Professional Abstract

Objective

To compare the effectiveness of a culturally adapted, family-centered diabetes self-management education (DSME) program versus standard diabetes education on lowering hemoglobin A1c (HbA1c) levels in Marshallese patients with type 2 diabetes living in Arkansas

Study Design

Design Elements	Description
Design	Randomized controlled trial
Population	221 Marshallese adults with type 2 diabetes living in Arkansas
Interventions/ Comparators	Adapted DSME Standard DSME
Outcomes	Primary: HbA1c levels Secondary: BMI, total cholesterol, HDL level, diabetes self-care behaviors (glucose monitoring, annual doctor visits, annual foot exam, annual eye exam, maintaining a healthy weight, physical activity)
Timeframe	1-year follow-up for primary outcome

This randomized controlled trial compared the effectiveness of a culturally adapted, family-centered diabetes self-management education program, called adapted DSME, with standard diabetes education, or standard DSME, on lowering HbA1c levels in US Marshallese patients, a population with high type 2 diabetes prevalence.

Researchers randomly assigned patients to either the adapted DSME or standard DSME program. Both programs included 10 hours of diabetes education on topics such as healthy lifestyle habits, blood glucose management, and goal setting. In the adapted program, a trained community health worker delivered eight weekly 75-minute education sessions in patients’ homes in Marshallese. Patients invited one or more adult family members to participate in the sessions with them. Researchers worked with the Marshallese community to create culturally appropriate content for the adapted DSME program. Content included collective goal setting and the use of personal testimonies and analogies common in Pacific Islander culture. In the standard DSME program, patients attended six weekly 100-minute diabetes education sessions at a local community organization without their family members. A certified diabetes educator offered sessions in English with the help of an interpreter.

The study included 221 Marshallese adults with type 2 diabetes living in Arkansas. The average age was 52, and 59% were female.

To measure HbA1c levels, researchers used a rapid A1c test kit. To assess diabetes self-care behaviors, researchers surveyed patients about their glucose monitoring, physical exams, and physical activity. Researchers measured patients’ height and weight to calculate body mass index (BMI), and they used a commercial lipid panel kit to measure total cholesterol and high-density lipoprotein (HDL) levels. Researchers assessed all outcomes at baseline, immediately after the intervention, and again 6 and 12 months after the intervention.

The Marshallese community, healthcare providers, and researchers used a community-based participatory research approach to design the study and collect data.

Results

After one year, compared with patients in the standard DSME program, patients in the adapted DSME program had greater declines in HbA1c levels (p=0.013).

Patients in the adapted DSME program were also more likely to check their blood glucose levels regularly compared with those in the standard DSME program (p<0.05).

Patients in the two programs did not differ in BMI, total cholesterol, HDL, or other diabetes self-care behaviors after one year.

Limitations

The study included Marshallese patients in Arkansas. Findings may not be generalizable to other geographic regions or populations, including Marshallese patients living outside of Arkansas. The adapted DSME program differed from the standard DSME program in several ways; researchers cannot be sure which aspects of the adapted DSME program affected which outcomes.

Conclusions and Relevance

In this study, a culturally adapted education program offered in patients’ homes and involving family members improved blood glucose levels for Marshallese patients with type 2 diabetes.

Future Research Needs

Future research could test whether the adapted DSME program is effective among other groups of Pacific Islanders.