Objective: To test whether a culturally-tailored self-management intervention co-created with ethnic communities (DiabEthic)improves glycemic control, diet, physical activity, and therapeutic adherence in a multi-ethnic cohort of first-generation immigrants in Italy. Design and method: A total of 202 adult first-generation immigrants with newly diagnosed type2 diabetes or HbA1c>8% recruited from diabetes services were randomized 1:1 to the DiabEthic intervention or usual care in a multicentric, randomized, parallel-controlled, clinical trial trial. The intervention was conducted by dieticians and cultural mediators, and targeted knowledge, attitudes, and self-management behaviours. The primary outcome was HbA1c. Secondary outcomes included lipids, blood pressure, weight, diet, physical activity, and adherence to therapy. Measures were collected at baseline and 12-month follow-up. Change in outcomes over time between the groups and the association between HbA1c and possible mediators were estimated using mixed-effects models and an intention-to-treat approach. Results: A significant difference in HbA1c change between the groups was observed at 12 months (intervention -1.7695%CI -2.16 to -1.37 versus control -1.06-1.53 to -0.59, P=0.026 for arm x time interaction). At multivariate linear regression, improvement in HbA1c was greater among individuals with higher baseline HbA1c or shorter duration of diabetes, and among those assigned to the intervention arm. A significant intervention effect at 12 months was also evident for reduction in total cholesterol (P=0.027 for arm x time interaction), triglycerides(P=0.031), waist circumference (P=0.037), and improvement in therapeutic adherence scores(P=0.002), and dietary quality.Conclusions: A culturally-tailored self-management intervention can improve diabetes control in immigrants and ethnic minorities.
Modesti et al. (Fri,) studied this question.