Abstract P194: Long-Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa
Introduction: Diabetes Care in American Samoa (DCAS) was a randomized controlled trial of a 12 month community health worker (CHW)-facilitated intervention which demonstrated improved HbA1c levels compared to usual care. These results add to growing evidence supporting the role of CHWs in diabetes care. However, most CHW programs are time-limited, and few pursue long-term follow-up of participants. Little is known about whether short-term CHW programs achieve sustained improvements in diabetes control over time.
Hypothesis: We hypothesized that HbA1c would increase over time in the experimental group of DCAS after CHW intervention completion. In the waitlist usual care group, which received the intervention at the end of DCAS, we expected HbA1c to decrease during the intervention and increase after completion.
Methods: We retrospectively collected HbA1c measurements from medical records of DCAS participants (n=268). We used mixed-effects regression models to assess change in HbA1c over time in each trial arm for 3 time periods: DCAS (intervention in experimental group), 1 year after DCAS (intervention in waitlist group), and 1 to 2 years after DCAS. Models were adjusted for baseline characteristics measured during DCAS.
Results: In the experimental group, HbA1c did not significantly change over time during DCAS (intervention period), but decreased by 0.88/year (95% CI -1.31, -0.45) during the 1 year after intervention completion (Table). No significant change was observed the following year. In the waitlist group, HbA1c did not significantly change during DCAS (usual care) but decreased by 1.31/year (-1.72, -0.91) during the intervention. During the 1 year after intervention completion, HbA1c increased by 1.18/year (0.42, 1.93).
Conclusions: Both trial arms experienced initial improvements in glycemic control, but HbA1c later plateaued or increased. These results suggest that time-limited CHW programs may have short-term effects on diabetes control, but standing programs may be needed for sustained impact.
Author Disclosures: M. Rao: None. J.D. DePue: None. S. Dunsiger: None. M. Elsayed: None. O. Nu'usolia: None. S.T. McGarvey: None.
- © 2015 by American Heart Association, Inc.