Diabetes Self-Management in a Community Health Center: Improving Health Behaviors and Clinical Outcomes for Underserved Patients

Abstract

Self-management is a crucial element of good diabetes care. Several large-scale trials have demonstrated that comprehensive interventions that include self-management can prevent complications from type 11,2 and type 2 diabetes.3 In addition, interventions that promote the adoption of healthy behaviors have been shown to significantly prevent or delay the onset of type 2 diabetes in patients at increased risk for this disease.4 A review and meta-analysis of self-management interventions for diabetes concluded that, although education alone does not lead to improved outcomes, self-management interventions can improve glycemic control.5 However, outside of the research arena, “real-world” settings face challenges when seeking to replicate self-management programs such as those found in clinical trials. Such interventions are resource intensive and not generally designed to meet the needs of patients from underserved populations. Issues such as low literacy, limited English proficiency, poverty, and cultural differences present additional barriers to promoting diabetes self-management. To combat the growing diabetes epidemic, it is crucially important that such barriers be overcome. Diabetes self-management interventions must be developed and tested to meet the needs of all patients, particularly underserved minority populations. Hispanic and African-American patients in the United States have nearly two times the prevalence of type 2 diabetes as non-Hispanic whites.6-8 Rates for Native Americans are even higher.8 In addition to higher prevalence, ethnic and racial minority patients with diabetes have higher mortality and higher rates of diabetic complications.9 Although the pathophysiology and treatment may be the same for different ethnic and racial groups, differences in behaviors, cultures, and health beliefs have a significant impact on how patients understand their illness and engage in self-management. Programs that account for these differences can improve diabetes outcomes.10-13 An additional barrier to effective diabetes self-management is the …