The prevalence and incidence of type 2 diabetes are rapidly increasing in the US population: approximately 18.0 million people, or 8.7% of the US population over the age of 19, have diabetes (CDC estimates). The prevalence of diabetes among US Hispanics was 1.5 times as high as the prevalence among white non-Hispanics in 2002. Mexican Americans (about 64% of US Hispanics), have a 2-3 times higher disease burden than non-Hispanic whites, and higher rates of related complications. National standards exist for treatment goals and for the delivery of services to diabetic patients but have not been widely incorporated into primary care practice, especially among low-income and minority populations. Strategies to deliver high quality care to patients with type 2 diabetes, in a broad range of outpatient care settings, must be developed and tested. Group office visits have advantages for the delivery of primary care to patients with type 2 diabetes. Existing trials have shown a favorable impact on utilization and adherence to treatment and screening guidelines. These studies, however, have not examined the impact on health outcomes. Results from community-based group diabetes education interventions suggest that group dynamics may be advantageous in promoting improved self-monitoring behaviors and glycemic control. Interventions directed at empowering diabetic patients have demonstrated that self-efficacy can be improved with accompanying modest improvement in blood glucose levels. We propose to develop a culturally competent group outpatient visit intervention for patients with type 2 diabetes. We will compare, in an RCT, usual care with the effect of a group outpatient visit intervention on behavioral and biologic (HbA1c, LDL, BP) outcomes in a predominantly Mexican American population of patients with type 2 diabetes. Preliminary data and effect size from this trial will be used to plan an effectiveness trial of group visit interventions for improvement of quality of care and biologic outcomes. The planning process will engage partners from clinics in Pima and Maricopa counties serving only or primarily Hispanic Medicaid-eligible or notch group populations. More effective outpatient management of diabetes will reduce the morbidity and mortality associated with this disease. ? ?
