Introduction and Objective: Despite benefits of modern diabetes (DM) care, population-level glycemic control has not improved, especially among groups often marginalized from traditional care due to socioeconomic and cultural factors.Methods: The DICHA (DM In Control for Hispanics through an Alliance) program is a 6-month enhanced primary care model for Latino people with diabetes (LPWD) that includes a population health manager (PHM), language concordant diabetes-trained community health worker (CHW), diabetologist and patient navigator (PN). Those in a single urban community health center with A1c >9% for > 1 year were enrolled. Interventions included addressing social determinants of health, medications, continuous glucose monitoring (CGM), diabetologist visits (DV) and weekly virtual care planning. We compared DICHA to matched LPWD contemporaneous controls on A1c change, initiation of new medication and CGM. While DICHA patients were referred to CHW, controls were referred at PCP discretion.Results: At baseline, DICHA (N=31) vs. Controls (N=49): age 61 ± 10 years vs. 58 ± 18 years; 52% vs. 43% male; BMI 30 ± 4 vs. 31 ± 6, A1c 10.9 ± 1.9% vs. 10.9% ± 1.6; 97% type 2 DM and 60% on insulin. A1c change at 6 months was greater in DICHA: -1.3 ± 1.7% vs. -0.3 ± 2.1%, p=0.04; and 12 month -1.5 ± 2.3%, vs. -0.5 ± 1.6%, p=0.05. In multivariate adjusted model, each additional hour of CHW time in DICHA was associated with a -0.46 (95% CI -0.04 to -0.88, p= 0.04) A1c change while DV time was not. In both groups (N=80), CHW time predicted CGM initiation and new medication start while age and DVs did not. Each additional hour of CHW time was associated with a >3 fold increase in the odds of CGM initiation (OR 3.64; 95% CI 1.78 to 7.46; p <0.001) and higher odds of initiating a new diabetes medication (OR 2.23; 95% CI 1.39 to 3.59; p<0.001).Conclusion: Within a non-traditional, culturally-tailored care model including diabetology and primary care, engagement with a DM-specialized CHW drove A1c-lowering and initiation of standard therapies to facilitate sustained glycemic control.
B.F. Altshuler: None. A.E. Caballero: None. K.L. Del Valle: None. M.E. McDonnell: Research Support; Ended; Dexcom, Inc. Research Support; Current; Abbott Diabetes. Advisory Panel; Ended; Vertex Pharmaceuticals Incorporated.
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