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Involve community health workers in sensitizing people with low Type 2 diabetes as part of a primary care practice has improved diabetes management, according to a new study published in the journal Annals of Internal Medicine.
Some communities in the United States experience worse diabetes-related outcomes – including members of racial minority groups, people who live in poorer neighborhoods and rural residents. This is true for both type 1 and type 2 diabetes, by some measures. For example, children who are black or who live in poor neighborhoods are more likely to be readmitted to hospital for diabetic ketoacidosis (DKA)a health emergency linked to high blood sugar that is more common in people with type 1 diabetes. Residential racial segregation has been linked to poorer diabetes managementand black rural residents are at particularly high risk of foot amputation due to diabetic foot ulcers. At the same time, rural residents in general have difficulty obtaining high-quality diabetes careand deaths from diabetes in rural areas stay stubbornly high.
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One way to potentially help understand and overcome the barriers people face to better diabetes management – external and internal barriers – is to have a community health worker as part of a primary care practice. According to the latest study, community health workers engage with patients with the goal of “understanding their social context, identifying their goals, navigating health care, and connecting with community resources.” With these goals in mind, researchers examined the effect of community health workers on diabetes management in 946 people with poorly controlled type 2 diabetes who received their care in a primary health care setting.” safety net” – i.e. the practice was aimed at low-income people. At the start of the study, participants had on average A1C level (a measure of long-term blood sugar control) in the range of 10.2% to 10.5%, as noted in an article about the study at Helio.
The researchers wanted to know if the participants progressed through three different stages in the diabetes self-care process – awareness, stabilization and generativity of self-care. “Awareness” simply meant meeting face-to-face with a community health worker to discuss barriers to diabetes management. “Stabilisation” meant working together to find ways to cope with life circumstances that made managing diabetes more difficult. And “self-care generativity” meant becoming better at diabetes self-care.
Engagement with community health workers linked to lower levels of A1C
Of the 946 participants, 27% did not progress beyond the “awareness” stage, while 41% progressed to “stabilization” and 33% reached “self-care generativity”. Over time, moving to an additional stage was also linked to lower A1C. By their fifth A1C measurement in the study — after an average of 859 days, or about two years and four months — participants in different stages began to show differences in A1C, which widened over time. At their tenth A1C measurement — after an average of 1,365 days, or about three years and nine months — participants in the “self-care generativity” group had an average A1C of 8.5%, compared to 8.8% in the “stabilization” group and 9.0% in the “awareness” group. Emergency room visits and hospital admissions were also lower in the self-care generativity group.
The researchers concluded that community health workers linked to primary care practices “can sustainably engage vulnerable patients, helping them achieve their self-management goals in the context of tremendous social disadvantage.” But these results also demonstrate how difficult it can be to engage with disadvantaged people with diabetes in a way that leads to blood sugar control — a problem for which no study is likely to find a simple solution any time soon.
Want to learn more about building a healthcare team? Lily “Your Diabetes Support System.”