EDUCATION AND GROUP SUPPORT FOR DIABETIC HISPANICS

2型糖尿病在墨西哥裔美国人中的患病率是非西班牙裔白人的三到五倍，分别位居西班牙裔女性和男性的第三和第四大死因。在得克萨斯州斯塔尔县，2型糖尿病影响着50%的西班牙裔成年人口。斯塔尔县糖尿病教育研究(1994-1998)致力于通过一项与文化相关的、基于社区的干预措施，改善墨西哥裔美国糖尿病患者及其家人的健康：(1)三个月的营养、家庭血糖监测、锻炼等指导；(2)九个月的团体支持，以促进行为改变。干预效果的主要指标是糖尿病知识和健康信念、健康行为、糖化血红蛋白和空腹血糖。初步研究结果表明，干预对代谢控制有积极的影响，在统计学上和临床上都有重要意义。干预1年后第3个月HbA1c和FBS显著降低，并维持在6个月和1年。拟议的延续将对目前为期一年的干预措施的三个月版本进行调整和测试，以确定适用于临床实践的缩短版本是否在这些墨西哥裔美国人中获得同样积极的健康结果。为了确定当前策略的关键组成部分，调查人员将与当前研究的对象举行焦点小组，以探索那些成功地整合了干预的自我护理组成部分的人和那些在代谢控制方面经历了显著改善的人与那些不那么成功的人之间的差异。在焦点小组之后，将采用前瞻性、纵向、随机、前测/后测控制组设计对当前干预进行修订和测试。256名糖尿病患者及其家属将被随机分配到短期干预(治疗)或为期一年的干预(对照)。此外，还将测试一个预测模型，以解释接受纵向护理和压缩护理的受试者的代谢控制情况。拟议的延续是将这一文化上适当的干预措施转化为临床实践的关键一步。

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.