African-American children and adolescents with diabetes mellitus have poorer glycemic control and markedly worse long-term outcomes than do their Caucasian counterparts. Current standard diabetes treatment programs are failing African-American children. Optimal glycemic control is critical for reducing the devastating complications of diabetes, and for improving both the duration and quality of life of diabetic individuals. There is a crucial need for effective alternate intervention strategies in African-American children and their families; these interventions must enable families to cope with barriers to diabetes care and to achieve improved glycemic control. Diabetes care in childhood is largely home based, and therefore this projects focuses on the home. As an alternative to the traditional model of diabetes care which is hospital or office based, we are proposing to establish a home-based intervention program designed to intensify diabetes management and improve glycemic control in African-American children. A key aspect of the program is that it will involve indigenous community based home health facilitators (CBHHF) as integral members of the diabetes team. These home workers will be the in- home extension of the diabetes treatment team, and act as educators and facilitators for diabetic patients and their families. They will transmit the expertise of the diabetes group in a culturally competent manner and perform the vital function of linking diabetes treatment goals to their implementation. The study will test the hypothesis that a one year home-based intervention program will improve diabetes management in African-American children with diabetes compared with controls, and that this improvement will be sustained over the following year. Subjects (7-17 years; n=6O), recruited in metropolitan Cleveland, will be randomly assigned to the home- intervention group or to a standard care group. The home-based intervention includes home visitation by the CBHHF working with a multidisciplinary diabetes team, an incremental program for education and goal setting, and support in coping with barriers to glycemic control. The control group will receive standard clinic-based diabetes care from the same diabetes team. Glycohemoglobin levels and other indices of diabetes management in the home-based intervention group will be compared with those in the control group. The study will also evaluate demographic and metabolic baseline measures that could be used to predict which patients are most likely to benefit from a home-based diabetes program. The significance of the proposed project is that it offers a method for correcting the disparity in blood glucose control that exists between African-American and Caucasian children. If the intervention is successful, it will guide the development of future programs and provide an approach to correcting the marked racial discrepancy in diabetes outcome.
