Table of Contents
Background on Diabetes Disparities in Minority Populations
Diabetes is a significant public health concern in the United States, particularly among Black and Hispanic adults. Recent statistics reveal that the prevalence of diagnosed diabetes is 12.1% for Black adults and 11.7% for Hispanic adults, compared to only 6.9% for non-Hispanic White adults (Centers for Disease Control and Prevention [CDC], 2021). Furthermore, Black and Hispanic adults with diabetes are three times more likely to experience complications from the disease and twice as likely to die from diabetes-related causes compared to their non-Hispanic White counterparts (Heisler et al., 2007; Patel et al., 2016).
The disparities in diabetes outcomes among these populations can be attributed to a variety of factors, including socioeconomic disparities, lack of access to healthcare, and cultural differences in health beliefs. A significant barrier to effective diabetes management is the negative impact of social determinants of health (SDOH), which encompass conditions in which individuals are born, grow, live, work, and age (U.S. Department of Health and Human Services, 2024). These factors can lead to lower adherence to diabetes medications and poorer health outcomes.
Key Statistics
| Ethnicity | Prevalence of Diabetes (%) | Complications Risk | Mortality Rate |
|---|---|---|---|
| Black Adults | 12.1 | 3x higher | 2x higher |
| Hispanic Adults | 11.7 | 3x higher | 2x higher |
| Non-Hispanic Whites | 6.9 | Baseline | Baseline |
Role of Pharmacists and Community Health Workers in Diabetes Care
In addressing the needs of Black and Hispanic adults with diabetes, the roles of pharmacists and Community Health Workers (CHWs) are crucial. Pharmacists are positioned to deliver Medication Therapy Management (MTM), which has been shown to improve clinical outcomes in patients with chronic diseases, including diabetes (Shiyanbola et al., 2024). MTM involves comprehensive medication reviews, medication optimization, and patient education to ensure effective management of diabetes medications.
Moreover, CHWs play a vital role in addressing SDOH barriers and health misperceptions that affect diabetes management. They provide culturally relevant support, help patients navigate healthcare systems, and offer guidance on lifestyle modifications. Research indicates that when CHWs work in conjunction with pharmacists, they can significantly reduce A1C levels and improve medication adherence among Black and Hispanic adults with diabetes (Shiyanbola et al., 2024).
Benefits of Pharmacists and CHWs
| Role | Key Contributions | Impact on Diabetes Management |
|---|---|---|
| Pharmacists | Medication Therapy Management, patient education | Improved A1C, reduced medication errors |
| Community Health Workers | Address SDOH, cultural support | Enhanced medication adherence, reduced health disparities |
Key Components of the Optimized Diabetes Management Intervention
The intervention designed for this study utilizes a multiphase optimization strategy (MOST) framework to identify the most effective and efficient combination of pharmacist-delivered MTM and CHW support. This approach enables researchers to evaluate the main effects of each component and their interactions to determine the optimal intervention package for Black and Hispanic adults with uncontrolled diabetes.
Components of the Intervention
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Pharmacist-Delivered Medication Therapy Management (MTM):
- Involves comprehensive medication reviews and education provided over the phone by bilingual pharmacists.
- Aims to optimize medication therapy and improve adherence.
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Community Health Worker Support:
- CHWs assess and address social determinants of health, focusing on barriers such as food insecurity and lack of access to healthcare.
- They provide education on diabetes and medication management, addressing misconceptions and empowering patients.
Study Design
The study employs a 2 × 2 factorial design to assess the effectiveness of the combined intervention. Participants will be randomized into one of four treatment conditions:
- MTM ON / CHW ON
- MTM ON / CHW OFF
- MTM OFF / CHW ON
- MTM OFF / CHW OFF (control group)
The primary outcome measured will be A1C levels at six months, with a follow-up assessment at 12 months to evaluate sustained improvements.
Methodology for Assessing Diabetes Outcomes and Mediators
To evaluate the effectiveness of the intervention, a mixed methods approach will be employed. This will include quantitative data collection through A1C measurements and medication adherence assessments, as well as qualitative interviews to gather participant perspectives on the intervention’s acceptability.
Quantitative Measures
- Primary Outcome: Hemoglobin A1C (A1C) levels measured at baseline, 6 months, and 12 months.
- Secondary Outcome: Medication adherence assessed through pharmacy refill data and self-report measures.
Qualitative Measures
Qualitative interviews will be conducted with a subset of participants to explore their experiences with the intervention. This will allow researchers to gain insights into the effectiveness and acceptability of both MTM and CHW support.
Implications for Future Research and Practice in Diabetes Management
The findings from this study are expected to provide valuable insights into the optimized intervention for diabetes management among Black and Hispanic adults. By identifying effective and cost-efficient intervention components, this research will inform future diabetes care practice and enhance the ability to address health disparities.
Expected Outcomes
- Identification of Effective Components: Determining which elements of the intervention are most beneficial for improving diabetes outcomes.
- Cost-Effectiveness Analysis: Evaluating the economic implications of the intervention components to inform resource allocation.
- Participant Acceptability: Understanding how participants perceive the intervention, which will guide future implementations.
Conclusion
The disparities in diabetes management among Black and Hispanic adults highlight the urgent need for targeted interventions. This study aims to optimize diabetes management strategies through the combined efforts of pharmacists and Community Health Workers, addressing both medication management and the social determinants of health that impact patient outcomes.
References
- Centers for Disease Control and Prevention. (2021). National Diabetes Statistics Report 2021: Estimates of Diabetes and Its Burden in the United States
- Heisler, M., Faul, J. D., Hayward, R. A., Langa, K. M., & Blaum, C. (2007). Mechanisms for Racial and Ethnic Disparities in Glycemic Control in Middle-Aged and Older Americans in the Health and Retirement Study. Archives of Internal Medicine, 167(17), 1853-1860. doi:10.1001/archinte.167.17.1853
- Patel, I., Erickson, S. R., Caldwell, C. H., & et al. (2016). Predictors of Medication Adherence and Persistence in Medicaid Enrollees with Developmental Disabilities and Type 2 Diabetes. Research in Social and Administrative Pharmacy, 12(3), 592-603. doi:10.1016/j.sapharm.2015.09.008
- Shiyanbola, O. O., Maurer, M. A., Piper, M. E., Bolt, D., Sharp, L. K., Ouayogodé, M. H., & Fisher, E. (2024). Optimizing Diabetes Management Interventions for Black and Hispanic Adults Using the Multiphase Optimization Strategy: Protocol for a Randomized Mixed Methods Factorial Trial. Contemporary Clinical Trials. doi:10.1016/j.cct.2024.107804
- U.S. Department of Health and Human Services. (2024). Healthy People 2030: Social Determinants of Health
FAQ
What is the purpose of this diabetes management study?
The study aims to optimize diabetes management interventions for Black and Hispanic adults by combining pharmacist-delivered medication therapy management with Community Health Workers addressing social determinants of health.
How will the effectiveness of the intervention be measured?
The effectiveness will be measured through changes in A1C levels and medication adherence, assessed at baseline, 6 months, and 12 months.
What role do Community Health Workers play in this intervention?
Community Health Workers will assist in addressing social determinants of health barriers and health misperceptions, providing culturally relevant support and education.
Why is there a focus on Black and Hispanic populations?
Black and Hispanic adults face significant disparities in diabetes prevalence and outcomes, making targeted interventions crucial to improving health equity.
What is the anticipated impact of the study?
The study is expected to identify effective intervention components, evaluate their cost-effectiveness, and provide insights into participant experiences to enhance diabetes management practices.
