Abstract
BackgroundAbout 13% of African Americans and 13% of Hispanics have diabetes, compared to 8% of non-Hispanic Whites (NHWs). This is more pronounced in the elderly where about 25–30% of those aged 65 and older have diabetes. Studies have found associations between social determinants of health (SDoH) and increased incidence, prevalence, and burden of diabetes; however, few interventions have accounted for the context in which the elderly live by addressing SDoH. Specifically, psychosocial factors (such as cognitive dysfunction, functional impairment, and social isolation) impacting this population may be under-addressed due to numerous medical concerns addressed during the clinical visit. The long-term goal of the project is to identify strategies to improve glycemic control and reduce diabetes complications and mortality in African Americans and Hispanics/Latinos with type 2 diabetes.MethodsThis is a 5-year prospective, randomized clinical trial, which will test the effectiveness of a home-based diabetes-modified behavioral activation treatment for low-income, minority seniors with type 2 diabetes mellitus (T2DM) (HOME DM-BAT). Two hundred, aged 65 and older and with an HbA1c ≥8%, will be randomized into one of two groups: (1) an intervention using in-home, nurse telephone-delivered diabetes education, and behavioral activation or (2) a usual care group using in-home, nurse telephone-delivered, health education/supportive therapy. Participants will be followed for 12 months to ascertain the effect of the intervention on glycemic control, blood pressure, and low-density lipoprotein (LDL) cholesterol. The primary hypothesis is low-income, minority seniors with poorly controlled type 2 diabetes randomized to HOME DM-BAT will have significantly greater improvements in clinical outcomes at 12 months of follow-up compared to usual care.DiscussionResults from this study will provide important insight into the effectiveness of a home-based diabetes-modified behavioral activation treatment for low-income, minority seniors with uncontrolled type 2 diabetes mellitus and inform strategies to improve glycemic control and reduce diabetes complications in minority elderly with T2DM.Trial registrationClinicalTrials.govNCT04203147). Registered on December 18, 2019, with the National Institutes of Health Clinical Trials Registry.
Highlights
About 13% of African Americans and 13% of Hispanics have diabetes, compared to 8% of nonHispanic Whites (NHWs)
Rates of diabetes are higher in minority groups compared to non-Hispanic whites (NHW), with 13% of African Americans and 13% of Hispanics diagnosed with diabetes compared to 8% of NHWs [1,2,3]
This paper describes the rationale, study aims and objectives, and research design and methods of an ongoing 5-year, randomized clinical trial to test the efficacy of a homebased diabetes-modified behavioral activation treatment for low-income seniors with type 2 diabetes mellitus (HOME DM-BAT)
Summary
About 13% of African Americans and 13% of Hispanics have diabetes, compared to 8% of nonHispanic Whites (NHWs). This is more pronounced in the elderly where about 25–30% of those aged 65 and older have diabetes. Rates of diabetes are higher in minority groups compared to non-Hispanic whites (NHW), with 13% of African Americans and 13% of Hispanics diagnosed with diabetes compared to 8% of NHWs [1,2,3]. Minorities consistently show a higher risk of complications, higher mortality rates, poorer self-management, and worse glycemic control than NHWs [4, 5]. Socioeconomic status adds to disparities, highlighting the need for interventions targeted towards low-income minority seniors with diabetes [12]
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