Diabetes Care in American Samoa

描述（由申请人提供）：随着美国2型糖尿病患病率的增加，糖尿病的负担更多地福尔斯在护理障碍较大的群体身上，例如语言和文化差异以及经济资源较低。《2010年健康人民》将糖尿病作为消除种族和族裔健康差距的六种疾病之一。这种差异延伸到美属萨摩亚，2002年，18岁以上的成年人糖尿病患者比例为19.6%，而美国成年人为6.4%。在美国，没有关于萨摩亚人糖尿病干预的报道。这项申请的总体目的是通过改进保健提供方法和改进糖尿病自我管理方法，将糖尿病护理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。社区卫生工作者（CHW）经常被用来作为“桥梁”之间的卫生保健服务和病人在贫困的少数民族社区。卫生保健工作者提供文化上适当的卫生教育和工具性社会支持，并为获得保健提供便利，甚至组织，同时还向医疗提供者提供病人信息。我们提出了一项临床试验，以测试CHW和初级保健协调干预措施的有效性，为美属萨摩亚的352名2型糖尿病患者及其家属提供外展，教育和支持。一年随访的结果将包括糖化血红蛋白（HbA1c）、心血管疾病风险因素、饮食和运动行为以及糖尿病护理指南的依从性。这项干预措施以糖尿病护理的最佳临床实践为基础，将有效的战略转化为美属萨摩亚人的做法。良好的糖尿病护理在那里的翻译可能提供一个模式，是潜在的复制在其他少数民族人口遭受糖尿病的负担。

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.