Community health team improves diabetes control in Polynesian community

A team of community health workers (CHWs) has been able to improve control of Type 2 diabetes in a group of individuals from American Samoa - a medically underserved territory with a high prevalence of obesity, diabetes, and other cardiovascular risk factors, report researchers.

The intervention gave rise to significant improvements in glycated hemoglobin (HbA1c) and increased the likelihood for individuals achieving a 0.5% decrease in HbA1c.

Samoan physical activity, dietary, and lifestyle attributes are largely similar to those in many US low-income and ethnic minority communities, such as Hispanics, African Americans, and Native Americans, note Judith DePue (Miriam Hospital, Providence, Rhode Island, USA) and colleagues. "Thus, translational research in AS [American Samoa] may be generalized not only to other Polynesians but also to other vulnerable US communities experiencing high health disparities," says the team.

As reported in Diabetes Care, 268 participants were randomly allocated by village cluster to the CHW intervention group or to a control group that received usual care. The intervention was modeled after the successful "Project Sugar 2" trial, but the researchers made extensive adaptations after conducting focus groups with the participants and adjusting literature and visual materials to include foods and activities that were familiar and accessible to Samoan culture.

The CHWs visited the patients' homes or workplaces or saw patients at group meetings weekly, monthly, or quarterly, depending on their level of health risk (high, moderate, or low, respectively). Risk profiles were based on baseline HbA1c, blood pressure, smoking status, alcohol use, and depression questionnaire scores.

The CHWs monitored patients' HbA1c levels, encouraged medication adherence and attendance of clinic appointments, and provided education on diet and exercise based on educational materials developed by the researchers.

After 12 months, the mean HbA1c was significantly lower in the intervention group than in the usual care group, after adjustment for baseline HbA1c levels, clustering, and possible confounders. The intervention participants were over twice as likely to achieve a drop in HbA1c of at least 0.5% from baseline than the usual care participants.

The team reports that the effect of treatment on probability for having a clinically significant decrease in HbA1c was modified by baseline health risk level. Among participants at a high health risk, the odds for those in the intervention group achieving a drop in HbA1c of at least 0.5% was 5.4-fold greater than that in the usual care group. For individuals at a low health risk, no significant association was observed.

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