Latinos understanding the need for adherence in diabetes (LUNA-D): a randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes

Abstract We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adult...

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Published inTranslational behavioral medicine Vol. 11; no. 9; pp. 1665 - 1675
Main Authors Talavera, Gregory A, Castañeda, Sheila F, Mendoza, Paulina M, Lopez-Gurrola, Maria, Roesch, Scott, Pichardo, Margaret S, Garcia, Melawhy L, Muñoz, Fatima, Gallo, Linda C
Format Journal Article
LanguageEnglish
Published US Oxford University Press 01.09.2021
Subjects
Blood Pressure
Care and treatment
Community health services
Culturally Competent Care
Diabetes Mellitus, Type 2 - therapy
Diagnosis
Evaluation
Female
Glycated Hemoglobin A
Glycosylated hemoglobin
Health aspects
Health Equity
Hispanic Americans
Hispanic or Latino
Humans
Male
Measurement
Medication Adherence
Patient compliance
Patient Education as Topic
Risk factors
Self-Management
Type 2 diabetes
United States
Type 2 diabetes
Integrated care
Latinos
Team care
Community health centers
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Abstract Abstract We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23–80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = −0.32, p < .01, 95% CI −0.49, −0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = −0.35, p = <.01) versus Usual Care (ΔHbA1c = −0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p < .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.
AbstractList Abstract We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23–80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = −0.32, p < .01, 95% CI −0.49, −0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = −0.35, p = <.01) versus Usual Care (ΔHbA1c = −0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p < .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.
We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23-80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbAlc) [greater than or equal to] 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbAlc, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbAlc and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = -0.32, p< .01, 95% CI -0.49, -0.15), indicating statistically greater improvement in HbAlc level over 6 months in the Special Intervention group (AHbAlc = -0.35, p = <.01) versus Usual Care (AHbAlc = -0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p < .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting. Keywords Latinos, Team care, Integrated care, Type 2 diabetes, Community health centers
We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23-80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbAlc) [greater than or equal to] 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbAlc, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbAlc and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = -0.32, p< .01, 95% CI -0.49, -0.15), indicating statistically greater improvement in HbAlc level over 6 months in the Special Intervention group (AHbAlc = -0.35, p = <.01) versus Usual Care (AHbAlc = -0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p < .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.
We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23-80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = -0.32, p < .01, 95% CI -0.49, -0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = -0.35, p = <.01) versus Usual Care (ΔHbA1c = -0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p < .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.
We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23–80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = −0.32, p < .01, 95% CI −0.49, −0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = −0.35, p = <.01) versus Usual Care (ΔHbA1c = −0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p < .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.
Audience Academic
Author Mendoza, Paulina M
Gallo, Linda C
Lopez-Gurrola, Maria
Talavera, Gregory A
Castañeda, Sheila F
Garcia, Melawhy L
Muñoz, Fatima
Pichardo, Margaret S
Roesch, Scott
AuthorAffiliation 5 Center for Latino Community Health, Evaluation, and Leadership Training, Department of Health Science, California State University Long Beach , Long Beach, CA , USA
4 Department of Chronic Disease Epidemiology, Yale School of Public Health , New Haven, CT , USA
6 Department of Research, San Ysidro Health , San Diego, CA , USA
1 South Bay Latino Research Center , Chula Vista, CA , USA
3 College of Medicine, Howard University , Washington, DC , USA
2 Department of Psychology, San Diego State University , San Diego, CA , USA
AuthorAffiliation_xml – name: 3 College of Medicine, Howard University , Washington, DC , USA
– name: 1 South Bay Latino Research Center , Chula Vista, CA , USA
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– name: 6 Department of Research, San Ysidro Health , San Diego, CA , USA
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Issue 9
Keywords Type 2 diabetes
Integrated care
Latinos
Team care
Community health centers
Language English
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Snippet Abstract We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income,...
We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking...
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StartPage 1665
SubjectTerms Blood Pressure
Care and treatment
Community health services
Culturally Competent Care
Diabetes Mellitus, Type 2 - therapy
Diagnosis
Evaluation
Female
Glycated Hemoglobin A
Glycosylated hemoglobin
Health aspects
Health Equity
Hispanic Americans
Hispanic or Latino
Humans
Male
Measurement
Medication Adherence
Patient compliance
Patient Education as Topic
Risk factors
Self-Management
Type 2 diabetes
Title Latinos understanding the need for adherence in diabetes (LUNA-D): a randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes
URI https://www.ncbi.nlm.nih.gov/pubmed/34057186
https://pubmed.ncbi.nlm.nih.gov/PMC8442567
Volume 11
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