Results of the Northern Manhattan Diabetes Community Outreach Project: A Randomized Trial Studying a Community Health Worker Intervention to Improve Diabetes Care in Hispanic Adults
- Walter Palmas1⇑,
- Sally E. Findley2,
- Miriam Mejia3,
- Milagros Batista3,
- Jeanne Teresi4,
- Jian Kong4,
- Stephanie Silver4,
- Elaine M. Fleck5,
- Jose A. Luchsinger5 and
- Olveen Carrasquillo6
- 1Columbia University Medical Center, New York, NY
- 2Columbia University Mailman School of Public Health, New York, NY
- 3Alianza, New York, NY
- 4Research Division, Hebrew Home for the Aged at Riverdale, Bronx, NY
- 5Columbia University, New York, NY
- 6Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, FL
- Corresponding author: Walter Palmas, .
OBJECTIVE The Northern Manhattan Diabetes Community Outreach Project evaluated whether a community health worker (CHW) intervention improved clinically relevant markers of diabetes care in adult Hispanics.
RESEARCH DESIGN AND METHODS Participants were adult Hispanics, ages 35–70 years, with recent hemoglobin A1c (A1C) ≥8% (≥64 mmol/mol), from a university-affiliated network of primary care practices in northern Manhattan (New York City, NY). They were randomized to a 12-month CHW intervention (n = 181), or enhanced usual care (educational materials mailed at 4-month intervals, preceded by phone calls, n = 179). The primary outcome was A1C at 12 months; the secondary outcomes were systolic blood pressure (SBP), diastolic blood pressure, and LDL-cholesterol levels.
RESULTS There was a nonsignificant trend toward improvement in A1C levels in the intervention group (from unadjusted mean A1C of 8.77 to 8.40%), as compared with usual care (from 8.58 to 8.53%) (P = 0.131). There was also a nonsignificant trend toward an increase in SBP and LDL cholesterol in the intervention arm. Intervention fidelity, measured as the number of contacts in the intervention arm (visits, phone contacts, group support, and nutritional education), showed a borderline association with greater A1C reduction (P = 0.054). When assessed separately, phone contacts were associated with greater A1C reduction (P = 0.04).
CONCLUSIONS The trend toward A1C reduction with the CHW intervention failed to achieve statistical significance. Greater intervention fidelity may achieve better glycemic control, and more accessible treatment models, such as phone-based interventions, may be more efficacious in socioeconomically disadvantaged populations.
Clinical trial reg. no. NCT00787475, clinicaltrials.gov.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
- Received September 10, 2013.
- Accepted November 27, 2013.
- © 2014 by the American Diabetes Association.
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