Effective Diabetes Management Possible in Disadvantaged Population

"In the U.S., Latino individuals have a high prevalence of diabetes and are often poor and uninsured," Dr. Anne Peters, of the University of Southern California Keck School of Medicine, Los Angeles, and colleagues write. "Research needs to be done to develop cost-effective, ethnically appropriate diabetes programs for these vulnerable individuals."

The researchers implemented a diabetes-management program in a center that served low-income Latino patients in east Los Angeles. They previously showed that while the program improves short-term outcomes, the improvement is often not sustained, so the team sought to identify correlates of success.

Patients were randomized to either an episodic model of care or a continuous model of care. After the same first 6 months of care, those in the episodic group were to be discharged and returned annually for an evaluation, while those in the continuous model were seen at least every 3 months for 2 years.

Of 211 eligible patients, 162 were enrolled. Ultimately, the number of visits was the same in both groups, "erasing the separation between the models," Dr. Peters and colleagues explain.

They report that mean A1C values fell by approximately 1% at 6 and 12 months in both groups. Overall, 62% patients achieved the A1C target of <8%.

"Patients in the group with 8% A1C group."

Adherence to metformin was significantly predictive of reaching the target A1C level (odds ratio = 19.31; p = 0.01).
Even though the patients could obtain their prescriptions for free in the same place where they were seen for care, the researchers say that "incorporating new approaches to enhance adherence might help improve outcomes."
Diabetes Care 2009;32:54-56.