Improvement in Diabetes Care of Underinsured Patients Enrolled in Project

OBJECTIVE — To improve clinical diabetes care, patient knowledge, and treatment satisfac-tion and to reduce health-adverse culture-based beliefs in underserved and underinsured pop-ulations with diabetes. RESEARCH DESIGN AND METHODS — A total of 153 high-risk patients with dia-betes recruited from six community clinic sites in San Diego County, California were enrolled in a nurse case management (NCM) and peer education/empowerment group. Baseline and 1-year levels of HbA1c, lipid parameters, systolic and diastolic blood pressure, knowledge of diabetes, culture-based beliefs in ineffective remedies, and treatment satisfaction were prospectively mea-sured. The NCM and peer education/empowerment group was compared with 76 individuals in a matched control group (CG) derived from patients referred but not enrolled in Project Dulce. RESULTS — After 1 year in Project Dulce, the NCM and peer education/empowerment group had significant improvements in HbA1c (12.0–8.3%, P 0.0001), total cholesterol (5.82–4.86 mmol/l, P 0.0001), LDL cholesterol (3.39–2.79 mmol/l, P 0.0001), and diastolic blood pressure (80–76 mmHg, P 0.009), which were significantly better than in the CG, in which no significant changes were noted. Accepted American Diabetes Association standards of dia-betes care, knowledge of diabetes (P 0.024), treatment satisfaction (P 0.001), and culture-based beliefs (P 0.001) were also improved. CONCLUSIONS — A novel, culturally appropriate, community-based, nurse case manage-ment/peer education diabetes care model leads to significant improvement in clinical diabetes care, self-awareness, and understanding of diabetes in underinsured populations