Church-Based Diabetes Program Improves Latino Lifestyles

Troy Brown, RN

April 30, 2015

A novel church-based type 2 diabetes education program led to healthier eating and more exercise among the primarily Hispanic participants but did not result in significant differences in weight, HbA1c, LDL cholesterol, or blood pressure levels at 3 and 6 months.

However, the researchers say it may be too soon to see changes in these measures.

Arshiya A Baig, MD, MPH, from the University of Chicago, Illinois, and colleagues report their findings April 29 in the Journal of General Internal Medicine.

"Making lifestyle changes can be very difficult for patients, so we were happy to see that patients improved their diet and exercise habits by going through our program. However, we did not see changes in weight or sugar control as a consequence of better diet and more exercise," Dr Baig told Medscape Medical News. "If we followed patients for longer, we might see the impact of these improved lifestyle behaviors on these clinical outcomes."

The setting may be particularly important in encouraging patients, Dr Baig said: "Diabetes education is important for all patients living with diabetes. By providing diabetes education in an accessible, familiar, and trusted setting, we can help Latino adults with diabetes improve their diet and exercise habits."

Each Session Began With a Prayer

The researchers conducted the community-based, randomized controlled pilot study in 100 adults with self-reported diabetes from a low-income Mexican-American neighborhood in Chicago, Illinois.

They randomly assigned participants in a 1:1 ratio to receive either the intervention — an 8-week class led by trained lay leaders — or enhanced usual care consisting of one 90-minute lecture on diabetes self-management at a local church.

The 8-week intervention class consisted of 90-minute weekly sessions on diabetes, nutrition, and physical activity. The group leaders assisted participants with goal setting, anticipating likely obstacles, identifying behavioral alternatives, and stimulus control. The researchers followed up the patients in both groups for 6 months.

The classes did not include religious scripture, but each session promoted discussion of faith and spirituality by beginning with a prayer.

The researchers partnered with two Catholic churches, a local Catholic social service agency, healthcare leaders, and community members. The Catholic social service agency provided patient-navigation services to participants in both groups and assisted them with finding a primary-care provider if they did not have one.

At the end of the study, the researchers provided those in the enhanced usual-care group an opportunity to participate in a less intensive 8-week diabetes education class.

Primary Objectives Not Met, but Lifestyle Changes Achieved

The primary objective of the study was change in HbA1c, and secondary outcomes included changes in LDL cholesterol, blood pressure, weight, and diabetes self-care activities.

The mean age of participants was 54 years, 81% of participants were female, 98% were Latino, and 51% were uninsured.

Diabetes self-empowerment improved in both groups. Neither diabetes knowledge nor self-reported health status changed within or across groups.

At 3 months, patients in both groups experienced a decrease in their HbA1c from baseline (−0.32%; 95 % confidence interval [CI], -0.62 to -0.02 %).

The difference in change in HbA1c, LDL cholesterol, blood pressure, and weight from baseline to 3-month and 6-month follow-up was not statistically significant between the two groups.

Participants in the intervention reported fewer days of high-fat food consumption in the previous week (−1.34) and more days of exercise participation (1.58) compared with those in the enhanced usual-care group from baseline to 6 months.

"Considering that Latinos tend to struggle with lifestyle changes due to competing demands and lack of resources for lifestyle change, our study demonstrated the possibility of a church-based diabetes self-management intervention helping participants overcome their struggles in making behavior change," Dr Baig and colleagues write.

"Working with community leaders and churches allowed us to tailor the education program to our patient population and incorporate local resources into the program. Participants learned of exercise programs at the local churches and received patient-navigation services from a local social service agency," Dr Baig told Medscape Medical News.

"Partnering with local agencies and incorporating local resources may be necessary to support patients living with diabetes," she concluded.

The authors have disclosed no relevant financial relationships.

J Gen Intern Med. Published online April 29, 2015. Abstract

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