Glucose metabolism / Glycated Hemoglobin / Glycated Hemoglobin - metabolism / glycemic control / Health care policy / Health facilities / high density lipoprotein cholesterol / Hispanic Americans / Humans / Intervention / low density lipoprotein cholesterol / Low density lipoproteins / Male / Medical sciences / Metabolic diseases / metabolism / Methods / Mexican Americans / Mexico / Middle Aged / middle-aged adults / Miscellaneous / noninsulin-dependent diabetes mellitus / Original Research / Patient education / Patient Education as Topic / patients / Peer Group / physiology / Public health. Hygiene / Public health. Hygiene-occupational medicine / Trans fatty acids / Young Adult