Journal of Education and Health Promotion

Diabetes management with a care coordinator improves glucose control in African Americans and Hispanics

Authors

. Wayne S. Rawlins
. Michele A. Toscano-Garand
. Garth Graham

Aetna Foundation, Aetna Inc., Hartford, Connecticut 06156, USA

Abstract
BACKGROUND: The purpose of this study was to evaluate diabetes control, as measured by
hemoglobin A1c (HbA1c) improvements among African American and Hispanic patients receiving
conventional clinical treatment combined with a bilingual diabetes educator using culturally and
linguistically appropriate educational materials. This study also sought to estimate the healthcare cost
savings resulting from any A1c improvements and assess the cost‑effectiveness of this approach.
MATERIALS AND METHODS: This was a multistage, face‑to‑face observational study undertaken
in Texas, United States and focused on 153 African American and Hispanic patients with poor
blood glucose control (baseline A1c >8.0%). For two years, a bilingual care coordinator motivated
patient behavior changes that could lead to improvements in glucose control. The primary
evaluation measure was change in %HbA1c, with secondary measures being change in blood
pressure (BP) and low‑density lipoprotein (LDL). We also sought to gauge the program’s potential
cost‑effectiveness.
RESULTS: Within the study group, A1c levels decreased over the study period from a mean of
10.0% to 8.4%. The same group saw no statistically significant improvement (reduction) in blood
concentrations of LDL. The African American subgroup had a small reduction in systolic BP while
changes for non‑White Hispanics were not statistically significant. The average A1c reduction
realized in this observational study provided estimated cost savings that are nearly twice pilot
expenditures.
CONCLUSIONS: Combining standard diabetes care with a bilingual educational care coordinator
results in significant reductions in mean A1c (−1.6% HbA1c) in patients with poorly controlled blood
glucose and African American/non‑White Hispanic heritage, an intervention that also was shown to
be cost‑effective. This may be an effective model for improving diabetes care in provider practices.

Keywords

Care coordination
cost‑effectiveness
glucose control
health care disparities
hemoglobin A1c
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Journal of Education and Health Promotion
Volume 7, Issue 2
May and June 2017
Pages 1-8

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