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Culturally Specific Diabetes Management Helps Low-Income Patients

Diabetes case management that takes a patient’s specific culture into consideration can help increase life expectancy// and decrease the incidence of diabetes-related complications over the patient’s lifetime, a new study finds.

"Better management results in reduced long-term complications, such as blindness, stroke, amputation and nerve damage,” said lead researcher Todd Gilmer, Ph.D.

The research focused on 3,893 people with diabetes who participated in San Diego’s Project Dulce, which set out to meet American Diabetes Association standards of care. The target population was primarily low-income, underinsured Latino people.

Study participants showed “clinically significant improvements in A1c, blood pressure, low-density lipoprotein and triglycerides,” said Gilmer, an associate professor in the department of family and preventive medicine at the University of California, San Diego.

Hemoglobin A1c — a measure of how well patients control their blood glucose — low-density lipoprotein (“bad cholesterol”) and blood pressure are commonly managed risk factors among diabetes patients.

The study appears in the latest online issue of Health Services Research.

The clinical team included a registered nurse/certified diabetes educator and a medical assistant and a registered dietitian who were bilingual and bicultural. Patients underwent an initial 50-minute visit with a nurse and were asked to return for additional visits. They also had a 25-minute visit with the dietitian and were called by team members for appointment reminders.

Patients also participated in a group self-management training program consisting of an eight-week curriculum delivered by trained peer educators who had diabetes themselves and were of the same cultural or ethnic group as the participants.

The researchers used the resulting clinical and cost data in what Gilbert describes as “a model that simulates l ong-term effects of implementing health policies for the management of diabetes.” The model estimates the number of years of life patients gain from treatment — adjusted for quality of life — for the amount spent to deliver the treatment.

Direct medical costs over a patient’s lifetime were higher for patients who received case-management and self-management training help. Nevertheless, a further breakdown showed that about one-third of the additional costs of implementing the intervention were offset by reduced expenses of diabetes-related complications over patients’ lifetimes.

“If these individuals live longer without these complications … it gives them a higher quality of life,” Gilmer said. “It is worth it.”

“Strategies such as [those used in the study] should help our awareness of the needs to reach overall goals and prevent long-term complications related to diabetes,” said Julienne Kirk, Pharm.D., an associate professor in the department of family and community medicine at Wake Forest University.

The results of the study should encourage health systems to consider setting up similar case-management and self-management training programs for their high-risk populations, Gilmer said.

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