Building Infrastructure for Diabetes Self-Management Support in Church-Based Settings—Results of a 15-Month Cluster-Randomized Controlled Trial

Abstract

Diabetes self-management support (DSMS) is not a covered benefit in the U.S. health system, and little is known about the infrastructure needed to provide effective DSMS in organizations without existing diabetes self-management education (DSME) programs. The Praise study is a 15-month cluster-randomized controlled trial in 9 African American (AA) churches in metro-Detroit, as a conduit to build infrastructure for DSMS in low-resource communities. From 2013-2015, Praise examined the effects of peer-led DSMS on A1C and diabetes distress (DD) at 3, 9, and 15 months. CDEs trained peer leaders (PL) (n=12) and parish nurses (PN) (n=3) on goal setting, skills development, and group facilitation. Following professionally-delivered DSME, 6 monthly DSMS groups were independently planned and facilitated by 12 PL (mean age: 61.9 years, 100% AA, 25% male), followed by an additional 6 months of ongoing support to assess the logistical feasibility of sustaining DSMS efforts. Churches (and their participants, n=94) were randomized to 3 parallel groups: 1) PL only DSMS (n= 28), 2) PN + PL DSMS (n= 36), or 3) enhanced usual care (n= 30). Over time, a significant increase in A1C (p=.03) was observed across groups overall, but not within study groups. After adjusting for multiple factors, younger age (β=-.04; p=.004) and lower levels of DD (p=.04) were associated with improvements in A1C over time, while insulin use (p= .032) was associated with increases in A1C. A marked improvement in DD was observed (p=.04) overall. PL only (p= .003), PL+PN (p=.01), and A1C (p=.02) were significantly associated with improvements in DD. Results suggest DD is a significant indicator of improvement in A1C levels. DD levels also improved following a faith community-based DSME intervention and were sustained by using the PL and PN DSMS infrastructure of the church. Opportunities to expand the DSMS infrastructure beyond churches and into other community organizations is needed. Disclosure N.J. Koscielniak: None. M. Funnell: Advisory Panel; Self; Sanofi US, Intarcia Therapeutics, Inc.. G. Piatt: None.