Racial/ethnic minorities and low-income individuals are at increased risk for diabetes complications and adverse cardiovascular outcomes. The disparities in diabetes management have been linked to social determinants of health (e.g., food insecurity, inadequate housing, and trouble paying for medical needs). Previous diabetes management studies with racial/ethnic minorities and low-income individuals have generally demonstrated a reduction in A1C when utilizing lay health workers, such as patient navigators and community health workers (CHWs), to address social and economic needs and/or deliver diabetes self-management training. However, methodological limitations, such as lack of randomization or a comparison group and use of lay health workers in different capacities across studies, make it difficult to determine the most effective approach for integrating these personnel in health care settings to help with patient diabetes management. The purpose of this feasibility study is to inform the design of a future large-scale, randomized trial that will test if there is added benefit to addressing both social and economic needs and diabetes self-management to improve diabetes management long-term among vulnerable populations. In this pilot, we will randomize 100 African American, Hispanic, and/or Medicaid (all race/ethnicities) patients from Kaiser Permanente Northwest (KPNW) with A1C ? 8 and poor follow-up in primary care to one of two 6-month interventions: 1) patient navigation only; or 2) patient navigation + diabetes self-management training. In both study arms, KPNW practice-embedded patient navigators will screen for medical, social and economic needs and connect participants to internal and external resources. In the second study arm, navigators will also refer participants to CHWs embedded in local community-based organizations, who will deliver diabetes self- management training. Feasibility of the full-scale trial will be based on several measures including recruitment, retention, success rate of referrals to navigators and CHWs, and whether medical, social, and/or economic needs are met. Qualitative interviews will be conducted with various stakeholders to assess intervention acceptability and determinants of implementation. Preliminary effects on A1C, diabetes-related care gaps, health care utilization, and medication adherence will also be examined. This pragmatic study design involves a collaborative effort among researchers, health system staff, health system senior leadership, and local community-based organizations. Findings from the full-scale trial will contribute critical knowledge on the most effective, sustainable model of care for integrating lay health workers in the efforts to improve diabetes management among high risk patient populations.

Public Health Relevance

Racial/ethnic and socioeconomic status disparities in diabetes outcomes and disease self-management have been linked to social determinants of health (e.g., food insecurity, inadequate housing, and trouble paying for medical needs). This pilot study will examine the feasibility, acceptability, and preliminary effectiveness of using patient navigators and community health workers to address social determinants of health and provide diabetes self-management training to racial/ethnic minority and low-income patients with suboptimal diabetes management.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Planning Grant (R34)
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Special Emphasis Panel (ZDK1)
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Thornton, Pamela L
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Kaiser Foundation Research Institute
United States
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