A Nurse-Led Diabetes Navigation Program for Rural Appalachian Ohio

In the Appalachian region of rural southeastern Ohio, diabetes rates are more than double the national average (19.9% vs. 9.4%). Here, diabetes patients are more likely to have a delayed diagnosis, microvascular complications, depression, and lower empowerment. Further, nearly a third of residents are living below the poverty line and suffer from higher unemployment rates, lower educational achievement, poorer health, food insecurity, and lower access to care. Thus, strategies that complement standard diabetes care are critically important to alleviate the burden of complications, reduce health disparities, and improve quality of life. We designed the Diabetes Navigation Program to improve health outcomes and address social determinants of health by expanding access to care and enhancing care coordination via nurse navigators. To date, 47 adult patients with type 2 diabetes have completed the program (94% white, 66% female, 61±16 years old, A1C=9.0±2.7%, 12±8 years duration). At baseline, 24% of patients reported moderately severe to severe depression as measured via the PHQ-9, and 53% reported moderate to serious diabetes distress as measured via the PAID-5. Patients showed a significant improvement in A1C from baseline to 6-month follow-up (mean change: -1.2 points, t=2.23, p=0.017); however, no improvements were observed in depressive symptoms (t=1.37, p=0.199) or diabetes distress (t=1.82, p=0.098). The nurse navigator provided increased insurance coverage (59%), food stamps (50%) and emergency food boxes (16%), permanent or temporary housing (23%), diabetes education (21%), reduced hospital bills (14%), diabetes medication (14%), and emotional support (71%). These data are promising though more data are necessary to evaluate the clinical effectiveness. The next step is to design a randomized controlled trial to test the efficacy of navigation as compared to usual care. In the long term, this work has the potential to reduce health disparities and improve access to care for in Appalachian Ohio.