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Community health worker intervention ineffective for Latinos with diabetes

A 12-month community health worker intervention lowered hemoglobin A1c levels by only 0.51% among Latinos with poorly controlled type 2 diabetes, and did not lead to improvements in LDL cholesterol levels or systolic BP, according to recent data.

“In the United Sates, Latinos are almost twice as likely as non-Hispanic white individuals to be diagnosed with type 2 diabetes,” Olveen Carrasquillo, MD, MPH, from the departments of medicine and public health at the University of Miami Miller School of Medicine, and colleagues wrote in JAMA Internal Medicine. “Furthermore, nearly three-quarters of the Latino population 45 years and older has type 2 diabetes or prediabetes. Effective strategies for improving health outcomes among this group incorporate culturally tailored multifactorial interventions delivered for longer than 6 months. Most promising are individualized high-intensity interventions that incorporate community health workers (CHWs; also known as lay health workers).”

While there is an extensive amount of data from nonexperimental studies that supports the use of CHWs among Latinos with type 2 diabetes, there is limited evidence from randomized clinical trials, they added.

Researchers compared a CHW intervention with enhanced usual care in a 52-week, randomized clinical trial of 300 Latino adults with type 2 diabetes aged 18 to 65 years, who were treated in two outpatient clinics in Florida between July 1, 2010, and Oct. 31, 2013. Participants had a hemoglobin A1c (HbA1c) level of 8% or higher. The 1-year CHW intervention included home visits, telephone calls and group-level activities. After the intervention, they tested for changes in systolic BP, LDL cholesterol levels and HbA1c levels. They also examined BMI, medication regimen intensification and self-reported measures of diet, physical activity and adherence to medication regimen.

The results showed that compared with participants in the enhanced usual care group, HbA1c level was 0.51% lower in the CHW group (95% CI, –0.94 to –0.08). The investigators found that the reduction in systolic BP was statistically insignificant at 4.62 mm Hg (95% CI, –9.01 to –0.24) and did not meet the preplanned target of 8 mm Hg. The intervention did not significantly change LDL cholesterol levels (mean difference, –8.2 mg/dL; 95% CI, –18.8 to –2.3). There were also no significant differences in BMI, medication regimen intensification and self-reported measures of diet, physical activity and adherence to medication regimen. Analyses performed after the study suggests that the intervention may be more effective among those with poorer control of their type 2 diabetes at baseline.

“Additional studies will need to examine whether CHW interventions affect other important measures such as access to or satisfaction with care,” Carrasquillo and colleagues wrote. “Furthermore, when our findings were presented to community groups, they noted our outcomes focused on physiologic and behavioral measures and did not include measures that may be more important to patients, such as immigration, housing and employment. With increased recognition that social determinants of health have a major effect on population health, future studies evaluating CHW interventions should also include such outcomes.” – by Savannah Demko

Disclosure : The researchers report no relevant financial disclosures.