Tailored diabetes care gets results
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Culturally specific diabetes management programs work better than a one-size-fits-all approach, going by the results achieved with a program tailored to Latino patients.
“This diabetes management program works,” Dr. Todd Gilmer of the University of California at San Diego, the study’s lead author, told Reuters Health in an interview. “For the amount that this costs, you get valuable improvements in health.”
The initiative is described in the latest online issue of the journal Health Services Research.
A registered nurse runs the program, dubbed Project Dulce, meeting with patients as often as necessary, with the goal of helping patients keep their blood sugar levels, blood pressure, and cholesterol levels down long-term.
The program also includes a self-management training program run by a peer educator, or promotora, who comes from the Hispanic community.
“It’s a collaborative education model so it’s not just didactic,” Gilmer explained. The promotoras “can address some misrepresented cultural beliefs…and hopefully connect to the patients on a peer level that complements the nurse management.”
He and his colleagues used a computer model to project how 3,893 participating patients would fare over the next 40 years in terms of their health and life expectancy.
Based on their projections, Gilmer and his team found the program was most beneficial for uninsured patients, who gained an additional 1.1 years of life expectancy, compared to 0.6 years for patients with County Medical Services insurance, which covers low-income or indigent adults; 0.3 years for patients insured by Medi-Cal, a state program for low-income people; and 0.2 for patients with commercial insurance.
Uninsured patients tended to be younger than the other patients, Gilmer noted. “By addressing this early, you get a lot of long term benefits,” he said.
The program was most cost-effective for the patients with the least insurance coverage, costing $10,141 per year of life in perfect health gained, the researchers found.
SOURCE: Health Services Research, online February 16, 2007.
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