CHWs as Standard Therapy for Diabetes? Implications of the Results from the Mexican-American Trial of Community Health Workers (MATCH)

Community health workers (CHWs) have gained popularity as a vehicle for accessing underserved communities and for involving communities in health initiatives. Their main activities are to provide health education, information, assistance with services, and build individual and community capacity for health. However, rigorous research studies--like those used to approve diabetes medications--on the effectiveness of CHW interventions are lacking, and this limits the ability to fully integrate CHWs into the health care delivery system.

The MATCH trial (Mexican-American Trial of Community Health Workers) was designed to test the hypothesis that CHWs, recruited from the community and trained to provide culturally appropriate diabetes education in the home, can promote pro-active self-management among urban Mexican-Americans with Type2 diabetes mellitus. This randomized controlled trial of 144 adults was recently completed, and results indicated a significant reduction in hemoglobin A1c in participants receiving a CHW intervention, compared to those receiving an attention control. This reduction was sustained over two years. No adverse effects were documented, and full costs of the CHW intervention were lower than most newly introduced diabetes medications.

The MATCH trial used the methodologic rigor and blinded assessments required for approval of new medical therapies. This trial provides strong evidence that CHW interventions are an effective, safe therapy for diabetes management. Implications of these results for medical and public health practice, including costs, resource needs and long-term benefits to overall patient health will be discussed. We will also discuss needs for additional research and moving research into policy.