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The DIALBEST Trial Among Latinos with Type 2 Diabetes

Structured intervention led by Community Health Workers shows success….

Noticeable discrepancies exist among Latinos American in socioeconomic status, health insurance coverage, and use and quality of healthcare services. Obesity and physical inactivity which is associated with poor diabetes control are more prevalent among this population. A recent study has been conducted to address these issues.

The objective of this study was to help improve glycemic control among Latinos with type 2 diabetes by intervention with healthcare professionals.

The Diabetes Among Latinos Best Practices Trial (DIALBEST) was a parallel community-based randomized control trial. This study targeted Latino adults with type 2 diabetes who attended a community-based ambulatory primary care clinic. Using electronic medical record database, potential baseline candidates were measured. A total of 211 participants were enrolled in this study from December 2006 to February 2009. All participants had written informed consent and contact information were collected prior to this study. Participants were randomly assigned into either the standard of care (n=106) or standard of care plus a 12 month Community Health Worker (CHW)-led intervention (n 105). This intervention provided diabetes education and counseling treatment. In this intervention, educators focused on type 2 diabetes complications, healthy lifestyles, nutrition, healthy food choices, blood glucose self-monitoring, and medication adherence. To confirm this study result, fasting blood glucose and lipid profile were collected at baseline and 3, 6, 12, and 18 months.
Inclusions:
21 years or older, diagnosed of type 2 diabetes for greater than 12 months
Lived in Hartford County, CT
HbA1C levels ≥7% and self-identified as Hispanic/ Latino

Exclusions:

  • Pregnancy or breastfeeding
  • renal failure
  • active cancer
  • active hepatitis
  • advanced cirrhosis
  • ESLD
  • cognitive impairment
  • dementia
  • Alzheimer disease
  • active and severe mental health problems
  • CVD event in 12 months
  • medical conditions that completely limit ability to perform physical activity independently
  • inability to consume meals orally

This study has demonstrated a significant difference in CHW group compared to standard of care group. Results were more significant at the 12 and 18 month visit. However, there was no significant difference on blood lipid levels, hypertension, and weight.

Baseline HbA1C (mean 9.58%), CHWs had a positive result on net HbA1C improvement at 3 months (-0.42%), 6 months (-0.47%), 12 months (-0.57), and 18 months (-0.55%). The overall statistically significant mean difference was – 0.51%, (95% CI -0.83, -0.19)(P= 0.002).

The authors concluded that DIALBEST is an effective intervention for Latinos with type 2 diabetes in improving their blood glucose control.

Practice Pearls:

  • DIALBEST intervention has demonstrated a superiority in improving blood glucose control compared to the standard of care in Latinos American with type 2 diabetes
  • In this study, DIALBEST intervention did not show any significant difference in lowering lipid levels, hypertension, and weight among Latinos American with type 2 diabetes
  • The limitation of this study is that primary provider data were not collected. Therefore, it is possible that CHW and provider that led to the significant result of DIALBEST on improved glycemic control

Perez-Escamilla R, Damio G, Chhabra J, et al. Impact of a Community Health Workers-Led Structured Program on Blood Glucose Control Among Latinos With Type 2 Diabetes: The DIALBEST Trial. Diabetes Care. 2015; 38:197-205