Self-Management Interventions Could Improve Outcomes for Low-Income Diabetics

A study assessed the effectiveness of a support intervention delivered by community health workers (CHWs) in the homes of low-income diabetics and found that it may have improved outcomes for those with poor glycemic control.

Prior research has suggested that CHW interventions can successfully help people with diabetes learn and use self-management strategies. The researchers involved in the recent study set out to determine the effectiveness of a low-intensity CHW intervention targeting low-income adults with diabetes, and published their findings in Preventing Chronic Disease.

The 145 participants assigned to the intervention received home visits (4 mandatory and 1 optional) from CHWs, who worked with them to set health goals and create an action plan to manage their diabetes. At each visit, the CHWs also conducted a structured interview to assess the current level of diabetes self-management and completed encounter forms to document the outcome of the visit. The study participants not receiving the intervention received their usual diabetes care.

The primary outcome measured at follow-up, glycated hemoglobin (A1C) levels, did not significantly change from the pre-study baseline in the intervention group compared with the controls. However, when restricting the analysis to the participants who had a baseline A1C value greater than 10%, the intervention group’s A1C levels decreased significantly more than those of the control group, suggesting that the CHW intervention was more effective for patients who had poor glycemic control prior to the study period.

Secondary outcomes like blood pressure, self-reported quality of life, and number of emergency department visits improved slightly more for the intervention participants, but the differences did not achieve statistical significance. Self-reported physician visits decreased significantly for the intervention group, and these participants also reported lower levels of social burden than the control group.

The researchers pointed to some strengths of the study, like its applicability in a “real world” setting that reached low-income, racially diverse participants. They acknowledged that their research had some limitations, like the small sample size, some reliance on self-reported data, and only utilizing 2 CHWs.

They recommended several ways the CHW intervention could be modified to potentially produce more significant results, such as adding more frequent home visits and outreach efforts from CHWs. They also suggested that combining the intervention with coordinated primary care services would strengthen its positive effects. Nonetheless, they felt the intervention had shown promising results in helping people with severe hypoglycemia manage their health.

“We found that it is feasible to deliver a CHW intervention using the health department as a hub to service multiple safety-net providers,” they concluded. “Next steps would include increasing intensity or enhancing care coordination to improve the effectiveness of the intervention in those with less severe hyperglycemia.”