Coleman Chad M, Bossick Andrew S, Zhou Yueren, Hopkins-Johnson Linda, Otto Mira G, Nair Anupama S, Willens David E, Wegienka Ganesa R
Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, MI 48202, USA.
Academic Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
Prev Med Rep. 2020 Nov 27;21:101267. doi: 10.1016/j.pmedr.2020.101267. eCollection 2021 Mar.
The burden of diabetes is higher in urban areas and among racial and ethnic minorities. The purpose of this research was to evaluate the effectiveness of extending a diabetes intervention program (DIP) by engaging a team, including a community health worker (CHW), to provide care for patients to meet glycemic control, specifically in a predominantly urban, minority patient population. The DIP enrolled diabetic patients from an internal medicine clinic. A CHW facilitated the collection of glucose meter readings. The CHW coached patients on glycemic control while the CHW's registered nurse partner titrated the patient's recommended insulin dose. Subsequent HbA1c values for participants were compared to those seen at the same clinic who were not enrolled. The DIP was deployed for nine months. One hundred forty-four patients were enrolled in the DIP and 348 patients constituted the comparator group. Ninety-three DIP participants had pre- and post-intervention HbA1c values and were compared to 348 non-DIP participants. Propensity score weighted adjusted analyses suggest that participants were more likely to reduce their HbA1c values by at least 1.0% and have HbA1c values of less than 8.0% (64 mmol/mol) than non-participants (adjusted odds ratio = aOR = 1.47, 95% CI 1.26-1.71, and aOR = 1.23, 95% CI 1.06-1.43, respectively). CHW coaches as part of a team in a clinical setting improved glycemic control in a predominantly urban, minority patient population.
糖尿病负担在城市地区以及种族和少数民族中更高。本研究的目的是评估通过组建一个团队（包括一名社区卫生工作者）来扩展糖尿病干预项目（DIP）的有效性，该团队为患者提供护理以实现血糖控制，特别是在以城市为主的少数族裔患者群体中。DIP从一家内科诊所招募糖尿病患者。一名社区卫生工作者协助收集血糖仪读数。社区卫生工作者指导患者进行血糖控制，同时其注册护士搭档调整患者推荐的胰岛素剂量。将参与者随后的糖化血红蛋白（HbA1c）值与同一家诊所未参与该项目的患者的HbA1c值进行比较。DIP实施了九个月。144名患者参与了DIP，348名患者构成对照组。93名DIP参与者有干预前后的HbA1c值，并与348名非DIP参与者进行比较。倾向评分加权调整分析表明，与非参与者相比，参与者更有可能将其HbA1c值至少降低1.
