Diabetes Care in American Samoa

描述(申请人提供)：随着美国2型糖尿病患病率的增加，糖尿病的负担更多地落在具有更大护理障碍的群体身上，例如语言和文化差异，以及较低的经济资源。2010年《健康人》将糖尿病作为消除种族和民族健康差距的六种疾病之一。这些差距延伸到美属萨摩亚领土，2002年，那里18岁的成年人患有糖尿病的比例为19.6%，而美国成年人的比例为6.4%。在美国，还没有关于萨摩亚人糖尿病干预的报道。这项应用的总体目的是通过改进医疗保健提供方法和改进糖尿病自我管理方法，将糖尿病护理方面的最新进展转化为美属萨摩亚社区的临床实践。我们将使用社区卫生工作者模式来测试扩展的糖尿病护理模式。在贫困的少数民族社区，社区卫生工作者经常被用来充当卫生保健服务和患者之间的桥梁。CHW工作人员提供文化上适当的健康教育和工具性的社会支持和便利，甚至组织获得护理，同时还向医疗提供者提供患者信息。我们建议进行一项临床试验，以测试CHW和初级保健协调干预的有效性，以向美属萨摩亚的352名2型糖尿病患者及其家人提供外展、教育和支持。一年的随访结果将包括糖化血红蛋白(HbA1c)、心血管疾病危险因素、饮食和运动行为，以及对糖尿病护理指南的遵守。该干预措施建立在糖尿病护理的最佳临床实践的基础上，将有效的策略转化为美属萨摩亚人。在那里，良好的糖尿病护理的翻译可能会提供一种模式，这种模式可能会在其他遭受糖尿病负担的少数民族人口中复制。

DESCRIPTION (provided by applicant): As type 2 diabetes prevalence increases in the United States, the burden of diabetes falls more on groups with greater barriers to care, such as language and cultural differences, and lower economic resources. Healthy People 2010 targeted diabetes as one of six diseases for the elimination of racial and ethnic health disparities. These disparities extend to the US Territory of American Samoa, where the proportion of adults >18 years with diabetes was 19.6% in 2002, compared to 6.4% of US adults. There have been no reported diabetes interventions in Samoans in the US. The overall purpose of this application is to translate recent advances in diabetes care into clinical practice for the American Samoan community by improving methods of health care delivery and improve methods of diabetes self management. We will use the community health worker model to test an expanded diabetes care model. Community health workers (CHW) have frequently been used to serve as "bridges" between health care services and patients in poor ethnic minority communities. CHW workers provide culturally appropriate health education and instrumental social support and facilitation, and even organization, of access to care, while also providing patient information to medical providers. We propose a clinical trial to test the effectiveness of a CHW and primary-care coordinated intervention to provide outreach, education and support to 352 type 2 diabetes patients and their families in American Samoa. The outcomes at a one-year follow-up will include glycosolated hemoglobin (HbA1c), cardiovascular disease risk factors, diet and exercise behaviors, and adherence to diabetes care guidelines. The intervention builds upon best clinical practices for diabetes care by translating effective strategies to American Samoans. The translation of good diabetes care there may offer a model that is potentially replicable in other ethnic minority populations suffering the burden of diabetes.