标题：Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership: Improving Diabetes-Related Outcomes Among African American and Latino Adults
摘要：Objectives . We sought to determine the effects of a community-based, culturally tailored diabetes lifestyle intervention on risk factors for diabetes complications among African Americans and Latinos with type 2 diabetes. Methods . One hundred fifty-one African American and Latino adults with diabetes were recruited from 3 health care systems in Detroit, Michigan, to participate in the Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership diabetes lifestyle intervention. The curriculum, delivered by trained community residents, was aimed at improving dietary, physical activity, and diabetes self-care behaviors. Baseline and postintervention levels of diabetes-specific quality-of-life, diet, physical activity, self-care knowledge and behaviors, and hemoglobin A1C were assessed. Results . There were statistically significant improvements in postintervention dietary knowledge and behaviors and physical activity knowledge. A statistically significant improvement in A1C level was achieved among REACH Detroit program participants ( P <.0001) compared with a group of patients with diabetes in the same health care system in which no significant changes were observed ( P =.160). Conclusions . A culturally tailored diabetes lifestyle intervention delivered by trained community residents produced significant improvement in dietary and diabetes self-care related knowledge and behaviors as well as important metabolic improvements. Although the overall health of the US population has improved over the last 2 decades, striking disparities continue in the burden of illness and death experienced by African Americans, Latinos, Native Americans/Alaska Natives, Asians, and Pacific Islanders. 1 Diabetes, in particular, presents a significant public health burden in terms of increased morbidity, mortality, and economic costs. 2 , 3 African Americans and Latinos experience a 50 to 100% higher burden of illness and mortality because of diabetes compared to White Americans. 4 – 6 The prevalence of blindness owing to diabetes is twice as high among African Americans as among Whites. 2 The incidence of kidney disease is 6 times higher in Native Americans, 4 to 6 times higher in Mexican Americans, and 4 times higher in African Americans than in Whites. 7 African Americans with diabetes have a higher rate of lower-extremity amputations, 7 and peripheral vascular disease is 80% more common in Mexican Americans than in non-Hispanic Whites with diabetes. 2 Two landmark clinical trials have demonstrated that tight control of blood glucose can greatly reduce the risk of diabetes complications. Dietary and physical activity changes are among the principal strategies recommended for controlling blood glucose among individuals with type 2 diabetes. 2 , 8 , 9 A continuing question is how best to assist people in making the lifestyle changes necessary for optimal metabolic control. Diabetes self-management education interventions hold the promise of improving metabolic control and promoting protective lifestyle behaviors that can reduce the risk of diabetes complications and improve quality of life. 8 , 10 , 11 Although diabetes education interventions have generally yielded positive results, few African Americans and Latinos have been included in these studies. Even fewer studies have evaluated culturally appropriate, community health worker–led interventions that may be more acceptable and cost-effective than interventions led by health care professionals. 8 , 12 , 13 Racial and Ethnic Approaches to Community Health (REACH) 2010 is the Centers for Disease Control and Prevention’s (CDC’s) effort to eliminate racial and ethnic disparities in 6 priority health areas, including diabetes. 14 The REACH Detroit partnership has used a community-based participatory approach at multiple levels to reduce risk factors for type 2 diabetes and its complications among African Americans and Latinos residing in low-resource neighborhoods of east and southwest Detroit. We assessed whether the REACH Detroit community-based diabetes lifestyle intervention delivered by trained community residents to African Americans and Latinos with type 2 diabetes resulted in significant diabetes-related knowledge and behavioral changes and glycemic control.
