Background:  High rates of diabetes among Bangladeshi immigrants in the U.S. and U.K. have been documented. However, few culturally- and linguistically-tailored health interventions have been implemented in this community.   Findings are reported from a CDC- & NIH-funded Community Health Worker (CHW) intervention designed to improve diabetic management among Bangladeshis in New York City (NYC). 

Methods:  Participants were recruited from clinic-based settings and randomized to treatment or control group.  Treatment participants received 5 group educational seminars and 2 one-on-one visits from a CHW over a 6-month period.  Control participants received an introductory seminar only.

Results:  Preliminary results include changes from baseline to 6-months for four cohorts.  In the treatment group (n=85), recommended physical activity levels increased from 19% to 57% (p<.001), and self-reported knowledge of A1c increased from 13% to 68% (p<.001).  Additionally, significant reductions in mean weight, BMI, and systolic blood pressure were demonstrated (p<0.05).  In the control group (n=74), no significant changes were demonstrated in the areas of physical activity, nutritional behaviors, or clinical measures between baseline and follow-up.  Retention rates were high; 70% of participants completed the full intervention (8% lost to follow-up).  Final analysis will include quantitative data on five cohorts; qualitative findings will be presented to illuminate specific mechanisms through which CHWs operate to impact behavior change.

Conclusions:   Significant improvements were demonstrated in the treatment group in several areas relevant to diabetes control. Findings suggest that a CHW intervention in this community can be effective.   Results from an additional study cohort, as well as qualitative findings are forthcoming.

A Community Health Worker (CHW)-centered intervention was implemented to identify, support, and educate diabetics in two low-income Chicago communities. A unique door-to-door recruitment strategy was executed to engage individuals with limited access to healthcare and classify participants as diabetic, high risk, or low risk at baseline. Only diabetics were followed-up after one year. During home visits, CHWs provided education, counseling for diabetes self-management and referrals to free health resources. The aim was to lower the average HbA1c level in diabetics by ≥0.05%.

Of 2160 participants, 21% were diabetic, 24% were high risk, and 55% were low risk. The diabetic group (n=459) was 70% female; mean age was 56.3 years; 68% were African American and 30% were Hispanic. High blood pressure and being overweight were associated with increased odds of being diabetic or high risk compared to low risk participants. The average HbA1c decrease at follow-up was 0.5% (95% CI: 0.3% - 0.7%). Diabetics with high HbA1c levels at baseline (≥ 9.0%) showed a higher decrease of 1.7% (p<0.01) than all diabetics. Statistically significant increases were seen in diabetes-related knowledge and medication adherence, along with a decrease in proportion depressed at follow-up. 

This study adds to the growing literature demonstrating CHWs can effectively reach and serve participants outside a traditional healthcare system. Importantly, we showed that significant improvement in HbA1c is possible, even in underserved communities in Chicago. The approach could be extended to other chronic conditions to reduce health disparities in the US.

The Downeast Community Health Regional Partnership (DCHRP)—consisting of community organizations, primary care providers, hospitals, an academic institute, and community members—sought to prevent the onset of diabetes in rural Maine using community health workers (CHWs) trained in the National Diabetes Prevention Program (NDPP) curriculum. CHWs were either lay volunteers or employed ancillary providers. The NDPP is 16-session evidence-based lifestyle change program for preventing type 2 diabetes.  CHWs either led or co-led each NDPP group of community members diagnosed with pre-diabetes.  To date, 12 groups have been conducted across 2 rural counties. 

Program evaluation utilized several data elements: patient biometric data including BMI, LDL and A1C levels at baseline, 6 months, and 12 months; before/after qualitative information collected from the NDPP program participants on health goals, and available support for lifestyle changes; and information from participants at each session, including weight and minutes of physical activity. 

Participants completing the program had an average body weight loss of 8.4%. Using paired t-tests, mean changes in BMI at 6 and 12-months were significant (p=0.05). 12-month results show that island residents (N=45) had significant reductions in LDL cholesterol (p=0.04) and weight (p<.02) compared to mainland residents. Mainland residents had greater reductions in A1C values (p<0.001).

Conclusion: Rural Maine residents participating in the NDPP show differences in biologic markers associated with type 2 diabetes. Dr. Ronald Deprez, PI and member of the DCHRP will discuss factors attributable to the variations in findings such as social support; the challenges/benefits of utilizing lay volunteer CHWs; and, issues in program sustainability.

Objective: To evaluate the effectiveness of a community-based lifestyle health promotion intervention in lowering obesity among adults with diabetes in two ethnically diverse Chicago area neighborhoods.

Methods: The trial enrolled 331 adults with BMI ≥24 kg/m²and prior diagnosis of type 2 diabetes.  Participants were randomized to either: (1) control - brief lifestyle counseling with nearby community resource information; or (2) intervention - encouragement to participate in a group-based adaptation of the LookAHEAD program offered free-of-charge by the YMCA. The primary outcome was mean difference in body weight at 6 months. Secondary outcomes included changes in HbA1c, cholesterol, and blood pressures. Intent-to-treat analyses used mixed-effects regression models (maximum likelihood estimation) that adjusted for weight at baseline.

Results: Participants had a mean (SD) age of 57.4 ± 11.4 years, BMI 35.6± 7.6 kg/m2, HbA1c 7.22 ± 1.25%. Approximately half (50.2%) were women, 30.5% were African American, 34.4% were non-Hispanic White, and 27.5% were Hispanic.  Approximately one third (35.3%) reported annual household income of <$25,000. Compared to controls, participants randomized to the group lifestyle intervention lost an additional 1.29 kg (95% CI 0.47 – 2.14 kg) at 6 months, regardless of intervention attendance. Differences in mean weight loss were not statistically significant across race/ethnicity. Future analyses will include comparisons at 12 months and 24 months.

Conclusions: Delivery of a group adaptation of the LookAHEAD program by YMCAs results in a scalable lower cost mechanism to help patients with type 2 diabetes lose weight. Health care reform models and reimbursement policies should include access to community-based intensive healthy lifestyle interventions to translate interventions into practice.