Tool Helps Communicate CVD Risk to Diabetic Latinos

Patients view a set of video presentations on a tablet computer just before a clinic visit.
Patients view a set of video presentations on a tablet computer just before a clinic visit.

PHILADELPHIA—Investigators believe a multimedia Spanish-language program intended to teach high-risk Latinos with diabetes about cardiovascular disease (CVD) has major potential.

Preliminary results, released at the 72nd Scientific Sessions of the American Diabetes Association show that the program stimulated therapeutic interventions related to CVD risk. In fact, patients who were taught about CVD using the multimedia program just prior to visits with their primary care physicians were more likely to discuss CVD risk during their visits or to have a change in medication directed toward CVD risk factors than patients undergoing usual care.

“Cardiovascular disease is the major cause of mortality in Latinos with type 2 diabetes yet CVD risk factors are undertreated in this population,” said Paris Roach, MD, Associate Professor of Clinical Medicine at Indiana University School of Medicine in Indianapolis. “In the Indianapolis area, we have a large Spanish-speaking population of primarily Mexican immigrants with type 2 diabetes.”

His team had found that the multimedia program is effective in an English-speaking population and believed it would be well-suited to the local Latino population. “A lot of area physicians aren't fluent in Spanish, and a lot of our Hispanic immigrants have low literacy not only in English but also in their native Spanish, and we felt that the program with its audiovisuals and simple explanations would be a natural fit for this population.”

Dr. Roach and colleagues randomized four urban primary care clinics to the intervention (70 patients) or usual care (52 patients).  Study participants had type 2 diabetes without CVD but had at least one uncontrolled CVD risk factor. Their low-density lipoprotein (LDL)–cholesterol level was greater than 130 mg/dL, their systolic blood pressure (SBP) was greater than 150 mm Hg, or their hemoglobin A1C was higher than 8.0%.

The multimedia program consists of a series of video presentations that patients view immediately before their outpatient clinic visits on a tablet computer. Each presentation incorporates individualized CVD risk factor data and the patient's 10-year CVD risk based on U.K. Prospective Diabetes Study (UKPDS) Risk Engine estimates. The UKPDS is a landmark randomized, controlled trial which showed that both intensive treatment of blood glucose and blood pressure can lower the risk of diabetes-related complications in individuals newly diagnosed with type 2 diabetes.

Patients who participate in the multimedia program also receive a one-page printout showing their updated CVD risk factor risk factor status for use during consultation with the health care provider.

“We wanted to be able to effectively communicate CVD risk in our target population, and this means putting the risk message into a context that patients can understand,” Dr. Roach said. “Often patients hear this ‘alphabet soup' of LDL-cholesterol, A1C, and so on, and they also hear about heart attacks, and strokes, but they never completely grasp the meaning of these outcomes in terms of overall health risk. Specifically, we tell the patient his/her risk of a heart attack over the next 10 years compared to a nondiabetic age- and sex-matched individual, and we explain to them how to lessen that risk.”

The primary endpoint was the rate of therapeutic intervention per 12 months of follow-up, defined as a discussion of CVD risk with their physician during their visits based on exit interviews or a change in medications directed at a CVD risk factor based on medical chart review.

The study found that the rate of therapeutic intervention was 87% higher in the group assigned to the multimedia program compared with usual care (19.6 vs. 10.5 interventions per patient per 12 months). Additionally, 94% to 100% of exit survey responses from patients in the intervention group indicated that the program facilitated interactions with their physicians.

“We now have evidence that this risk communication tool stimulates the patient and physician to discuss CVD risk discussion and to intensify therapy,” Dr. Roach noted. He said that the next step is adapting the program for use in real-world settings. 

Dr. Roach's work was supported by a grant from the Robert Wood Johnson Foundation's  Finding Answers: Disparities Research for Change program.

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