1 / 21

Action for Diabetes Education Program for South Asian Patients with Diabetes

Action for Diabetes Education Program for South Asian Patients with Diabetes. Grishma Parikh, MD 1 , Kamala Mantha-Thaler 1 , Anto Ayinikal MPH 1 , Sapna Pandya MPH 2 , Prajesh Joshi MD 1 , Peter Homel PhD 1 , Leonid Poretsky, MD 1.

starr
Télécharger la présentation

Action for Diabetes Education Program for South Asian Patients with Diabetes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Action for Diabetes Education Program for South Asian Patients with Diabetes Grishma Parikh, MD1, Kamala Mantha-Thaler1, Anto Ayinikal MPH1, Sapna Pandya MPH2, Prajesh Joshi MD1, Peter Homel PhD1, Leonid Poretsky, MD1 1Division of Endocrinology and Friedman Diabetes Institute, Department of Medicine, Beth Israel Medical Center and Albert Einstein College of Medicine, New York, NY 10003 2 New York University Center of Immigrant Health, New York University, New York, NY, 10003

  2. Abstract South Asians are at high risk of diabetes mellitus at lower BMI. A 2004 New York City health and nutrition examination survey suggested that diabetes prevalence in south Asians is 35.4 % compared to 10.7% among Caucasians. The ADEPT program is a collaborative effort between Gerald J. Friedman Diabetes Institute at Beth Israel Medical Center and South Asian Health Initiative at New York University Medical Center. A network of 8 primary care physicians of South Asian origin who provide care to a large south Asian community in Queens has been created to facilitate diabetes care and education. A South Asian certified diabetes educator (CDE) administers American Diabetes Association education curriculum. Specially designed culturally competent diabetes education material which is translated into several South Asian languages is available to patients in the network. A pilot non-randomized study is being conducted to measure outcomes in patients receiving education in the program with CDE (education group) compared to the other patients in the same practice (control group). All diabetes education sessions are one-to-one, with follow-up sessions every 2 to 4 weeks. At baseline and at 3 month intervals, weight, blood pressure, hemoglobin AC, lipid profile and urine microalbumin levels are recorded. Preliminary data of 80 patients are presented in the table

  3. Abstract Cont. P values are given for comparison between the groups. Hemoglobin A1C in the education group showed a trend towards reduction from 8.0% to 7.2%, but this change was not statistically significant compared to control group. We concluded that a culturally sensitive program for south Asian patients with diabetes appears to have a potential to improve “hard” clinical outcomes. Further analysis of the data is in progress.

  4. Risk of Diabetes in South Asians • Many studies have suggested that South Asians have higher prevalence of diabetes mellitus • This higher prevalence of diabetes is at lower BMI even after adjusting for other demographic risk factors • Racial differences for risk of diabetes in different Asian populations exists. From the data provided by New York City Department of Health and Mental Hygiene, adults born in South Asia had 3 times higher prevalence of diabetes than those born in East Asia (1) • Differences in metabolic parameters, circulating insulin levels, triglyceride and C-reactive protein were observed between South Asian children and children of other European descent by age 9-10 years in a study conducted in United Kingdom (2)

  5. Diabetes Education Studies in South Asians • Most studies evaluating effect of culturally and linguistically sensitive diabetes education in South Asian population were conducted in United Kingdom and Canada • A study conducted in Glasgow UK, to provide culturally appropriate diabetes education in adult day care setting resulted in significant improvements in scores of knowledge, complications, practice and attitude toward seriousness of diabetes as disease(3)

  6. Effect of Educational Intervention in Other Studies • In a systemic review of 9 studies of the effect of diabetes education in South Asian patients, effectiveness of the interventions was variable • Improvement in knowledge was more commonly achieved than in the metabolic parameters • Only one of three randomized clinical trials showed significant improvement in HbA1c, at short term follow of 3 months (4)

  7. South Asians in New York City • “South Asian” population for our project consisted of immigrants from and those who trace ancestry of origin to India, Pakistan, Bangladesh, Sri Lanka, Bhutan, Nepal and Maldives • South Asian population in the United states from 2000 census data is approximately 1.8 million (5) • This population is highly concentrated in New York, New Jersey, California, Texas and Illinois • New York city is one of the metro-city areas with largest South Asian population approximating to 315,000 (5) • In New York, large South Asian population is concentrated in neighborhoods in the borough of Queens

  8. South Asian Community B A • A. Geographic map of South Asia • B. Map depicting high concentration of Asian Indian in neighborhoods of Queens as per US Census data

  9. Queens/South Asian Action for Diabetes Education Program and Treatment (ADEPT) • Collaborative effort of Gerald J. Friedman Diabetes Institute at Beth Israel Medical Center and the South Asian Health Initiative (SAHI) at New York University School of Medicine's Center for Immigrant Health • This program was designed to deliver culturally competent diabetes education to patients of South Asian community in neighborhoods of Queens. The program met American Diabetes Association (ADA) standard of care • This program provided essential partnership of the community, public health practitioners, physicians, health educators and advocates to address diabetes mellitus in the South Asian community

  10. ADEPT Program • A network of primary care physicians from Queens whose practices include a large number of patients of South Asian origin • A certified diabetes educator (CDE) was hired for this project. He was of South Asian origin, fluent in many South Asian languages and well aware of cultural practices of this population • Standard diabetes education material was translated into several common South Asian languages • All diabetes education sessions were conducted at primary care providers’ practice locations • Physicians were trained in ADA diabetes education and standard of care by CDE • CDE provided one to one and group diabetes education to South Asian patients with diabetes referred by primary care provider. Diabetes education focused on basic knowledge and general management guidelines

  11. ADEPT Program (Cont) • Community efforts • ADEPT’s diabetes educator participated in many community gatherings and events to increase awareness of diabetes. Many events included free glucose testing to screen for diabetes • A round table conference for medical providers, patients and community leaders to understand and address barriers for diabetes care in South Asian patients was held at Beth Israel Medical Center

  12. Program Data • Created a network of 8 primary care physicians • Provided education to 400 patients with diabetes of South Asian descent • Screened 1100 patients for diabetes during community fairs

  13. Pilot study • A pilot non-randomized study enrolled South Asian patients with diabetes from the ADEPT network • Goal of the study: Compare differences in outcome in the group that received diabetes education to the group that did not receive education • Hypothesis: Culturally competent diabetes education program improved diabetes related metabolic parameters namely HbA1c • Study was approved by Institutional Review Board at Beth Israel Medical Center and informed consent was obtained from all participants • Groups: • Education group (n=39): received formal, culturally sensitive diabetes education from CDE • initial education was followed by additional sessions every 2 to 4 weeks • Control group (n=41): patient from same practice as education group but who did not receive formal diabetes education

  14. Data Collection • Demographic information: age, sex, weight, height, duration of diabetes, blood pressure; collected at baseline • Laboratory data including hemoglobin A1c, total cholesterol (TC), high density cholesterol (HDL) , low density cholesterol (LDL), creatinine, urine microalbumin and creatinine; collected at baseline and 3 months • Statistical analysis: Changes between groups from baseline to follow-up were compared using either mixed model regression in the case of normally distributed variables or generalized linear modeling in the case of skewed variables

  15. Serum Cholesterol level, HbA1c and Urine Microalbumin Levels p for comparison between the groups p* for comparison between baseline and 3 months for control group P** for comparison between baseline and 3 months for education group

  16. Results • Significant reduction in total cholesterol, LDL, triglyceride and urine microalbumin levels in the education group at 3 months compared to the control group • Trend for reduction in HbA1c from 8.0 to 7.2% in the education group

  17. Legacy effect of ADEPT • Created a network of 8 primary care providers trained in ADA standard of care • Provided linguistically and culturally sensitive diabetes education material for continued use in ADEPT provider offices • Obtained data about barriers to achieve diabetes related goals in this population

  18. Limitations • Short duration of follow-up (3 months) • Selection bias • Not a randomized trial: patients with the least controlled diabetes could have been preferably referred by their primary care providers to the educator. This may explain significant baseline differences between the groups

  19. Conclusions • Culturally sensitive program for South Asian patients with diabetes appears to have a potential to improve “hard” clinical outcomes

  20. References • Kim M. Berger D, Matte T. Diabetes in New York City: Public Health Burden and Disparities New York:New York City Department of Health and Mental Hygiene, 2006 • Whincup PH, Nightlingle CM, Owen CG, Rudnicka AR, Gibb I, McKay CM, Donin AS, Sattar N, Alberti KG, Cook DG. Early emergence of ethnic differences in type 2 diabetes precursors in the UK: the Child Heart and Health Study in England (CHASE Study). PLoS Med 2010; 7(4):e1000263 • Baradaran HR, Knill-Jones RP, Wallia S, Rodgers A. A controlled trial of the effectiveness of diabetes education programme in a multi-ethnic community in Glasgow BMC Public Health 2006; 6:134 • Khunti K, Camosso-Stefinovic J, Carey M, Davies MJ, Stone MA Educational interventions for migrant South Asians with Type 2 diabetes: a systematic review. Diabet Med. 2008; 25(8):985-92 • U.S. Census Bureau, Summary File 2 (SF 2) and Summary File 4 (SF 4)-2000 • McNeely M, Boyko E. Type 2 diabetes prevalence in Asian Americans: results of a national health survey. Diabetes Care 2004; 27:66–69,

  21. Acknowledgements We are thankful for the support from • Gerald J. and Dorothy Friedman Foundation • New York State Health Foundation

More Related