Diabetes management with a care coordinator improves glucose control in African Americans and Hispanics

BACKGROUND: The purpose of this study was to evaluate diabetes control, as measured by hemoglobin A1c (HbA1c) improvements among African American and Hispanic patients receiving conventional clinical treatment combined with a bilingual diabetes educator using culturally and linguistically appropriate educational materials. This study also sought to estimate the healthcare cost savings resulting from any A1c improvements and assess the cost-effectiveness of this approach. MATERIALS AND METHODS: This was a multistage, face-to-face observational study undertaken in Texas, United States and focused on 153 African American and Hispanic patients with poor blood glucose control (baseline A1c >8.0%). For two years, a bilingual care coordinator motivated patient behavior changes that could lead to improvements in glucose control. The primary evaluation measure was change in %HbA1c, with secondary measures being change in blood pressure (BP) and low-density lipoprotein (LDL). We also sought to gauge the program's potential cost-effectiveness. RESULTS: Within the study group, A1c levels decreased over the study period from a mean of 10.0% to 8.4%. The same group saw no statistically significant improvement (reduction) in blood concentrations of LDL. The African American subgroup had a small reduction in systolic BP while changes for non-White Hispanics were not statistically significant. The average A1c reduction realized in this observational study provided estimated cost savings that are nearly twice pilot expenditures. CONCLUSIONS: Combining standard diabetes care with a bilingual educational care coordinator results in significant reductions in mean A1c (-1.6% HbA1c) in patients with poorly controlled blood glucose and African American/non-White Hispanic heritage, an intervention that also was shown to be cost-effective. This may be an effective model for improving diabetes care in provider practices.