Alliance to Reduce Disparities in Diabetes

Wind River Team at ADA 2014

A Community-Clinical Partnership for Improving Diabetes Management and Outcomes for American Indians

American Diabetes Association's 74th Scientific Sessions
June 14-17, 2014
San Francisco, CA

Authors
K. Langwell, Catherine Keene, Matthew Zullo, and Linda Ogu

Abstract
The age-adjusted prevalence of diabetes among American Indians and Alaska Natives served by the Indian Health Service is substantially higher than for other racial/ethnic groups in the U.S., at 16.1 percent of the adult population (NIDDK, 2011).  Although there has been considerable attention to development of strategies and interventions to reduce diabetes risk factors in this population, there has been limited research on the effectiveness of these interventions. This paper describes the implementation, evolution, and outcomes of an interventional program designed and conducted by participating Tribes, in partnership with IHS clinicians, to improve diabetes management and outcomes for Tribal members with diagnosed diabetes or pre-diabetes. The interventions included development of culturally-tailored diabetes self-management education (DSME) programs, training of Tribal staff to deliver the DSME, followed by 16 weeks of additional physical activity based on the Lifestyle Balance program, and creation of a community-clinical partnership for referrals to the Tribal program and sharing of data and resources to support people with diabetes. Evaluation of the impact of the initial three years of the program indicate that DSME provided by lay health educators, combined with increased communication and support from Indian Health Service physicians, resulted in statistically significant increases in confidence in ability to manage diabetes, positive changes in self-reported eating patterns and physical activity levels, and improvements in perceptions of the support from the diabetes care team. Clinical outcomes were assessed using pre-post intervention clinical data for 103 program participants who had provided HIPAA authorization for release of these data.  Findings indicate that that HbA1c levels declined for 46%, with a decrease in average HbA1c of 1.12 points.  Participants with initial HbA1c levels above 12.0 achieved an average reduction of 3.0 points.