Randomized trial of an integrated care intervention among Latino adults: Sustained effects on diabetes management.
Transl Behav Med
; 14(5): 310-318, 2024 Apr 29.
Article
in En
| MEDLINE
| ID: mdl-38340345
ABSTRACT
We examined the 12-month maintenance effects of a previously successful integrated model of diabetes care at improving glycemic management and psychological well-being among Latino adults with type 2 diabetes (T2D). A randomized controlled trial (2015-19) compared an integrated care intervention (ICI) with usual care among 456 adults with T2D. The ICI included integrated medical and behavioral care and health education over 6 months. Assessments were completed at baseline, 3, 6, 9, and 12 months. Most participants were female (63.7%) with a mean age of 55.7 years. In multilevel models, significant Group × Time (quadratic) interaction effects were found for HbA1c [Bintâ
=â
0.10, 95% confidence interval (CI) 0.02, 0.17, Pâ
<â
.01] and anxiety symptoms (Bintâ
=â
0.20, 95% CI 0.05, 0.35, Pâ
<â
.009), but not depression symptoms (Bintâ
=â
0.15, 95% CI -0.01, 0.31, Pâ
<â
.07). Analyses of instantaneous rate of change in the ICI group showed significant decreases at 3 and 6 months for both HbAc1 (B = -0.31 at 3 months; B = -0.12 at 6 months) and anxiety symptoms (B = -0.92 at 3 months; B = -0.46 at 6 months), and no significant instantaneous changes at 9 or 12 months, suggesting that initial improvements were largely maintained. The usual care group showed a small decrease in anxiety symptoms at 6 months (B = -0.17), but no other significant changes at any time-point for anxiety or HbA1c (all Psâ
>â
.05). This culturally tailored integrated care model shows potential in producing and sustaining positive effects on clinical and psychological outcomes above standard care.
Our previous studies found that a culturally adapted, enhanced service (integrated care intervention) that we developed improved glycemic management and decreased depression and anxiety symptoms over the 6 months that the service was offered. In this study, we examined whether those improvements in diabetes management and depression and anxiety symptoms were maintained up to 6 months after the conclusion of the intervention. The integrated care intervention involved providing medical and behavioral healthcare on the same day and at the same location as well as health education for 6 months. The study participants were 456 Latino adults (aged 2380 years) who had type 2 diabetes and were not taking insulin. Participants were randomly assigned to one of two groups the integrated care intervention or usual care. In this study, we found that the improvements in glycemic management and in anxiety and depression symptoms previously shown were largely maintained. These findings suggest that culturally adapted health services that include both medical and behavioral care and health education programs may benefit Latino patients with type 2 diabetes.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Anxiety
/
Glycated Hemoglobin
/
Hispanic or Latino
/
Delivery of Health Care, Integrated
/
Diabetes Mellitus, Type 2
Type of study:
Clinical_trials
/
Prognostic_studies
Limits:
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Transl Behav Med
Year:
2024
Document type:
Article
Affiliation country:
United States