Culturally Sensitive Diabetes Program Promising

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ORLANDO, Fla.—Investigators have reported favorable results with a culturally sensitive diabetes education program “piloted” in diabetics of South Asian origin living in Queens, N.Y.

“We believe that the Queens/South Asian Action of Diabetes Education Program and Treatment, known as ADEPT, has the potential to improve hard clinical outcomes,” said Grishma Parikh, MD, a clinical fellow in endocrinology at Beth Israel Medical Center in New York.

Results in 80 patients at three months showed significant improvements of multiple measures in patients who participated in the diabetes education program compared with a group of patients from the same primary care practice who did not participate in the program. Diabetes education in the program focused on basic knowledge and general management guidelines.

South Asian patients who participated in the program had decreases in total cholesterol, low-density lipoprotein cholesterol, triglyceride, and urine microalbumin levels.

“With a higher prevalence of diabetic nephropathy in South Asian patients, an educational program with proven benefit in urine microalbumin is extremely valuable,” Dr. Parikh told Renal & Urology News. She reported findings at the American Diabetes Association annual meeting.

Investigators also observed a trend for a reduction in hemoglobin A1C levels in the education group.

With ADEPT, a network of eight primary care physicians of South Asian origin provide care to a large South Asian community in Queens. A South Asian certified diabetes educator (CDE) administers the ADA education curriculum. Specially designed culturally competent diabetes education material that is translated into several South Asian languages is available to patients in the network.

Patients received formal culturally sensitive diabetes education in one-on-one sessions, with follow-up sessions every two to four weeks. All sessions were conducted at primary care providers' practice locations.

The South Asian population in the study included immigrants from Pakistan, Bangladesh, Sri Lanka, Bhutan, Nepal, and the Maldives as well as individuals who trace their ancestry to these countries. According to census data released in 2000, the overall south Asian population in the United States is roughly 1.8 million. The population is heavily concentrated in New York, New Jersey, California, Texas, and Illinois. 

New York has a South Asian population totaling around 315,000; most of these individuals live in Queens.

Diabetes risk varies by Asian populations, Dr. Parikh said. For example, data provided by the New York Department of Health and Mental Hygiene suggest that the prevalence of diabetes is three times greater in adults born in South Asia than adults born in East Asia. 

Dr. Parikh emphasized that her study findings are preliminary and limited by the short follow-up period. Selection bias may also be a drawback given that the study was not a randomized trial and thus patients with the worst diabetes control might have been preferentially referred to the program by their primary care providers.

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