Improving Diabetes Self Management in Minorities

糖尿病在美国已被确定为一种流行病。S.并且继续增长， 尤其是2型糖尿病。此外，糖尿病的负担，包括患病率和风险， 对于低收入个人和少数群体，特别是拉丁美洲人和非洲人， 美国人《2010年健康人群报告》指出，糖尿病的负担可以通过以下方式减轻： 二级和三级预防以及促进最佳自我管理。很少有对照研究 重点是加强少数民族或其他得不到充分服务的人群的糖尿病自我管理战略。 增加我们的覆盖面和影响力的一种方法是培训非专业人员或准专业人员， 与多学科糖尿病护理团队合作，支持最佳的糖尿病自我管理， 额外的费用。本研究的目的是开发、实施和评估 结合糖尿病自我管理教育、培训和支持的创新干预 医疗助理教练（MAC）提供的病例管理方面，以支持 低收入少数群体的最佳糖尿病自我管理（以及二级和三级预防） 2型糖尿病人群。 这项疗效试验比较了医疗助理自我管理教练（MAC）干预与 “一切照旧”（treatment as usual）。目标人群将形成914名非裔美国人的总样本， 拉丁美洲人在芝加哥的五个联邦合格的健康中心接受护理，为低收入者服务。 拟定研究将采用前瞻性随机化两组裂区重复测量设计。 具体而言，将为2（治疗组：TAU、MAC）× 4（时间：基线、6个月、12个月、18个月） 重复测量设计。MAC干预将根据以下内容单独定制： 跨理论模型和文化定制，包括西班牙语翻译在需要的地方。的MAC 干预措施将在一年内每月提供一次，包括在一年内进行面对面接触， 常规初级保健访问和定期电话辅导联系。主要结局变量为 通过HbA 1C值测量血糖控制。次要结果包括：心理社会中介， 行为结果，以及短期和长期的生物医学结果。如果有效改善血糖 控制和/或糖尿病自我管理的其他措施，这种干预有可能很容易 在为少数群体服务的其他初级保健诊所实施。此外，这一干预措施 帮助控制成本的潜力，同时最大限度地扩大我们的覆盖范围并促进可持续性。

Diabetes has been identified as an epidemic in the U. S. and is continuing to grow in prevalence, especially type 2 diabetes. In addition, the burden of diabetes, including prevalence and risk of complications, is greater for low-income individuals and minority groups, especially Latinos and African Americans. The Healthy People 2010 report notes that the burden of diabetes can be reduced through secondary and tertiary prevention and facilitating optimal self-management. Few controlled studies have focused on strategies to enhance diabetes self-management in minority or other underserved populations. One approach to increasing our reach and impact is to train nonprofessionals or paraprofessionals to work with multidisciplinary diabetes care teams to support optimal diabetes self-management with minimal added expense. The purpose of this study is to develop, implement, and evaluate the impact of an innovative intervention that combines diabetes self-management education, training, andsupport with aspects of case management delivered by Medical Assistant Coaches (MACs), to support optimal diabetes self-management (and secondary and tertiary prevention) in low-income minority populations with type 2 diabetes. This efficacy trial compares the Medical Assistant self-management coach (MAC) Intervention with "treatment as usual" (TAD). The target populations will form a total sample of 914 African Americans and Latinos receiving care at five Federally Qualified Health Centers serving low-income individuals in Chicago. The proposed study will use a prospective randomized two-group split-plot repeated measures design. Specifically, it will be a two (treatment groups: TAU, MAC) by four (time: baseline, 6-month, 12-month, 18- month) repeated measures design. The MAC Intervention will be individually tailored based on the Transtheoretical Model and culturally tailored, including Spanish translation where needed. The MAC intervention will be delivered monthly over a one-year period, including both face-to-face contacts during routine primary care visits and regular telephone coaching contacts. The primary outcome variable will be glycemic control measured by HbA1C values. Secondary outcomes include: psychosocial mediators, behavioral outcomes, and short- and longer term biomedical outcomes. If effective in improving glycemic control and/or other measures of diabetes self-management, this intervention has the potential to be easily implemented in other primary care clinics serving minority populations. Furthermore, this intervention has the potential to help contain costs while maximizing our reach and facilitating sustainability.