Evidence-based medical treatment guidelines for Type 2 Diabetes are known to improve key clinical outcomes (blood glucose, blood pressure, blood cholesterol control rates) and reduce serious diabetes complications. However, a clear gap exists between these evidence-based guidelines and diabetes care actually delivered by providers, particularly for underserved Hispanic populations in primary care settings. The diabetes complications that result from this "quality gap" are debilitating to patients and costly to treat. Effective diabetes self management education (DSME) for patients is also a critical factor in improving diabetes control rates, yet this is also suboptimal. Culturally sensitive diabetes case management could potentially be a highly effective model for the deli very of integrated and comprehensive care if a culturally sensitive and integrated approach was developed that was feasible, acceptable, scaleable, cost-effective, and linked systematically with the primary ca re provider. We will conduct a 4 year RCT to evaluate a comprehensive diabetes case management intervention to determine its impact on diabetes control and screening rates and its cost effectiveness, and to explore key psychosocial mechanisms (self efficacy, diabetes distress, depression) that may mediate the impact of the intervention on outcomes. Several important gaps in diabetes case management intervention research will be tackled in this study to potentially advance knowledge in this area, including: minimal focus on Hispanic populations, lack of standardization of DSME and case management training, a prior focus on only HbA1c as a study end point, and lack of focus on the sustainability of the case management intervention.
Research shows that medical care for Hispanic people with Type 2 diabetes could be much improved. This may be because doctors are busier today and also spend most or their time on problems patients walk in with rather than their chronic diabetes care. Poor diabetes care can lead to additional medical problems for patients and more medical expenses for society. We will test a new approach to diabetes ca re that uses a bilingual/bicultural nurse/dietitian team that works with each doctor to help him or her follow treatment rules and order services. The nurse/dietitian team will also teach patients to eat better, take their medications, get regular exercise, and test their blood sugars as these are important to diabetes care. Because the new Hispanic diabetes team will have a similar ethnic background as that of the patients we expect the patients will find it easier to come to clinic visits and make positive changes.