Randomized Trial of a Literacy-Sensitive, Culturally Tailored Diabetes Self-Management Intervention for Low-Income Latinos
Latinos en Control
- Milagros C. Rosal, PHD1⇓,
- Ira S. Ockene, MD2,
- Angela Restrepo, MD3,
- Mary Jo White, MS, MPH4,
- Amy Borg, MPH1,
- Barbara Olendzki, RD, MPH1,
- Jeffrey Scavron, MD5,
- Lucy Candib, MD6,
- Garry Welch, PHD7 and
- George Reed, PHD1
- 1Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- 2Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- 3Department of Medicine, Division of Endocrinology, University of Massachusetts Medical Center, Worcester, Massachusetts
- 4Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts
- 5Department of Psychology, Brightwood Health Center/Tufts University, Springfield, Massachusetts
- 6Family Health Services of Worcester, Worcester, Massachusetts
- 7Department of Psychiatry, Baystate Medical Center/Tufts University, Springfield, Massachusetts
- ↵Corresponding author: Milagros C. Rosal, .
OBJECTIVE To test whether a theory-based, literacy, and culturally tailored self-management intervention, Latinos en Control, improves glycemic control among low-income Latinos with type 2 diabetes.
RESEARCH DESIGN AND METHODS A total of 252 patients recruited from community health centers were randomized to the Latinos en Control intervention or to usual care. The primarily group-based intervention consisted of 12 weekly and 8 monthly sessions and targeted knowledge, attitudes, and self-management behaviors. The primary outcome was HbA1c. Secondary outcomes included diet, physical activity, blood glucose self-monitoring, diabetes knowledge and self-efficacy, and other physiological factors (e.g., lipids, blood pressure, and weight). Measures were collected at baseline and at 4- and 12-month follow-up. Change in outcomes over time between the groups and the association between HbA1c and possible mediators were estimated using mixed-effects models and an intention-to-treat approach.
RESULTS A significant difference in HbA1c change between the groups was observed at 4 months (intervention −0.88 [−1.15 to −0.60] versus control −0.35 [−0.62 to 0.07], P < 0.01), although this difference decreased and lost statistical significance at 12 months (intervention −0.46 [−0.77 to −0.13] versus control −0.20 [−0.53 to 0.13], P = 0.293). The intervention resulted in significant change differences in diabetes knowledge at 12 months (P = 0.001), self-efficacy (P = 0.001), blood glucose self-monitoring (P = 0.02), and diet, including dietary quality (P = 0.01), kilocalories consumed (P < 0.001), percentage of fat (P = 0.003), and percentage of saturated fat (P = 0.04). These changes were in turn significantly associated with HbA1c change at 12 months.
CONCLUSIONS Literacy-sensitive, culturally tailored interventions can improve diabetes control among low-income Latinos; however, strategies to sustain improvements are needed.
- Received October 19, 2010.
- Accepted January 11, 2011.
- © 2011 by the American Diabetes Association.
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