Overcoming social and cultural barriers to care for patients with diabetes.

We attempted to develop a culturally sensitive alternative approach to diabetes management in a multiethnic, socially disadvantaged community (Waianae, Hawaii). The aims of this 3.5-year demonstration project were to establish regular community-based medical contact with diabetic patients who had a history of nonadherence to treatment regimens and to determine whether this strategy would lead to better health care (particularly improved self-management) in these patients. This community-based, culturally sensitive outreach system of medical follow up dramatically improved the amount and quality of medical care provided to this high-risk subpopulation of patients with diabetes.