Cargando…
Long-Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa
INTRODUCTION: Diabetes Care in American Samoa (DCAS) was a randomized controlled trial of a 12-month intervention facilitated by community health workers (CHWs) that demonstrated improved HbA1c levels compared with usual care at trial completion. We sought to evaluate the long-term impact of this in...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Centers for Disease Control and Prevention
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617456/ https://www.ncbi.nlm.nih.gov/pubmed/26491815 http://dx.doi.org/10.5888/pcd12.150160 |
_version_ | 1782396798094016512 |
---|---|
author | Rao, Mayuree DePue, Judith D. Dunsiger, Shira Elsayed, Mohammad Nu'usolia, Ofeira McGarvey, Stephen T. |
author_facet | Rao, Mayuree DePue, Judith D. Dunsiger, Shira Elsayed, Mohammad Nu'usolia, Ofeira McGarvey, Stephen T. |
author_sort | Rao, Mayuree |
collection | PubMed |
description | INTRODUCTION: Diabetes Care in American Samoa (DCAS) was a randomized controlled trial of a 12-month intervention facilitated by community health workers (CHWs) that demonstrated improved HbA1c levels compared with usual care at trial completion. We sought to evaluate the long-term impact of this intervention on diabetes control. METHODS: We retrospectively collected HbA1c measurements from medical records of DCAS participants (n = 268). The study group received the intervention during the trial, and the control group received the intervention after the trial. We used mixed-effects longitudinal regression models to assess change in HbA1c within each trial arm during 3 time periods: DCAS (12 months of the study group’s intervention), the first year after DCAS (control group’s intervention), and the second year after DCAS. Models were adjusted for baseline characteristics that differed significantly for participants with a low number of HbA1c measurements from those with a high number of HbA1c measurements. RESULTS: After adjustment for confounders, the experiment group experienced a decrease in HbA1c of 0.28 units per year (95% confidence interval [CI], −0.64 to 0.07) during DCAS (intervention). HbA1c decreased by 0.88 units per year (95% CI, −1.31 to −0.45) during the year after the intervention. No significant change was observed the following year. HbA1c of the control group did not significantly change during DCAS (usual care) but decreased by 1.31 units per year (95% CI, −1.72 to −0.91) during its intervention. During the year after the control group’s intervention, HbA1c increased by 1.18 units per year (95% CI, 0.42 to 1.93). CONCLUSION: Both groups had initial improvements in glycemic control, but HbA1c later plateaued or increased. These results suggest that time-limited CHW programs improve diabetes control in the short term, but ongoing programs are needed for sustained impact. |
format | Online Article Text |
id | pubmed-4617456 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Centers for Disease Control and Prevention |
record_format | MEDLINE/PubMed |
spelling | pubmed-46174562015-11-02 Long-Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa Rao, Mayuree DePue, Judith D. Dunsiger, Shira Elsayed, Mohammad Nu'usolia, Ofeira McGarvey, Stephen T. Prev Chronic Dis Original Research INTRODUCTION: Diabetes Care in American Samoa (DCAS) was a randomized controlled trial of a 12-month intervention facilitated by community health workers (CHWs) that demonstrated improved HbA1c levels compared with usual care at trial completion. We sought to evaluate the long-term impact of this intervention on diabetes control. METHODS: We retrospectively collected HbA1c measurements from medical records of DCAS participants (n = 268). The study group received the intervention during the trial, and the control group received the intervention after the trial. We used mixed-effects longitudinal regression models to assess change in HbA1c within each trial arm during 3 time periods: DCAS (12 months of the study group’s intervention), the first year after DCAS (control group’s intervention), and the second year after DCAS. Models were adjusted for baseline characteristics that differed significantly for participants with a low number of HbA1c measurements from those with a high number of HbA1c measurements. RESULTS: After adjustment for confounders, the experiment group experienced a decrease in HbA1c of 0.28 units per year (95% confidence interval [CI], −0.64 to 0.07) during DCAS (intervention). HbA1c decreased by 0.88 units per year (95% CI, −1.31 to −0.45) during the year after the intervention. No significant change was observed the following year. HbA1c of the control group did not significantly change during DCAS (usual care) but decreased by 1.31 units per year (95% CI, −1.72 to −0.91) during its intervention. During the year after the control group’s intervention, HbA1c increased by 1.18 units per year (95% CI, 0.42 to 1.93). CONCLUSION: Both groups had initial improvements in glycemic control, but HbA1c later plateaued or increased. These results suggest that time-limited CHW programs improve diabetes control in the short term, but ongoing programs are needed for sustained impact. Centers for Disease Control and Prevention 2015-10-22 /pmc/articles/PMC4617456/ /pubmed/26491815 http://dx.doi.org/10.5888/pcd12.150160 Text en https://creativecommons.org/licenses/by/4.0/This is a publication of the U.S. Government. This publication is in the public domain and is therefore without copyright. All text from this work may be reprinted freely. Use of these materials should be properly cited. |
spellingShingle | Original Research Rao, Mayuree DePue, Judith D. Dunsiger, Shira Elsayed, Mohammad Nu'usolia, Ofeira McGarvey, Stephen T. Long-Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa |
title | Long-Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa |
title_full | Long-Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa |
title_fullStr | Long-Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa |
title_full_unstemmed | Long-Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa |
title_short | Long-Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa |
title_sort | long-term impact of a community health worker intervention on diabetes control in american samoa |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617456/ https://www.ncbi.nlm.nih.gov/pubmed/26491815 http://dx.doi.org/10.5888/pcd12.150160 |
work_keys_str_mv | AT raomayuree longtermimpactofacommunityhealthworkerinterventionondiabetescontrolinamericansamoa AT depuejudithd longtermimpactofacommunityhealthworkerinterventionondiabetescontrolinamericansamoa AT dunsigershira longtermimpactofacommunityhealthworkerinterventionondiabetescontrolinamericansamoa AT elsayedmohammad longtermimpactofacommunityhealthworkerinterventionondiabetescontrolinamericansamoa AT nuusoliaofeira longtermimpactofacommunityhealthworkerinterventionondiabetescontrolinamericansamoa AT mcgarveystephent longtermimpactofacommunityhealthworkerinterventionondiabetescontrolinamericansamoa |