The state of New Mexico contains a significant portion of the Navajo Nation which is the second largest American Indian (AI) tribe with 2.5 times the rate of diabetes compared to the US general population. The age-adjusted diabetes death rate for AI's is 41.1/100,000 compared to 12.4/100,000 for the US All Races. The proposal will evaluate the effect that formally trained diabetes medical interpreters have on diabetes outcomes and health care utilization patterns compared to usual care interpreters (no formal medical interpreter or diabetes knowledge training). The project is a pre-test/post-test randomized group design.
The specific aims of the proposal are: 1. to avoid development of pathology (retinopathy, creatinine, proteinuria, foot pathology) or improve intermediate clinical outcomes (A1C, blood pressure (B/P), low density lipoprotein (LDL), weight). 2. to evaluate participant adherence to selected examinations and laboratory tests for diabetes care (Opthalmology referrals, urine protein, lipid profile, Podiatry referral, immunizations, and diabetes educator referrals). 3. to evaluate the change in diabetes knowledge. 4. to evaluate the change in self-care practices (self-blood glucose monitoring (SBGM), medication adherence, daily activities and physical fitness). 5. to evaluate participant health care utilization patterns (hospitalizations for hypoglycemia, hyperosmotic non-ketotic states including coma, diabetic ketoacidosis, pneumonia, infections of the feet, skin, pyelonephritis; emergency/urgent care visits for medication refills, foot problems, hypoglycemia, urinary tract infections, pyelonephritis). The two research sites are the Indian Health Service (IHS) diabetes clinics located at the Gallup Indian Medical Center (GIMC) in Gallup, New Mexico, and the Northern Navajo Medical Center (NNMC) in Shiprock, New Mexico. Long term objectives of the study are the development and implementation of a Navajo culture-based medical interpreters training program and the expansion of the culture-based medical interpreters training program to other American Indian peoples.
