IN BRIEF In the United States, Hispanics have a 66% greater risk of developing type 2 diabetes and, once diagnosed, exhibit worse outcomes than non-Hispanic whites. It is therefore imperative to ensure that interventions meet the specific needs of this at-risk group. This article provides a selective review of the evidence on innovative, real-world approaches (both live and technology-based) to improving behavioral, psychosocial, and clinical outcomes in underserved Hispanics with type 2 diabetes. Key aspects of successful live interventions have included multimodal delivery, greater dosage/attendance, and at least some in-person delivery; effective technology-based approaches involved frequent but intermittent communication, bi-directional messaging, tailored feedback, multimodal delivery, and some human interaction. Across modalities, cultural tailoring also improved outcomes. Additional research is needed to address methodological limitations of studies to date and pinpoint the most efficacious components and optimal duration of interventions. Future efforts should also attend to variability within the U.S. Hispanic population to ensure acceptability and sustainability of interventions in this diverse group.

Diabetes affects 14% of the U.S. population (1), and this prevalence is projected to grow to 21% (a 50% increase) by 2040 (2). Type 2 diabetes comprises the vast majority (90–95%) of these cases (3). Within the United States, socioeconomically disadvantaged, racial/ethnic minority populations experience significant type 2 diabetes disparities. Hispanics/Latinos (hereafter referred to as Hispanics), representing the largest and second-fastest-growing minority group in the country (4), have a 66% higher risk of developing type 2 diabetes (5). The 2013–2016 National Health and Nutrition Examination Survey reported a 19.8% total diabetes prevalence among Hispanics compared to 12.4% in non-Hispanic whites (1). The Hispanic Community Health Study/Study of Latinos, a prospective, multi-center, population-based cohort of 16,145 Hispanics, reported an overall diabetes prevalence of 16.9% (6). In addition to having a higher diabetes prevalence, Hispanics exhibit poorer self-management and outcomes once diagnosed compared to non-Hispanic whites (69). For example, only 48% of Hispanics with type 2 diabetes in the Hispanic Community Health Study/Study of Latinos had an A1C <7% (6).

The causes of Hispanic diabetes disparities are multifactorial and multilevel and span biological, environmental (e.g., built environments not conducive to exercise and limited access to healthy foods), and health care system factors (e.g., differential access and quality of medical care and high treatment costs) (10). Low socioeconomic status and health literacy (6,11), language barriers (12,13), patient-provider mismatch (14), as well as prominent cultural values (15,16), beliefs (e.g., fatalism) (14), and attitudes toward diabetes and treatments also serve as powerful influences on adherence and outcomes in Hispanics (17).

Diabetes self-management education and support (DSME/S) is considered a cornerstone of effective care that can lead to improved clinical, quality of life, and health care cost outcomes (18,19). Two meta-analyses that synthesized findings from 65 trials in the overall population found DSME/S to achieve average A1C reductions of 0.70% (20) and 0.76% (21). Despite the potential clinical and other benefits, DSME/S utilization is low; <5% of eligible individuals with diabetes access DSME/S (22). Access to (23) and participation in (24) DSME/S is particularly low among underserved populations, such as Hispanics, because of practical (e.g., work schedules, caregiving responsibilities, and lack of transportation) and health system barriers (2528). Given the unique socio-cultural experiences and barriers encountered by U.S. Hispanics (16), it is imperative to ensure that diabetes programs meet the specific needs of this large and growing at-risk group.

This narrative review summarizes the current literature with respect to innovative, real-world approaches for improving diabetes outcomes in the underserved U.S. Hispanic population. Research regarding the impact of both traditional (“live”) and technology-based interventions on diabetes self-management behaviors (i.e., blood glucose monitoring, healthful eating, exercise, and medication adherence) and clinical control (i.e., glycemic, lipid, and blood pressure control) is reviewed. Additionally, given the growing and important consideration of emotional well-being in type 2 diabetes, this review also summarizes available evidence on the impact of these interventions on relevant psychosocial outcomes (i.e., depression, anxiety, and diabetes distress). Given the authors’ extensive experience in developing and evaluating innovative interventions for underserved Hispanic adults with type 2 diabetes, examples from our work are included as illustrations to complement the broader literature review.

A variety of live interventions (i.e., those delivered in-person or by telephone without the assistance of mobile health [mHealth] or Internet technology) have been developed to improve outcomes in Hispanics with type 2 diabetes. These approaches have varied widely in terms of format, interventionist, and dosage. The majority have involved group-based sessions, whereas a smaller number have consisted of one-on-one visits delivered in person or by telephone or a blend of these strategies (29,30). Many interventions have been delivered by community health workers (CHWs; individuals of the same cultural background as participants, who are familiar with the community and have their own lived experience with diabetes [30,31]), whereas some have been delivered by certified diabetes educators (CDEs) or via a team approach (29). Session frequency has most commonly been weekly; however, duration has varied from 1 to 2.5 hours per session, and intervention periods have ranged from 6 weeks to 24 months (2931).

Live interventions have achieved improvements in A1C, nutrition (32,33), physical activity (32,34), medication adherence (32), and overall diabetes self-care (35) among Hispanics with type 2 diabetes. However, few studies have reported positive effects for blood pressure, weight, BMI, or lipids (2931). Overall, the specific aspects that were associated with more favorable outcomes in this population included multimodal implementation (e.g., a blend of in-person and telephone delivery), interdisciplinary approaches, longer intervention periods (34,35), tailoring for low literacy (32,3639) and cultural relevance (29,33,34,39), social elements (e.g., invited family/friends or encouraged camaraderie among participants (32,33,37), and consideration of diabetes-related cultural beliefs (40).

Spotlight 1: Project Dulce

Project Dulce is an American Diabetes Association (ADA)-recognized program developed in 1997 by the Scripps Whittier Diabetes Institute in collaboration with San Diego federally qualified health centers (FQHCs), the County of San Diego, and San Diego State University to improve health and access to care of underserved, primarily Hispanic adults with type 2 diabetes. Informed by the Chronic Care Model (41,42), Project Dulce’s nurse-led multidisciplinary team of registered dietitian/CDEs and medical assistants provides clinical management, while bilingual/bicultural peer educators (promotoras) deliver culturally tailored DSME/S. Project Dulce DSME/S consists of weekly, 2-hour classes and integrates key educational content (e.g., healthful eating, exercise, blood glucose monitoring, and medications) with evidence-based behavior change processes (e.g., goal-setting and problem-solving). Importantly, Project Dulce builds on cultural strengths/resources to motivate health behavior change (e.g., the high value that is placed on family and other interpersonal relationships in the Hispanic population), incorporates culturally relevant food and activity recommendations, and addresses the sociocultural context of this underserved population (e.g., healthy eating on a budget and cultural beliefs).

Studies evaluating Project Dulce have demonstrated positive effects on clinical, behavioral, and cost outcomes (40,4346). To date, the program has reached >20,000 ethnically diverse patients at Southern California FQHCs (45), and its effectiveness has been replicated in other health systems across the United States and in Mexico, demonstrating program scalability.

Although most diabetes interventions in Hispanics have been conducted in person or on the phone, technology-based approaches have gained traction in recent years. mHealth or other technology-driven (e.g., Web-based) interventions are convenient to deliver, eliminate some of the logistical barriers that can interfere with the delivery of live interventions, and have the potential to increase patient engagement (47).

Technology platforms examined in Hispanics with type 2 diabetes have included text messaging, telemedicine, and Web-based tools. In one study that examined unidirectional, twice-daily text messaging (including educational/motivational content, medication reminders, healthy living challenges, and trivia questions), there were no differences between the intervention and a control group in behavioral or clinical outcomes at 6 months; however, intervention effects for A1C and medication adherence were larger for Spanish- versus English-speaking participants (48). An approach that evaluated CHWs’ use of telemedicine and videoconferencing in a clinical setting to enhance diabetes care (49) achieved a significant mean A1C improvement (49). In another intervention, CHWs introduced participants to tablet technology to deliver a Web-based diabetes education and decision support tool with in-person support (50). The intervention was individually tailored for participants’ laboratory values, medications, health insurance status, personal preferences, and adherence barriers. Compared to a control group that received printed materials, the CHW-plus-technology group showed improvements in A1C and medication adherence.

Overall, frequent but asynchronous communication, bi-directional messaging, tailored feedback, and cultural tailoring have improved outcomes in Hispanics (47). Notably, maintaining human interaction as part of the technology intervention can facilitate engagement.

Spotlight 2: Dulce Digital

The Dulce Digital intervention included culturally tailored, educational, and supportive text messages derived from the Project Dulce curriculum. In contrast to the text message intervention described above (48), Dulce Digital encouraged patient monitoring and transmission of blood glucose values, which were remotely monitored by study staff for safety reasons. In a randomized, controlled trial including 126 Hispanic participants, Dulce Digital improved A1C over 6 months relative to usual care (51).

Participants reported high satisfaction but expressed a preference for a more personalized intervention (52). Thus, our in-progress trial compares Dulce Digital to Dulce Digital-Me, an adaptive intervention that adds real-time feedback and goal-setting messaging based on participants’ wirelessly transmitted blood glucose values and self-reported adherence (National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Disease grant 5R01DK112322-03; authors A.P.-T. and L.C.G. principal investigators). The adaptive feedback is delivered via algorithm-driven messaging to half of the Dulce Digital-Me participants and by the care team medical assistant to the remaining half to determine the feasibility and acceptability, cost-differential, and comparative effectiveness of each delivery method. This research is being conducted as a collaboration between Scripps Whittier Diabetes Institute, San Diego State University, the University of California San Diego, and Neighborhood Healthcare, a Southern California FQHC system.

Spotlight 3: Glucose as a Vital Sign

The Scripps Whittier Diabetes Institute is also examining the utility of remote blood glucose monitoring in the hospital. Optimally, in the inpatient setting, blood glucose monitoring should occur continuously, similar to the observation of other vital signs. There are several continuous glucose monitoring (CGM) systems available in the outpatient setting that facilitate rapid, real-time monitoring of patients’ subcutaneous interstitial fluid glucose values, although these are not yet approved for use in U.S. hospitals. This in-progress trial examines the utility of CGM versus point-of-care testing in reducing hyper- and hypoglycemia and increasing time in the target glycemic range among predominantly Hispanic, high-risk patients with type 2 diabetes at Scripps Mercy Hospital, a large, safety-net hospital in the U.S./Mexico border region of San Diego. CGM devices are placed on all participants, and bedside values are blinded. In the point-of-care testing group, CGM data are used for evaluation purposes only. In the CGM group, CGM data are wirelessly transmitted to a management team that follows protocols designed for early intervention to prevent hypo- and hyperglycemia.

Preliminary analysis showed the CGM group to exhibit fewer hyper- and hypoglycemia values. Although the small sample size (n = 45) precluded significance testing, effects were small to moderate in size. Preliminary results also demonstrated that CGM-based remote monitoring by glucose management teams in the hospital is feasible, safe, and acceptable in this underserved, predominantly Hispanic group (53).

Although the impact of innovative diabetes interventions on clinical outcomes has been widely researched, less is known about the impact of these programs on psychosocial outcomes. Psychosocial factors such as general distress (i.e., depression [54] and anxiety [55]) and health-specific emotional distress (i.e., diabetes distress [56]) are prevalent in the general type 2 diabetes population (56) and even higher among Hispanics compared to non-Hispanic whites (57,58). The presence of emotional distress adversely affects diabetes self-care and glycemic control (5961) and has also been linked to reduced quality of life (62) and self-efficacy (63). The ADA’s position statement on psychosocial care for people with diabetes (64) calls for routine psychosocial screenings and DSME/S as the first line of treatment for diabetes-related distress.

Two systematic reviews conducted to date have reported positive effects of DSME/S on depression symptoms (65) and other psychosocial outcomes (66) in the overall population of people with type 2 diabetes. However, in their recent systematic review of the literature, Gutierrez et al. (67) did not observe the same strength of evidence for the effects of DSME/S on psychosocial outcomes in Hispanics. The 15 studies included in the review examined general emotional distress (i.e., depression and anxiety), health-specific emotional distress (i.e., diabetes distress), or a combination thereof and used group or individual formats. The majority of studies targeted emotional distress directly by incorporating elements of cognitive behavioral therapy, mindfulness, or stress management exercises. This review reported a lack of methodologically robust evidence that culturally tailored DSME/S interventions are effective in reducing emotional distress in Hispanics. However, interventions that were relatively more effective commonly incorporated 1) content directly targeting emotional distress and 2) cultural tailoring beyond language alone (e.g., community venues, group format, or delivery by CHWs).

Racial/ethnic disparities in the prevalence and outcomes for chronic conditions, including diabetes, were estimated to cost the U.S. health care system $4.5 billion in 2009, and these costs have been projected to increase to $22 billion by 2050 if disparities are not addressed (68). Innovative, culturally appropriate interventions are needed to address these disparities and improve quality and quantity of life among Hispanics. This selective review identified several promising intervention approaches, while also highlighting important areas for future research.

Recent systematic reviews and meta-analyses show that DSME/S interventions delivered in person or by phone are effective in enhancing diabetes self-management and clinical outcomes, and particularly glycemic control, among Hispanics. Although the ADA recommends DSME/S for individuals experiencing diabetes distress, there is no compelling evidence that this approach improves psychosocial outcomes in U.S. Hispanics with type 2 diabetes. Thus, additional research is needed to develop interventions with a greater emphasis on emotional well-being, and in turn increased potential to improve psychosocial outcomes in this population.

Characteristics or processes that appear to enhance behavioral and clinical effectiveness in Hispanics with type 2 diabetes include multimodal interventions, at least some in-person delivery (versus telephone only), and greater adherence to the intervention (high attendance and low attrition). From a cultural perspective, specific tailoring of these programs, including linguistic translation, tailoring to literacy levels and socioeconomic context, delivery by a peer educator or CHW, consideration of cultural values and beliefs, and a social emphasis through a group format or inclusion of family and friends, may facilitate program engagement and augment effects. However, additional research using robust designs is needed to address methodological limitations of the research to date, which include small samples, high attrition in some studies, and uncontrolled designs. Furthermore, given the heterogeneity in content and dosage across interventions, studies that pinpoint the efficacious components and optimal duration of interventions would be valuable.

The high attrition rates, poor adherence rates, and overall low access to and utilization of these types of programs by U.S. Hispanics, combined with the increasing use of cell phones and the Internet in low-income and Hispanic populations (i.e., the close of the “digital divide” [69]) underscore the need to move beyond traditional delivery approaches to overcome utilization barriers. Recent studies that incorporate a focus on mHealth and remote monitoring to improve access to self-management support interventions show promise. In addition to the cultural tailoring strategies noted above, technology-based interventions that integrated frequent but asynchronous communication, bi-directionality of messages, and tailored feedback were noted to be effective in improving diabetes self-management and clinical control in Hispanic adults.

In summary, the reviewed literature indicates that live and technology-based interventions largely improve behavioral and clinical outcomes in Hispanics with type 2 diabetes, and to a greater extent than psychosocial outcomes. Future research is needed to determine how to best leverage the value inherent in both live and technology-based approaches, while incorporating individual patients’ unique preferences, resources, and barriers. Hybrid approaches that capitalize on the value of live interventions (especially among Hispanics), while minimizing the number of sessions (and burden and cost) by incorporating technology to deliver a portion of the intervention warrant consideration. Incorporating CHWs or other personnel into mHealth interventions (an approach currently under evaluation as part of Dulce Digital-Me) may help overcome barriers of technology literacy and improve patient activation, satisfaction, and adherence (47). Additionally, and consistent with the ADA’s call for ongoing DSME/S, future investigations should consider extending the duration of support provided by incorporating technology for the maintenance period.

Regardless of modality, cultural tailoring must go beyond linguistic translation to maximize relevance to participants’ socio-cultural context (1416). Although this review summarizes findings for U.S. Hispanics, it is important to note that the panethnic term “Hispanics” describes a large, heterogeneous group originating from multiple Spanish-speaking nations and that evidences substantial variability in socio-cultural characteristics, beliefs, behaviors, and attitudes toward health and health care. Thus, the incorporation of community-engaged research approaches and formative methods will be imperative to accommodate within-group variability and ensure the acceptability, feasibility, and sustainability of future approaches in the U.S. Hispanic population.

The research programs summarized in Spotlights 1, 2, and 3 were/are supported by the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (Project Dulce: R18DK070666; Dulce Digital-Me: 5R01DK112322-03), the McKesson Foundation (Dulce Digital: 115M803379), the Investigator-Initiated Study Program of LifeScan, Inc. (Dulce Digital), the Confidence Foundation (Glucose as a Vital Sign), and NIH/NCRR (1 U54 TR002359-01). The authors thank the staff and participants in these research efforts for their important contributions and the administration and staff at Neighborhood Healthcare for their partnership in these investigations.

1.
Mendola
ND
,
Chen
T-C
,
Gu
Q
,
Eberhardt
MS
,
Saydah
S
.
Prevalence of total, diagnosed, and undiagnosed diabetes among adults: United States, 2013–2016. NCHS Data Brief, no. 319
.
Hyattsville, Md
.,
National Center for Health Statistics
,
2018
2.
International Diabetes Federation
.
IDF Diabetes Atlas
. 7th ed.
Brussels, Belgium
,
International Diabetes Federation
,
2015
3.
Centers for Disease Control and Prevention
.
National diabetes statistics report, 2017
.
Atlanta, Ga
.,
Centers for Disease Control and Prevention, U.S. Department of Health and Human Services
,
2017
4.
Flores
A
.
How the U.S. Hispanic population is changing
.
5.
U.S. Department of Health and Human Services, Office of Minority Health
.
Diabetes and Hispanic Americans
.
Available from minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=63. Accessed 12 December 2018
6.
Schneiderman
N
,
Llabre
M
,
Cowie
CC
, et al
.
Prevalence of diabetes among Hispanics/Latinos from diverse backgrounds: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
.
Diabetes Care
2014
;
37
:
2233
2239
7.
Xu
JQ
,
Murphy
SL
,
Kochanek
KD
,
Bastian
B
,
Arias
E
.
Deaths: final data for 2016. National Vital Statistics Reports, vol. 67, no. 5
.
Hyattsville, Md
.,
National Center for Health Statistics
,
2018
8.
Dominguez
K
,
Penman-Aguilar
A
,
Chang
MH
, et al
.
Vital signs: leading causes of death, prevalence of diseases and risk factors, and use of health services among Hispanics in the United States: 2009–2013
.
MMWR Morb Mortal Wkly Rep
2015
;
64
:
469
478
9.
Chow
EA
,
Foster
H
,
Gonzalez
V
,
McIver
L
.
The disparate impact of diabetes on racial/ethnic minority populations
.
Clin Diabetes
2012
;
30
:
130
133
10.
Mayberry
LS
,
Bergner
EM
,
Chakkalakal
RJ
,
Elasy
TA
,
Osborn
CY
.
Self-care disparities among adults with type 2 diabetes in the USA
.
Curr Diab Rep
2016
;
16
:
113
11.
Dewalt
DA
,
Berkman
ND
,
Sheridan
S
,
Lohr
KN
,
Pignone
MP
.
Literacy and health outcomes: a systematic review of the literature
.
J Gen Intern Med
2004
;
19
:
1228
1239
12.
Parker
MM
,
Fernandez
A
,
Moffet
HH
,
Grant
RW
,
Torreblanca
A
,
Karter
AJ
.
Association of patient-physician language concordance and glycemic control for limited-English proficiency Latinos with type 2 diabetes
.
JAMA Intern Med
2017
;
177
:
380
387
13.
Lopez-Quintero
C
,
Berry
EM
,
Neumark
Y
.
Limited English proficiency is a barrier to receipt of advice about physical activity and diet among Hispanics with chronic diseases in the United States
.
J Am Diet Assoc
2010
;
110
(
Suppl. 5
):
S62
S67
14.
Moreira
T
,
Hernandez
DC
,
Scott
CW
,
Murillo
R
,
Vaughan
EM
,
Johnston
CA
.
Susto, coraje, y fatalismo: cultural-bound beliefs and the treatment of diabetes among socioeconomically disadvantaged Hispanics
.
Am J Lifestyle Med
2017
;
12
:
30
33
15.
Katiria Perez
G
,
Cruess
D
.
The impact of familism on physical and mental health among Hispanics in the United States
.
Health Psychol Rev
2011
;
8
:
95
127
16.
Caballero
AE
.
Understanding the Hispanic/Latino patient
.
Am J Med
2011
;
124
(
Suppl. 10
):
S10
S15
17.
Smith-Miller
CA
,
Berry
DC
,
Miller
CT
.
Diabetes affects everything: type 2 diabetes self-management among Spanish-speaking hispanic immigrants
.
Res Nurs Health
2017
;
40
:
541
554
18.
American Diabetes Association
.
2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2019
.
Diabetes Care
2019
;
42
(
Suppl. 1
):
S13
S28
19.
Beck
J
,
Greenwood
D
,
Blanton
L
, et al
.
2017
national standards for diabetes self-management education and support
.
Diabetes Care
2017
;
40
:
1409
1419
20.
Tshiananga
JKT
,
Kocher
S
,
Weber
C
,
Erny-Albrecht
K
,
Berndt
K
,
Neeser
K
.
The effect of nurse-led diabetes self-management education on glycosylated hemoglobin and cardiovascular risk factors: a meta-analysis
.
Diabetes Educ
2012
;
38
:
108
123
21.
Norris
SL
,
Engelgau
MM
,
Narayan
KM
.
Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials
.
Diabetes Care
2001
;
24
:
561
587
22.
Strawbridge
LM
,
Lloyd
JT
,
Meadow
A
,
Riley
GF
,
Howell
BL
.
Use of Medicare’s diabetes self-management training benefit
.
Health Educ Behav
2015
;
42
:
530
538
23.
Peyrot
M
,
Rubin
RR
,
Funnell
MM
,
Siminerio
LM
.
Access to diabetes self-management education
.
Diabetes Educ
2009
;
35
:
246
263
24.
Centers for Disease Control and Prevention
.
Behavioral Risk Factor Surveillance System survey data, 2010
.
Atlanta, Ga
.,
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention
,
2012
25.
Centers for Disease Control and Prevention
,
National Center for Chronic Disease Prevention and Health Promotion, Training and Technical Assistance Support Center. Emerging practices in diabetes prevention and control: Medicaid coverage for diabetes self-management education
.
26.
American Diabetes Association
.
Introduction: Standards of Medical Care in Diabetes—2019
.
Diabetes Care
2019
;
42
(
Suppl. 1
):
S1
S2
27.
Horigan
G
,
Davies
M
,
Findlay-White
F
,
Chaney
D
,
Coates
V
.
Reasons why patients referred to diabetes education programmes choose not to attend: a systematic review
.
Diabet Med
2017
;
34
:
14
26
28.
Schwennesen
N
,
Henriksen
JE
,
Willaing
I
.
Patient explanations for non-attendance at type 2 diabetes self-management education: a qualitative study
.
Scand J Caring Sci
2015
;
30
:
187
192
29.
Ferguson
S
,
Swan
M
,
Smaldone
A
.
Does diabetes self-management education in conjunction with primary care improve glycemic control in Hispanic patients? A systematic review and meta-analysis
.
Diabetes Educ
2015
;
41
:
472
484
30.
Gonzalez
LS
,
Berry
DC
,
Davison
JA
.
Diabetes self-management education interventions and glycemic control among Hispanics: a literature review
.
Hisp Health Care Int
2013
;
11
:
157
166
31.
Little
TV
,
Wang
ML
,
Castro
EM
,
Jimenez
J
,
Rosal
MC
.
Community health worker interventions for Latinos with type 2 diabetes: a systematic review of randomized controlled trials
.
Curr Diab Rep
2014
;
14
:
558
32.
Babamoto
KS
,
Sey
KA
,
Camilleri
AJ
,
Karlan
VJ
,
Catalasan
J
,
Morisky
DE
.
Improving diabetes care and health measures among hispanics using community health workers: results from a randomized controlled trial
.
Health Educ Behav
2009
;
36
:
113
126
33.
Rosal
MC
,
Ockene
IS
,
Restrepo
A
, et al
.
Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income Latinos: Latinos en Control
.
Diabetes Care
2011
;
34
:
838
844
34.
Rothschild
SK
,
Martin
MA
,
Swider
SM
, et al
.
Mexican American Trial of Community Health Workers: a randomized controlled trial of a community health worker intervention for Mexican Americans with type 2 diabetes mellitus
.
Am J Public Health
2014
;
104
:
1540
1548
35.
Ryabov
I
.
The impact of community health workers on behavioral outcomes and glycemic control of diabetes patients on the U.S.-Mexico border
.
Int Q Community Health Educ
2010
;
31
:
387
399
36.
Prezio
EA
,
Cheng
D
,
Balasubramanian
BA
,
Shuval
K
,
Kendzor
DE
,
Culica
D
.
Community Diabetes Education (CoDE) for uninsured Mexican Americans: a randomized controlled trial of a culturally tailored diabetes education and management program led by a community health worker
.
Diabetes Res Clin Pract
2013
;
100
:
19
28
37.
Lorig
K
,
Ritter
PL
,
Villa
F
,
Piette
JD
.
Spanish diabetes self-management with and without automated telephone reinforcement: two randomized trials
.
Diabetes Care
2008
;
31
:
408
414
38.
Sixta
CS
,
Ostwald
S
.
Texas-Mexico border intervention by promotores for patients with type 2 diabetes
.
Diabetes Educ
2008
;
34
:
299
309
39.
Lujan
J
,
Ostwald
SK
,
Ortiz
M
.
Promotora diabetes intervention for Mexican Americans
.
Diabetes Educ
2007
;
33
:
660
670
40.
Philis-Tsimikas
A
,
Fortmann
A
,
Lleva-Ocana
L
,
Walker
C
,
Gallo
LC
.
Peer-led diabetes education programs in high-risk Mexican Americans improve glycemic control compared with standard approaches: a Project Dulce promotora randomized trial
.
Diabetes Care
2011
;
34
:
1926
1931
41.
Wagner
EH
,
Austin
BT
,
Davis
C
,
Hindmarsh
M
,
Schaefer
J
,
Bonomi
A
.
Improving chronic illness care: translating evidence into action
.
Health Affairs (Millwood)
2001
;
20
:
64
78
42.
Wagner
EH
,
Austin
BT
,
Von Korff
M
.
Improving outcomes in chronic illness
.
Manag Care Q
1996
;
4
:
12
25
43.
Gilmer
TP
,
Walker
C
,
Johnson
ED
,
Philis-Tsimikas
A
,
Unutzer
J
.
Improving treatment of depression among Latinos with diabetes using Project Dulce and IMPACT
.
Diabetes Care
2008
;
31
:
1324
1326
44.
Philis-Tsimikas
A
,
Walker
C
,
Rivard
L
, et al
.
Improvement in diabetes care of underinsured patients enrolled in Project Dulce: a community-based, culturally appropriate, nurse case management and peer education diabetes care model
.
Diabetes Care
2004
;
27
:
110
115
45.
Philis-Tsimikas
A
,
Gallo
LC
.
Implementing community-based diabetes programs: the Scripps Whittier Diabetes Institute experience
.
Curr Diab Rep
2014
;
14
:
462
46.
Philis-Tsimikas
A
,
Gilmer
TP
,
Schultz
J
,
Walker
C
,
Fortmann
AL
,
Gallo
LC
.
Community-created programs: can they be the basis of innovative transformations in our health care practice? Implications from 15 years of testing, translating, and implementing community-based, culturally tailored diabetes management programs
.
Clin Diabetes
2012
;
30
:
156
163
47.
Lopez
L
,
Tan-McGrory
A
,
Horner
G
,
Betancourt
JR
.
Eliminating disparities among Latinos with type 2 diabetes: effective eHealth strategies
.
J Diabetes Complications
2016
;
30
:
554
560
48.
Arora
S
,
Peters
AL
,
Burner
E
,
Lam
CN
,
Menchine
M
.
Trial to examine text message-based mHealth in emergency department patients with diabetes (TExT-MED): a randomized controlled trial
.
Ann Emerg Med
2014
;
63
:
745
754
.
e6
49.
Mayes
PA
,
Silvers
A
,
Prendergast
JJ
.
New direction for enhancing quality in diabetes care: utilizing telecommunications and paraprofessional outreach workers backed by an expert medical team
.
Telemed J E Health
2010
;
16
:
358
363
50.
Heisler
M
,
Choi
H
,
Palmisano
G
, et al
.
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial
.
Ann Intern Med
2014
;
161
(
Suppl. 10
):
S13
S22
51.
Fortmann
AL
,
Gallo
LC
,
Garcia
MI
, et al
.
Dulce Digital: an mHealth SMS-based intervention improves glycemic control in Hispanics with type 2 diabetes
.
Diabetes Care
2017
;
40
:
1349
1355
52.
Fortmann
AL
,
Garcia
MI
,
Ruiz
M
, et al
.
Acceptability and feasibility of an mHealth self-management intervention in underserved Hispanics with poorly controlled type 2 diabetes
.
Presented at the 97th Annual Meeting of the Endocrine Society
,
San Diego, Calif
.,
March 2015
53.
Garcia
MI
,
Talavera
L
,
Fortmann
AL
, et al
.
Use of remote digital monitoring by glucose management teams in hospitalized high-risk patients to reduce hypo- and hyperglycemia
.
Presented at the American Diabetes Association’s 77th Scientific Sessions
,
San Diego, Calif
.,
June 2017
54.
Andreoulakis
E
,
Hyphantis
T
,
Kandylis
D
,
Iacovides
A
.
Depression in diabetes mellitus: a comprehensive review
.
Hippokratia
2012
;
16
:
205
214
55.
Grigsby
AB
,
Anderson
RJ
,
Freedland
KE
,
Clouse
RE
,
Lustman
PJ
.
Prevalence of anxiety in adults with diabetes: a systematic review
.
J Psychosom Res
2002
;
53
:
1053
1060
56.
Perrin
NE
,
Davies
MJ
,
Robertson
N
,
Snoek
FJ
,
Khunti
K
.
The prevalence of diabetes-specific emotional distress in people with type 2 diabetes: a systematic review and meta-analysis
.
Diabet Med
2017
;
34
:
1508
1520
57.
Peyrot
M
,
Egede
LE
,
Campos
C
, et al
.
Ethnic differences in psychological outcomes among people with diabetes: USA results from the second Diabetes Attitudes, Wishes, and Needs (DAWN2) study
.
Curr Med Res Opin
2014
;
30
:
2241
2254
58.
Welch
G
,
Schwartz
CE
,
Santiago-Kelly
P
,
Garb
J
,
Shayne
R
,
Bode
R
.
Disease-related emotional distress of Hispanic and non-Hispanic type 2 diabetes patients
.
Ethn Dis
2007
;
17
:
541
547
59.
Brown
SA
,
Garcia
AA
,
Brown
A
, et al
.
Biobehavioral determinants of glycemic control in type 2 diabetes: a systematic review and meta-analysis
.
Patient Educ Couns
2016
;
99
:
1558
1567
60.
Anderson
RJ
,
Grigsby
AB
,
Freedland
KE
, et al
.
Anxiety and poor glycemic control: a meta-analytic review of the literature
.
Int J Psychiatry Med
2002
;
32
:
235
247
61.
Sumlin
LL
,
Garcia
TJ
,
Brown
SA
, et al
.
Depression and adherence to lifestyle changes in type 2 diabetes: a systematic review
.
Diab Educ
2014
;
40
:
731
744
62.
Liu
MY
,
Tai
YK
,
Hung
WW
,
Hsieh
MC
,
Wang
RH
.
Relationships between emotional distress, empowerment perception and self-care behavior and quality of life in patients with type 2 diabetes
.
Hu Li Za Zhi
2010
;
57
:
49
60
[in Chinese]
63.
Sacco
WP
,
Wells
KJ
,
Vaughan
CA
,
Friedman
A
,
Perez
S
,
Matthew
R
.
Depression in adults with type 2 diabetes: the role of adherence, body mass index, and self-efficacy
.
Health Psychol
2005
;
24
:
630
634
64.
Young-Hyman
D
,
de Groot
M
,
Hill-Briggs
F
,
Gonzalez
JS
,
Hood
K
,
Peyrot
M
.
Psychosocial care for people with diabetes: a position statement of the American Diabetes Association
.
Diabetes Care
2016
;
39
:
2126
2140
65.
Cezaretto
A
,
Ferreira
SR
,
Sharma
S
,
Sadeghirad
B
,
Kolahdooz
F
.
Impact of lifestyle interventions on depressive symptoms in individuals at-risk of, or with, type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials
.
Nutr Metab Cardiovasc Dis
2016
;
26
:
649
662
66.
Steed
L
,
Cooke
D
,
Newman
S
.
A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus
.
Patient Educ Couns
2003
;
51
:
5
15
67.
Gutierrez
AP
,
Fortmann
AL
,
Savin
K
,
Clark
TL
,
Gallo
LC
.
Effectiveness of diabetes self-management education programs for US Latinos at improving emotional distress: a systematic review
.
Diab Educ
2019
;
45
:
13
33
68.
Waidmann
TA
.
Estimating the cost of racial and ethnic health disparities
.
69.
Lopez
MH
,
Gonzalez-Barrera
A
,
Patten
E
.
Closing the digital divide: Latinos and technology adoption
.
Available from www.pewhispanic.org/2013/03/07/iii-cellphone-use. Accessed 6 January 2017