Language
English
Publication Date
8-1-2024
Journal
Journal of Diabetes and its Complications
DOI
10.1016/j.jdiacomp.2024.108794
PMID
38878424
PMCID
PMC11590161
PubMedCentral® Posted Date
8-1-2025
PubMedCentral® Full Text Version
Author MSS
Abstract
Aims: Conduct a secondary analysis of the TIME (Telehealth-supported, Integrated Community Health Workers (CHWs), Medication access, diabetes Education) made simple trial (SIMPLE) to evaluate healthcare utilization and explore variables that may have influenced HbA1c.
Methods: Participants (N = 134 [67/group]) were low-income, uninsured Hispanics with or at risk for type 2 diabetes mellitus. We included in-person and telehealth clinician visits, other visits, missed visits, orders placed, and guideline-adherence (e.g., vaccinations, quarterly HbA1c for uncontrolled diabetes). Using multivariable models, we explored for associations between HbA1c changes and these measures.
Results: The control arm had higher missed visits rates (intervention: 45 %; control: 56 %; p = 0.007) and missed telehealth appointments (intervention: 10 %; control: 27.4 %; p = 0.04). The intervention group received more COVID vaccinations than the control (p = 0.005). Other health measures were non-significant between groups. Intervention individuals' HbA1c improved with more missed visits (-0.60 %; p < 0.01) and worsened with improved guideline-adherent HbA1c measurements (HbA1c: 1.2 %; p = 0.057). The control group had non-significant HbA1c associations.
Conclusions: Findings suggest that the SIMPLE trial's improved HbA1c levels stemmed from a CHW-driven intervention and not additional healthcare contact. Exploratory outcomes resulted in seemingly counterintuitive HbA1c associations with missed visits and guideline-adherent measurements; these may suggest that an intervention that enhances communication provides support to reduce the amount of follow-up needed by participants without sacrificing clinical improvements.
Keywords
Humans, Female, Male, Diabetes Mellitus, Type 2, Middle Aged, Community Health Workers, Self-Management, Telemedicine, Patient Education as Topic, Glycated Hemoglobin, Adult, COVID-19, Aged, Hispanic or Latino, Patient Acceptance of Health Care, community health worker, Hispanic, Diabetes, Education, Telehealth, disparities\community health worker, Hispanic, Diabetes, Education, Telehealth, disparities
Published Open-Access
yes
Recommended Citation
Porterfield, Laura; Yu, Xiaoying; Warren, Victoria; et al., "A Community Health Worker Led Diabetes Self-Management Education Program: Reducing Patient and System Burden" (2024). Faculty and Staff Publications. 4271.
https://digitalcommons.library.tmc.edu/baylor_docs/4271