206884 Role of education programs in mediating disparities in glycemic control

Monday, November 9, 2009: 4:30 PM

Suad F. Ghaddar, PhD , South Texas Border Health Disparities Center, University of Texas-Pan American, Edinburg, TX
Cynthia J. Brown, PhD , Office of Graduate Studies and Academic Centers, University of Texas-Pan American, Edinburg, TX
José A. Pagán, PhD , Department of Health Management and Policy, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX
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.

Learning Objectives:
1. Identify the determinants of glycemic control in U.S.-Mexico border communities. 2. Assess whether participation in education-based chronic disease prevention programs can help reduce glycemic control disparities that stem from lack of health insurance coverage.

Keywords: Diabetes, Insurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been involved with the evaluation component of Alliance for a Healthy Border since its inception and over its 3 year duration.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Pfizer, Inc. Evaluation Independent Contractor (contracted research and clinical trials)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.