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Enhanced Participation in Diabetes Screening and Care After Gestational Diabetes Through Community Health Workers: Results from the Es Mejor Saber Randomized Controlled Trial

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Abstract

Gestational diabetes mellitus (GDM) is a strong risk factor for type 2 diabetes mellitus, but many women with GDM do not return for postpartum diabetes screening. Interventions utilizing community health workers have demonstrated improvements in health knowledge and participation in other disease settings. The objective of this study was to therefore determine whether bilingual, bicultural community health workers (i.e., promotoras) increase participation in postpartum disease screening and referral for diabetes prevention or care in an urban, low-resource Hispanic community. Ninety-four women with GDM were recruited from the postpartum ward of a safety-net hospital and randomized equally to receive either standard-of-care alone or standard-of-care with a promotora-based intervention consisting of education, appointment reminders, and assistance navigating the healthcare system. Adherence to diabetes screening visits by 12 weeks postpartum and referral for preventive or diabetes care by 18 weeks postpartum was assessed through electronic medical record review. Compared to controls, women in the promotora group completed more diabetes screening visits (74% vs. 96%; relative risk [RR] 3.9; 95% Confidence Interval [CI] 1.1–14.1; p = 0.04). Among those who completed diabetes screening visits, women in the promotora group were also more likely to complete a subsequent referral visit for preventive or diabetes care (17% vs. 83%; RR 4.0; 95% CI 2.1–7.4; p < 0.01). A promotora-based intervention consisting of bilingual, bicultural community health workers improved diabetes screening, prevention, and treatment visits in a resource-limited community of Hispanic women with GDM. ClinicalTrials.gov Identifier: NCT00998595.

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Acknowledgements

The authors are grateful to the Centers for Disease Control and Prevention and the American Association of Medical Colleges for funding through a cooperative agreement (MM-1107-09/09) and would like to thank Drs. Thomas Buchanan, Martin Montoro, Melissa Wilson, Anny Xiang, Shing Kim, Lucinda England, and of course the study participants for their contributions to the Es Mejor Saber project.

Funding

This research was supported by NIH/National Institute of Diabetes and Digestive and Kidney Diseases F32 DK123878 (AZ) and the Center for Disease Control 2008-R-02 (PSG).

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Authors and Affiliations

  1. Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado, Anschutz Medical Campus, Mailstop C263, 12348 E. Montview Blvd, Aurora, CO, 80045, USA

    Adnin Zaman

  2. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA

    Adnin Zaman

  3. Department of Obstetrics and Gynecology,, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

    Blanca Ovalle, Carolina Reyes & Penina Segall-Gutierrez

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PSG and BO conceived and carried out the experiments. AZ, PSG, CR, and BO analyzed and interpreted the data and wrote the first draft of the manuscript. All authors were involved in writing the paper and had final approval of the submitted and published versions.

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Correspondence to Adnin Zaman.

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Zaman, A., Ovalle, B., Reyes, C. et al. Enhanced Participation in Diabetes Screening and Care After Gestational Diabetes Through Community Health Workers: Results from the Es Mejor Saber Randomized Controlled Trial. J Immigrant Minority Health 26, 45–53 (2024). https://doi.org/10.1007/s10903-023-01547-5

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