Rosal Milagros C, Olendzki Barbara, Reed George W, Gumieniak Olga, Scavron Jeffrey, Ockene Ira
University of Massachusetts Medical School, Preventative and Behavioural Medicine, Worcester, MA 01655, USA.
Ann Behav Med. 2005 Jun;29(3):225-35. doi: 10.1207/s15324796abm2903_9.
The prevalence of type 2 diabetes and diabetes-related morbidity and mortality is higher among low-income Hispanics when compared to that of Whites. However, little is known about how to effectively promote self-management in this population.
The objectives were first to determine the feasibility of conducting a randomized clinical trial of an innovative self-management intervention to improve metabolic control in low-income Spanish-speaking individuals with type 2 diabetes and second to obtain preliminary data of possible intervention effects.
Participants for this pilot study were recruited from a community health center, an elder program, and a community-wide database developed by the community health center, in collaboration with other agencies serving the community, by surveying households in the entire community. Participants were randomly assigned to an intervention (n = 15) or a control (n = 10) condition. Assessments were conducted at baseline and at 3 months and 6 months postrandomization. The intervention consisted of 10 group sessions that targeted diabetes knowledge, attitudes, and self-management skills through culturally specific and literacy-sensitive strategies. The intervention used a cognitive-behavioral theoretical framework.
Recruitment rates at the community health center, elder program, and community registry were 48%, 69%, and 8%, respectively. Completion rates for baseline, 3-month, and 6-month assessments were 100%, 92%, and 92%, respectively. Each intervention participant attended an average of 7.8 out of 10 sessions, and as a group the participants showed high adherence to intervention activities (93% turned in daily logs, and 80% self-monitored glucose levels at least daily). There was an overall Group x Time interaction (p = .02) indicating group differences in glycosylated hemoglobin over time. The estimated glycosylated hemoglobin decrease at 3 months for the intervention group was -0.8% (95% confidence intervals = -1.1%, -0.5%) compared with the change in the control group (p = .02). At 6 months, the decrease in the intervention group remained significant, -0.85% (95% confidence intervals = -1.2, -0.5), and the decrease was still significantly different from that of the controls (p = .005). There was a trend toward increased physical activity in the intervention group as compared to that of the control group (p = .11) and some evidence (nonsignificant) of an increase in blood glucose self-monitoring in the intervention participants but not the control participants. Adjusting for baseline depressive scores, we observed a significant difference in depressive symptoms between intervention participants and control participants at the 3-month assessment (p = .02).
Low-income Spanish-speaking Hispanics are receptive to participate in diabetes-related research. This study shows that the pilot-tested diabetes self-management program is promising and warrants the conduct of a randomized clinical trial.
与白人相比，低收入西班牙裔人群中2型糖尿病的患病率以及与糖尿病相关的发病率和死亡率更高。然而，对于如何在这一人群中有效促进自我管理却知之甚少。
目标一是确定开展一项创新性自我管理干预随机临床试验以改善低收入说西班牙语的2型糖尿病患者代谢控制的可行性，目标二是获取可能的干预效果的初步数据。
该试点研究的参与者是从一个社区健康中心、一个老年项目以及该社区健康中心与服务该社区的其他机构合作开发的全社区数据库中招募的，通过对整个社区的家庭进行调查。参与者被随机分配到干预组（n = 15）或对照组（n = 10）。在基线、随机分组后3个月和6个月进行评估。干预包括10次小组会议，通过文化特定且对读写能力敏感的策略，针对糖尿病知识、态度和自我管理技能展开。干预采用认知行为理论框架。
社区健康中心、老年项目和社区登记处的招募率分别为48%、69%和8%。基线、3个月和6个月评估的完成率分别为100%、92%和92%。每位干预组参与者平均参加了10次会议中的7.8次，作为一个群体，参与者对干预活动表现出高度依从性（93%提交了每日日志，80%至少每天自我监测血糖水平）。存在总体的组×时间交互作用（p = .02），表明糖化血红蛋白随时间存在组间差异。干预组在3个月时糖化血红蛋白估计下降-0.8%（95%置信区间 = -1.1%，-0.5%），而对照组的变化为（p = .02）。在6个月时，干预组的下降幅度仍然显著，为-0.85%（95%置信区间 = -1.2，-0.5），且下降幅度仍与对照组有显著差异（p = .005）。与对照组相比，干预组有身体活动增加的趋势（p = .11），并且有一些证据（不显著）表明干预组参与者而非对照组参与者的血糖自我监测有所增加。调整基线抑郁评分后，我们观察到在3个月评估时干预组参与者和对照组参与者在抑郁症状方面存在显著差异（p = .02）。
低收入说西班牙语的西班牙裔人群愿意参与糖尿病相关研究。本研究表明，经过试点测试的糖尿病自我管理项目很有前景，值得开展一项随机临床试验。
