Abstract
Objective: Hispanic patients with type 1 diabetes (T1D) face cultural and language barriers in care that contribute to a high A1c, infrequent use of diabetes technology and risk of complications. Culturally sensitive programs and shared medical appointments (SMAs) have been recognized as effective models of care. Our aim is to develop a culturally sensitive, cost effective SMA model for pediatric Hispanic T1D patients.
Methods: Hispanic patients, ages 1-20, with T1D (n= 88), and their families were recruited to participate in the SMAs. They received routine care appointments alternating with SMAs that included group diabetes education. Teens, ages 12 to 18 attended a separate educational session from parents. Younger children and parents were seen together. A1c, behavioral tools, and use of diabetes technology were measured at baseline and every 3 months for two years. Satisfaction questionnaires were obtained.
Results: 62% of young children and 48% of teens completed the first 2 years of the SMA model of care. Results showed that there was a significant association between age and change in A1c for SMA participants from baseline to year 1 (p =.001) and baseline to year 2 (p = <.0001). Participants < 12 years old, there was a significant improvement in A1c from baseline to year 1 (p = 0.014) and from year 1 to year 2 (p = 0.007). Participants ≥ 12 years old, also had a change in A1c from year 1 to year 2 (p = 0.008). Technology use increased significantly from baseline to year 2 for participants who were less than 12 years of age (17% to 40% p =.014) and marginally significant for participants who were >11 years of age (10% to 18% p = .083). Participants had a 90% satisfaction rate.
Conclusions: The culturally sensitive SMA proved to be an appreciated, feasible and effective alternative to care for Hispanics with T1D. It may prove to be cost-effective and more effective over the long-term if begun shortly after diagnosis.
Disclosure
A. Gerard Gonzalez: None. A. Brady: None. G.J. Klingensmith: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Foundation. L. Pyle: None. J. Thurston: None.