Results Summary

What was the research about?

Type 2 diabetes is a long-term health problem that causes blood sugar levels to rise. It is common among people from the Marshall Islands. Keeping blood sugar levels normal can help prevent damage to the heart, brain, eyes, limbs, and kidneys. Patients can manage diabetes by eating healthy foods, exercising, and checking blood sugar levels regularly.

In this study, the research team worked with Marshallese people living in Arkansas to adapt a diabetes education program. The new program included personal stories and analogies common in Marshallese culture. Patients with type 2 diabetes could invite family members to take part in the education sessions. Patients and family members worked together to set health goals.

The research team compared patients in the new program with those in a standard diabetes education program. The team looked at patients’

  • Blood sugar levels
  • Cholesterol levels
  • Body mass index, or BMI, which measures body fat based on height and weight
  • Diabetes self-care tasks, such as checking blood sugar levels and seeing a doctor

What were the results?

After one year, compared with patients in the standard program, patients in the new program

  • Had lower blood sugar levels
  • Were more likely to check their blood sugar levels regularly

Patients in the two programs didn’t differ in cholesterol levels, BMI, or other diabetes self-care tasks after one year.

Who was in the study?

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

What did the research team do?

The research team worked with Marshallese adults to create the new program. Then the team assigned patients by chance to the new or the standard program. Both programs included 10 hours of diabetes education on topics like healthy eating, exercise, checking blood sugar, and setting health goals.

In the new program, a trained community health worker led eight weekly 75-minute sessions in patients’ homes in the Marshallese language. Community health workers are trained to teach people about health and link people in their community with health and social services. In the standard program, patients went to six weekly 100-minute sessions at a local community center without their family members. A trained diabetes educator gave sessions in English with help from an interpreter.

People from the Marshallese community and healthcare providers were members of the research team.

What were the limits of the study?

The study included Marshallese adults in Arkansas. Results may differ in other places or for people of other backgrounds. The two programs differed in many ways; the research team can’t be sure which parts of the program led to the results.

Future research could test how the new program works for other groups of Pacific Islanders.

How can people use the results?

Health centers that serve Marshallese patients can use these results when considering diabetes education programs.

Final Research Report

View this project's final research report.

Journal Citations

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Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Reviewers asked whether the researchers based their hypothesis on the limitations of previous research in this population, or on evidence that a family-based approach to diabetes care was successful in other communities. The researchers added this discussion to the report, stating that they developed their hypothesis and intervention based on their own pilot work, the limitations of other studies, input from stakeholders, and success of other family-care models.
  • Reviewers noted that the two interventions tested differed in several ways that included but were not limited to the family component.  They also stated that the trial did not allow for the possibility of attributing any observed differences in results to any particular component of each intervention. The researchers agreed that the original name of one of the two diabetes self-management education (DSME) interventions “Family DSME,” did not fully capture the extent of the differences that the intervention offered compared to Standard DSME. They changed the name of Family DSME to Adapted DSME in response to this concern.
  • Reviewers asked that the report describe the clinical importance of any observed differences in results and not overinterpret small differences. The researchers edited the report to soften the language and offer more context in describing differences observed between the two study arms.

Conflict of Interest Disclosures

Project Information

Peter O. Kohler, MD
University of Arkansas for Medical Sciences
Extended Family Model of DSME to Reduce Disparities in a US Pacific Islander Community

Key Dates

July 2014
May 2019

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: April 11, 2024