Involving community health workers in outreach to lower-income people with type 2 diabetes as part of a primary care practice led to improved diabetes management, according to a new study published in the journal Annals of Internal Medicine.
Certain communities in the United States experience worse outcomes related to diabetes — including members of racial minority groups, people who live in poorer neighborhoods, and rural residents. This is true for both type 1 and type 2 diabetes, according to certain measures. For example, children who are Black or who live in disadvantages neighborhoods are more likely to experience readmission to the hospital for diabetic ketoacidosis (DKA), a health emergency linked to high blood glucose that’s more common in people with type 1 diabetes. Residential racial segregation has been linked to worse diabetes management, and Black rural residents are at especially high risk for foot amputation due to diabetic foot ulcers. At the same time, rural residents in general often experience difficulty getting high-quality diabetes care, and diabetes deaths in rural areas remain stubbornly high.
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One way to potentially help understand and address the barriers people face to better diabetes management — both external and internal barriers — is to have a community health worker as part of a primary care practice. Community health workers engage with patients in an effort to “understand their social context, identify goals, navigate health care, and connect to community resources,” according to the latest study. With these goals in mind, the researchers looked at the effect community health workers had when it came to diabetes management in 946 people with poorly controlled type 2 diabetes who got their care at a “safety-net” primary health care facility — meaning the practice was targeted toward people with lower incomes. At the beginning of the study, participants had an average A1C level (a measure of long-term blood glucose control) in the range of 10.2% to 10.5%, as noted in an article on the study at Healio.
The researchers were interested in whether participants progressed through three different stages in the process of diabetes self-care — outreach, stabilization, and self-care generativity. “Outreach” meant simply meeting face-to-face with a community health worker to discuss barriers to diabetes management. “Stabilization” meant collaborating to come up with ways to address life circumstances that made diabetes management more difficult. And “self-care generativity” meant becoming better at diabetes self-care.
Engagement with community health workers linked to lower A1C levels
Out of the 946 participants, 27% did not progress beyond the “outreach” stage, while 41% progressed to “stabilization” and 33% made it to “self-care generativity.” Over time, progressing to a further stage was also linked to lower A1C. By their fifth A1C measurement in the study — after an average of 859 days, or about two years and four months — participants in the different stages started to show differences in A1C, which widened over time. By their tenth A1C measurement — after an average of 1,365 days, or about three years and nine months — participants in the “self-care generativity” group had an average A1C of 8.5%, compared with 8.8% in the “stabilization” group and 9.0% in the “outreach” group. Emergency department visits and hospital admissions were also lower in the “self-care generativity” group.
The researchers concluded that community health workers linked to primary care practices “can sustainably engage vulnerable patients, helping them advance self-management goals in the context of formidable social disadvantage.” But these results also demonstrate how difficult it can be to engage with disadvantaged people with diabetes in a way that leads to optimal blood glucose control — a problem that no study is likely to find a simple solution for anytime soon.
Want to learn more about building a health care team? Read “Your Diabetes Support System.”
