EDUCATION AND GROUP SUPPORT FOR DIABETIC HISPANICS

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Type 2 diabetes is three to five times more prevalent in Mexican Americans than in non-Hispanic whites and ranks as the third and fourth leading cause of death in Hispanic females and males, respectively. In Starr County, Texas, type 2 diabetes affects 50 percent of the adult Hispanic population. The Starr County Diabetes Education Study (1994-1998) sought to improve the health of diabetic Mexican Americans and their families with a culturally-relevant, community-based intervention of: (1) three months of instruction on nutrition, home glucose monitoring, exercise, etc.; and (2) nine months of group support to promote behavioral changes. Primary indicators of intervention effectiveness were diabetes knowledge and health beliefs, health behaviors, HbA1c, and FBS. Preliminary findings suggested that the intervention had a positive impact, statistically and clinically significant, on metabolic control. HbA1c and FBS were reduced significantly by the third month of the one-year intervention, and these changes were maintained at six-months and at one-year. The proposed continuation will adapt and test a three-month version of the current one-year intervention to determine if the shortened version, applicable to clinical practice, attains the same positive health outcomes in this Mexican American population. To identify key components of the current strategy, investigators will hold focus groups with subjects of the current study to explore differences between those who successfully integrated self-care components of the intervention and who experienced significant improvements in metabolic control and those who were not as successful. Following the focus groups, the current intervention will be revised and tested with a prospective, longitudinal, randomized, pretest/posttest control group design. 256 diabetic subjects and their family members will be randomly assigned to the shortened intervention (treatment) or the one-year intervention (control). In addition, a predictive model will be tested to explain metabolic control in subjects receiving longitudinal care versus compressed care. The proposed continuation is a critical step in translating this culturally-appropriate intervention into clinical practice.