Family-Focused Intervention Produces Positive Health Outcomes for African Americans With Type 2 Diabetes

Natasha Greene, PhD, FNP, BC, created an innovative way to give low-income African Americans lessons in diabetes self-management, but the study participants taught her a few things, too.

Dr Greene, an assistant professor of Nursing at North Carolina Central University, is the principal investigator for the Diabetes Family Project, which aims to tackle the high rates of type 2 diabetes mellitus (T2DM) and early deaths by addressing the cultural challenges of behavioral change. Specifically, Dr Greene and her team realized that getting the person with T2DM to eat properly means educating others in the house who prepare meals or influence what the family eats.

She presented her findings at the session, “Effective Strategies for Overcoming Barriers in Self-Management,” which took place Sunday during the 75^th Scientific Sessions of the American Diabetes Association in Boston. Her study, “Effect of Family-Focused DSME on Physiological Outcomes in African Americans with Type 2 Diabetes,” found that having an influential family member—typically the spouse—take a diabetes education course alongside the person with T2DM produced measurable, positive health outcomes, compared with a control group of T2DM patients who took the course without a family member.

The research team trained 5 community lay persons and 2 dieticians in curricula that included 3 classes about diabetes, 1 about exercise, and 4 classes devoted to nutrition. T2DM participants had to be at least 40 years old and diagnosed for at least 1 year. The team recruited participants from a rural area of North Carolina to take part in the study, either in the intervention or control group. That’s when the surprises began.

Dr Greene said recruitment took place in churches, community centers, and even in local restaurants that served families. “We emphasized that this was something that was for the family and about the family,” she said. To get spouses to take part, Dr Greene said they were told, “It’s so that you can be healthier, too.”

When the research team held its first meeting with the participants, 74 families were scheduled to show up. Instead, 80 appeared. Word had spread.

Fifty-two couples began the intervention, with the other T2DM patients taking the education course as individuals. The mean age of the participants was 58.8 years, and the average income was $21,000 a year.

Each of the 8 weekly classes took 90 minutes, and participants completed surveys to evaluate the content, the educator’s presentation skills, and to test their knowledge. Focus groups were done 3 weeks after the end of the course. Health measurements were taken at baseline and 3 months after the completion of the course.

Results. Forty-eight couples completed the intervention, attending at least 6 of the 8 classes. Participants scored 27 of 28 on the course’s design, content, objectives, and teachers’ knowledge as highly acceptable. Health measurements (averages) for the intervention group compared with the control group were as follows:

· Glycated hemoglobin. The intervention group went from 8.1% at baseline to 7.8% at follow-up; the control group went from 7.8% at baseline to 7.7% at follow-up.

· Blood pressure (BP). Systolic BP for the intervention group went from 154.2 to 139.5; systolic BP for the control group went from 146.3 to 140.2. Diastolic BP for the intervention group went from 75.0 to 69. Diastolic BP for the control group went from 72.2 to 73.5.

· LDL cholesterol. For the intervention, from 106.0 to 96.3; for the control group, from 95.0 to 99.0.

Dr Greene credited the teaching methods, which taught the intervention group how to resolve conflicts over food preparation with real-life scenarios. “We asked them to think about it and work it out,” she said. The results show that for the African American community, having persons with T2DM take diabetes classes with a family member can be “feasible, acceptable, and more beneficial,” than having patients take classes alone.

But did the participants gain knowledge about diabetes? Well, yes, Dr Greene said, but the data are problematic. As she went through the test results, it became apparent that the couples in the intervention group were sharing answers, as their results, “correlated perfectly.” Going forward, Dr Greene will separate couples during the test. “I call it, ‘new investigator learning curve,’ ” she said.

Funding for the Diabetes Family Project comes from the National Institute of Minority Health and Health Disparities P20 grant.

Reference

Greene N, Eaton S, Hoag J. Effect of family-focused DSME on physiological outcomes in African Americans with type 2 diabetes. Diabetes. 2015; 64(suppl1) abstract 204-OR.