Community-based lifestyle intervention for underserved Hispanics with pre-diabetes and type 2 diabetes in Southwest Virginia

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Virginia Tech

In the U.S., diabetes mellitus cases have been increasing, from 25 million in 2010 to 29 million in 2012. Healthy People 2020, the U.S. National Health Agenda, has established specific goals and objectives for diabetes. In the U.S., prevalence of pre-diabetes and diabetes for adult Hispanics was 38% and 12%, respectively, in 2012. The total estimated diabetes cost in the U.S. has been increasing, from $176 billion in 2007 to $245 billion in 2012.

The current study had two research hypotheses; the formative phase was expected to demonstrate a need for a community-based Type 2 Diabetes Mellitus (T2DM) self-management intervention for Spanish-speaking Hispanics. Random Control Trial (RTC) was expected to demonstrate the potential impact in preventing and managing T2DM.

Methods. A community-based lifestyle education curriculum was translated into Spanish, and adapted to Hispanic culture. This study includes three phases: 1) a formative phase; 2) a two-group pilot RCT with Hispanic Living with Diabetes (HBLD) and a delayed treatment condition; and 3) post-HBLD focus groups held with three participating groups of HBLD.

Results. Of 60 participants screened in the formative phase, 62% had A1c > 5.7%, and 75% did not have medical insurance. Of 6 participants who completed the pilot, A1c decreased for all six participants. Of 67 participants screened in phase 2, 61% had A1c > 5.7%. Of 30 HBLD participants in the RCT, baseline versus 3-month mean A1c increased 0.2 for the delayed control group (n = 10) and did not experience any change for the intervention group (n = 11). The difference in A1c change from baseline to follow up between treatment groups was not statistically significant (Kruskal Wallis, p < 0.05). Diabetes knowledge and SCT variables change from baseline to follow-up between groups were not statistically significant. Major themes identified in focus group discussions included barriers to access to health and nutrition services, the value of having a Spanish-speaking Hispanic as a health educator, and barriers to recruiting community members as promotoras.

Implications. HBLD has potential to reduce complications of diabetes among Hispanic participants by providing education to those who may not otherwise have access to it.

Social Cognitive Theory, Community Based Participatory Research, type 2 diabetes, Hispanics, healthcare access