Type 2 Diabetes Mellitus
Conditions
Keywords
Community health workers, Type 2 diabetes mellitus, Rural, Hispanic, telehealth, mentor, low-income, implementation, education, access to care
Brief summary
The goal of this study is to evaluate a Community Health Worker (CHW) program for people living with diabetes in rural areas or locations that are remote from the research team. The study aims to answer the following questions: 1. Does the CHW program improve diabetes-related health outcomes, such as blood sugar control? 2. What is the sustainability of the program? 3. Is the program feasible and acceptable? Participants will be invited to attend monthly diabetes education classes led by CHWs and receive weekly mobile health check-ins from CHWs for coaching and to help coordinate care with their clinic team.
Detailed description
Background: Type 2 diabetes disproportionately affects low-income and Hispanic populations, who face barriers such as limited literacy, poverty, and lack of insurance. Prevalence is projected to rise, worsening disparities and increasing healthcare costs. Community Health Workers (CHWs) have been shown to improve diabetes outcomes by bridging patients and healthcare systems. Tele-mentoring CHWs allows interventions to be scaled geographically, but effectiveness in real-world clinics remains to be evaluated. Objective & Aims: This 12-month, single-arm study implements a CHW-delivered diabetes intervention in community clinics distant from the parent research team. Aim 1: Evaluate participant clinical outcomes (primary: HbA1c; secondary: blood pressure, cholesterol, BMI, and ADA adherence measures). Aim 2: Monitor program sustainability through 36 months at the clinic level. Aim 3: Assess implementation outcomes, including CHW knowledge, participant satisfaction, and attrition. Inclusion/Exclusion: Inclusion: Hispanic, Spanish-speaking adults ≥18 with type 2 diabetes and recent HbA1c. Exclusion: Conditions affecting HbA1c, severe cognitive/mental illness, pregnancy, type 1 diabetes. Study Design & Procedures: Design: Single-arm study; all consenting participants receive the intervention. Recruitment: Clinic database search (ICD-10 E11.x) and provider referrals; verbal consent obtained. Intervention Phases: Clinic readiness assessment CHW training via telehealth Tele-mentored CHW delivery of 12-month program (group classes, weekly mHealth coaching, participant-clinician feedback loop) Sustainability assessment through month 36 CHWs: Hispanic, Spanish-fluent, trained and certified; supported by experienced CHW instructors. Safety: CHWs identify urgent issues for clinicians; standard diabetes care guidelines followed; HIPAA compliance ensured.
Interventions
BEHAVIORALCommunity Health Worker-led diabetes program
The intervention consists of four phases: (1) clinic readiness assessment, (2) CHW training, (3) tele-mentoring CHWs to deliver the 12-month diabetes program, and (4) sustainability assessment through 36 months.
Sponsors
The University of Texas Medical Branch, Galveston
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Self-identified Hispanic Ethnicity * Spanish-speaking * Type 2 diabetes diagnosis, .g., physician documented diagnosis, HbA1c at least 6.5, treatment with a glucose-lowering agent
Exclusion criteria
* Condition known to alter HbA1c levels, e.g., recent transfusion, systemic steroids * Severe mental illness or cognitive impairment that would preclude participation in group activities * Pregnancy during the intervention period * Type 1 diabetes mellitus
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Hemoglobin A1c (HbA1c) | baseline to 12 months | Change in glycemic control measured by hemoglobin A1c (HbA1c). HbA1c values will be collected at baseline and follow-up visits. Change will be calculated as the difference between baseline and post-intervention HbA1c levels. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Blood Pressure | baseline to 12 months | Change in systolic and diastolic blood pressure measured using standard clinical procedures. Blood pressure readings will be obtained at baseline and follow-up visits. Change will be calculated as the difference between baseline and post-intervention values. |
| Change in Cholesterol Levels | baseline to 12 months | Change in lipid profile including total cholesterol, LDL, HDL, and triglycerides. Laboratory values will be collected at baseline and follow-up visits. Change will be calculated as the difference between baseline and post-intervention levels. |
| Change in Body Weight | baseline to 12 months | Change in body weight measured in kilograms using a calibrated scale. Measurements will be collected at baseline and follow-up visits. Change will be calculated as the difference between baseline and post-intervention weight. |
| Change in Body Mass Index (BMI) | baseline to 12 months | Change in body mass index (BMI), calculated as weight in kilograms divided by height in meters squared (kg/m²). BMI will be assessed at baseline and follow-up visits. Change will be calculated as the difference between baseline and post-intervention BMI. |
| Adherence to American Diabetes Association (ADA) Standards of Care | baseline to 12 months | Adherence to ADA Standards of Care will be assessed based on predefined clinical indicators (e.g., HbA1c monitoring, blood pressure control, lipid management, and recommended screenings). Adherence will be evaluated using medical record review and/or standardized assessment tools. |
Contacts
CONTACTValeria Lescano Ventura
PRINCIPAL_INVESTIGATORElizabeth M. Vaughan, DO, MPH
University of Texas
Outcome results
None listed