Role of education programs in mediating disparities in glycemic control

The purpose of this study is to determine whether participation in health education programs helps reduce glycemic control disparities that stem from lack of health insurance coverage. The analysis utilizes data from participants in Alliance for a Healthy Border, an education-based prevention program targeting the high incidence of diabetes and heart disease in U.S.-Mexico border communities.

Surveys were administered at baseline and at six months after the intervention to 518 participants diagnosed with diabetes. Forty-eight percent of the program participants were uninsured. Corresponding anthropometric measures, including glycosylated hemoglobin (HbA1c), were also collected. At baseline, 217 participants had poor glycemic control, defined as HbA1c ≥ 8%. Of those, 152 individuals completed the intervention and were available for analysis at six-months. After controlling for socio-demographic and diabetes-related variables, binary logistic regression revealed that individuals with health insurance coverage had a higher likelihood of having controlled diabetes at study entry (OR: 1.88, 95% CI: 1.22-2.88). However, six months after the intervention, health insurance coverage was no longer a significant predictor of glycemic control (OR: 1.08, 95% CI: 0.47-2.46). Diabetes severity, as measured by insulin use, remained as the major factor predicting glycemic control (OR: 0.34, 95% CI: 0.21-0.55 at baseline and OR: 0.23, 95% CI: 0.10-0.55 six months post-intervention).

Diabetes education programs are successful at reducing the effects of disparities that stem from lack of health insurance coverage. While the uninsured were less likely to control their diabetes, participation in such programs neutralized the effect of lack of health insurance coverage.