Culturally Specific Diabetes Management Helps Low-Income Patients
Diabetes case management that takes a patient’s specific culture into consideration can help increase life expectancy and decrease the incidence of diabetes-related complications over the patient’s lifetime, a new study finds.
“Better management results in reduced long-term complications, such as blindness, stroke, amputation and nerve damage,” said lead researcher Todd Gilmer, Ph.D.
The research focused on 3,893 people with diabetes who participated in San Diego’s Project Dulce, which set out to meet American Diabetes Association standards of care. The target population was primarily low-income, underinsured Latino people.
Study participants showed “clinically significant improvements in A1c, blood pressure, low-density lipoprotein and triglycerides,” said Gilmer, an associate professor in the department of family and preventive medicine at the University of California, San Diego.
Hemoglobin A1c — a measure of how well patients control their blood glucose — low-density lipoprotein (“bad cholesterol”) and blood pressure are commonly managed risk factors among diabetes patients.
The study appears in the latest online issue of Health Services Research.
The clinical team included a registered nurse/certified diabetes educator and a medical assistant and a registered dietitian who were bilingual and bicultural. Patients underwent an initial 50-minute visit with a nurse and were asked to return for additional visits. They also had a 25-minute visit with the dietitian and were called by team members for appointment reminders.
Patients also participated in a group self-management training program consisting of an eight-week curriculum delivered by trained peer educators who had diabetes themselves and were of the same cultural or ethnic group as the participants.
The researchers used the resulting clinical and cost data in what Gilbert describes as “a model that simulates long-term effects of implementing health policies for the management of diabetes.” The model estimates the number of years of life patients gain from treatment — adjusted for quality of life — for the amount spent to deliver the treatment.
Direct medical costs over a patient’s lifetime were higher for patients who received case-management and self-management training help. Nevertheless, a further breakdown showed that about one-third of the additional costs of implementing the intervention were offset by reduced expenses of diabetes-related complications over patients’ lifetimes.
“If these individuals live longer without these complications … it gives them a higher quality of life,” Gilmer said. “It is worth it.”
“Strategies such as [those used in the study] should help our awareness of the needs to reach overall goals and prevent long-term complications related to diabetes,” said Julienne Kirk, Pharm.D., an associate professor in the department of family and community medicine at Wake Forest University.
The results of the study should encourage health systems to consider setting up similar case-management and self-management training programs for their high-risk populations, Gilmer said.
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Health Behavior News Service: Lisa Esposito at (202) 387-2829 or hbns-editor@cfah.org.
Health Services Research is the official journal of AcademyHealth and is published by Blackwell Publishing on behalf of the Health Research and Educational Trust. Contact Jennifer Shaw, HSR Business Manager, at (312) 422-2646 or jshaw@aha.org. HSR is available online at www.blackwell-synergy.com/loi/hesr.
Gilmer TP, et al. Cost-effectiveness of diabetes case management for low-income populations. Health Services Research online, 2007.
FOR MORE INFORMATION:
Health Behavior News Service: (202) 387-2829 or www.hbns.org. Center for the Advancement of Health
Health Behavior News Service
Contact: Lisa Esposito, Editor
202.387.2829
hbns-editor@cfah.org
March 19th, 2008 at
This indeed is a welcome change in the way treatement and prevention of the condition is approached. Every culture has its own special cuisine and lifestyle. Most of the cultures have their cuisine and food intake depending on their geographical positioning and style of work but in todays age of globalisation the food requirement of our bodies may not be the same it was 100 years ago. Today we almost never walk more than 5 miles a day whereas in earlier times most of the travelling was done on foot. As walking is an exercise which helps in burning up calories our confortable lifestyles today preserve more of these calories than would be needed. So looking into each culture in a different manner may help in issuing culture specific tips to people for avoiding diabetes.
March 19th, 2008 at
It’s hard to be diabetic since there are lots of maintenance medicines that you need to take. Like insulin and other medicines which are very expensive. It’s great to know that there are organizations who can help low income patients.
March 19th, 2008 at
i agree with you bless, there are need to take more medicines. some times this is not good to health by taking more medicines. i think it is prevented by half the way, not to eating oily foods and sweet and fried recipes.
July 31st, 2008 at
Its not hard to be diabetic but it hard to get control on Diabetes. We have to take proper precautionary methids to control and with regular medical course also we can’t prevent it. The important thing to get control on our Diabetes is through Diabetes Management where we can find more methods and they are very easy like Medications and taking healthy diet with regular medicines.