Establishing diabetes self-management in a community health center serving low-income Latinos.

PURPOSE: The purpose of this study is to describe the implementation of the chronic care model for Latinos with diabetes. Additional interventions to enhance disease self-management were also implemented. Programmatic elements are described, data are reviewed to characterize the extent to which patients were engaged in various activities, and changes in glycosylated hemoglobin (HbA1c) are presented.
METHODS: Culturally appropriate self-management activities were implemented over a course of 3 years to offer a variety of options in which to engage patients. Bilingual (Spanish/English) multisession activities include formal diabetes education classes, an exercise class, and chronic disease self-management classes. Informal drop-in sessions include breakfast and snack clubs. Individual interactions include consultations with a nurse and nutritionist. Community health workers and community mentors also work with patients. Cross-sectional data from a disease registry, participation data, and clinical data on glycemic control are presented.
RESULTS: Glycemic control for this population of Latinos with diabetes improved following implementation of the self-management program. Nearly half of all diabetic patients participated in self-management activities, and participation was associated with improved glycemic control.
CONCLUSIONS: The self-management activities were successfully implemented to improve diabetes self-management for low-income Latino patients. Nearly one half of the patients reached a target goal of HbA1c <7.0. There was also a large reduction in the proportion of patients with markedly elevated HbA1c. Implementing the chronic care model with an emphasis on self-management appears to improve diabetes self-management and overall diabetes care for patients and may have the potential for replication.