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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...

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Autores principales: Rao, Mayuree, DePue, Judith D., Dunsiger, Shira, Elsayed, Mohammad, Nu'usolia, Ofeira, McGarvey, Stephen T.
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
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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.
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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
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