EDUCATION AND GROUP SUPPORT FOR DIABETIC HISPANICS

2型糖尿病在墨西哥裔美国人中的发病率是非西班牙裔白人的三到五倍，分别是西班牙裔女性和男性的第三和第四大死因。在德克萨斯州的斯塔尔县，50%的西班牙裔成年人患有2型糖尿病。斯塔尔县糖尿病教育研究（1994-1998）旨在通过与文化相关的社区干预来改善墨西哥裔美国糖尿病患者及其家庭的健康：(1)三个月的营养指导、家庭血糖监测、运动等；(2) 9个月的团体支持，以促进行为改变。干预效果的主要指标为糖尿病知识与健康信念、健康行为、HbA1c、FBS。初步结果表明，干预对代谢控制具有统计学和临床意义的积极影响。在为期一年的干预的第三个月，HbA1c和FBS显著降低，并且这些变化在6个月和1年后保持不变。拟议的延续将调整和测试目前为期一年的干预措施的三个月版本，以确定适用于临床实践的缩短版本是否在墨西哥裔美国人口中取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，研究人员将与当前研究的受试者进行焦点小组讨论，以探索那些成功整合干预的自我保健组成部分并在代谢控制方面取得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，将对当前的干预措施进行修订，并采用前瞻性、纵向、随机、测试前/测试后对照组设计进行测试。将256名糖尿病患者及其家庭成员随机分为缩短干预组（治疗组）和1年干预组（对照组）。此外，将测试一个预测模型来解释接受纵向护理与压缩护理的受试者的代谢控制。建议的延续是将这种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.