TY - JOUR
T1 - ¡sí, Yo Puedo Vivir Sano con Diabetes! A Self-Management Randomized Controlled Pilot Trial for Low-Income Adults with Type 2 Diabetes in Mexico City
AU - Whittemore, Robin
AU - Vilar-Compte, Mireya
AU - De La Cerda, Selene
AU - Delvy, Roberta
AU - Jeon, Sangchoon
AU - Burrola-Méndez, Soraya
AU - Pardo-Carrillo, Mariana
AU - Lozano-Marrufo, Annel
AU - Pérez-Escamilla, Rafael
N1 - Funding Information:
Copyright ©C The Author(s) on behalf of the American Society for Nutrition 2020. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Manuscript received January 6, 2020. Initial review completed March 28, 2020. Revision accepted April 6, 2020. Published online April 14, 2020. Supported by National Institute of Nursing Research grant R21NR015856 (to RW). Author disclosures: The authors report no conflicts of interest. RW, RD, and RP-E traveled to Mexico City during study start-up. SDLC traveled to the United States during data analysis. Address correspondence to RW (e-mail: robin.whittemore@yale.edu). Abbreviations used: BP, blood pressure; DSME, diabetes self-management education; GAM, mutual help groups; GLMM, generalized linear mixed model; HbA1c, glycated hemoglobin; PHQ-8, Patient Health Questionnaire-8; RA, research assistant; SDSCA, Summary of Diabetes Self-Care Activities questionnaire; SMBG, self-monitoring of blood glucose; T2D, type 2 diabetes.
Publisher Copyright:
Copyright © 2020 The Author(s) on behalf of the American Society for Nutrition.
PY - 2020/4/29
Y1 - 2020/4/29
N2 - Background: Type 2 diabetes (T2D) is a worldwide epidemic and a leading cause of death in Mexico, with a prevalence of 15.9%, and >70% of diagnosed adults have poor glycemic control [glycated hemoglobin (HbA1c) >7.5%]. We developed a diabetes self-management education program contextualized to the study population, including dietary preferences, health literacy, and health system. Objectives: We aimed to evaluate the efficacy of a self-management + text message program (¡Sí, Yo Puedo Vivir Sano con Diabetes!) on primary (HbA1c), and secondary behavioral (self-management), clinical, and psychosocial outcomes in adults with T2D in Mexico City. Methods: Participants were recruited at public primary healthcare centers (Seguro Popular), and randomly allocated to treatment (n = 26) or wait-list control groups (n = 21) with data collected at 3 and 6 mo. The program included 7 weekly sessions and 6 mo of daily text/picture messages. Descriptive statistics and a generalized linear mixed model with intent-to-treat analysis were calculated. Results: Participants were 55.5 ± 8.8 y of age (mean ± SD), 68% female, 88.6% overweight/obese, and 57% lived in food-insecure households. Mean ± SD T2D duration was 11.9 ± 7.8 y and HbA1c was 9.2% ± 1.5%. There was 89% attendance at sessions and 6.4% attrition across both groups at 6 mo. Group-by-time effects were seen in self-monitoring of blood glucose (P < 0.01) and diabetes self-efficacy (P < 0.04); and a trend for lower HbA1c was seen in the intervention group at 6 mo (P = 0.11). Significant improvements in dietary behavior (P < 0.01) were demonstrated in the intervention group over time, but this did not reach statistical significance compared with the control group. Conclusions: The program was associated with clinically significant improvements in T2D self-management, self-efficacy, and HbA1c over time. Thus, T2D self-management skills, including diet, were improved in a vulnerable metropolitan population. This trial was registered at clinicaltrials.gov as NCT03159299.
AB - Background: Type 2 diabetes (T2D) is a worldwide epidemic and a leading cause of death in Mexico, with a prevalence of 15.9%, and >70% of diagnosed adults have poor glycemic control [glycated hemoglobin (HbA1c) >7.5%]. We developed a diabetes self-management education program contextualized to the study population, including dietary preferences, health literacy, and health system. Objectives: We aimed to evaluate the efficacy of a self-management + text message program (¡Sí, Yo Puedo Vivir Sano con Diabetes!) on primary (HbA1c), and secondary behavioral (self-management), clinical, and psychosocial outcomes in adults with T2D in Mexico City. Methods: Participants were recruited at public primary healthcare centers (Seguro Popular), and randomly allocated to treatment (n = 26) or wait-list control groups (n = 21) with data collected at 3 and 6 mo. The program included 7 weekly sessions and 6 mo of daily text/picture messages. Descriptive statistics and a generalized linear mixed model with intent-to-treat analysis were calculated. Results: Participants were 55.5 ± 8.8 y of age (mean ± SD), 68% female, 88.6% overweight/obese, and 57% lived in food-insecure households. Mean ± SD T2D duration was 11.9 ± 7.8 y and HbA1c was 9.2% ± 1.5%. There was 89% attendance at sessions and 6.4% attrition across both groups at 6 mo. Group-by-time effects were seen in self-monitoring of blood glucose (P < 0.01) and diabetes self-efficacy (P < 0.04); and a trend for lower HbA1c was seen in the intervention group at 6 mo (P = 0.11). Significant improvements in dietary behavior (P < 0.01) were demonstrated in the intervention group over time, but this did not reach statistical significance compared with the control group. Conclusions: The program was associated with clinically significant improvements in T2D self-management, self-efficacy, and HbA1c over time. Thus, T2D self-management skills, including diet, were improved in a vulnerable metropolitan population. This trial was registered at clinicaltrials.gov as NCT03159299.
KW - health disparities
KW - low income
KW - Mexico
KW - mHealth
KW - self-management
KW - text message
KW - type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85087455163&partnerID=8YFLogxK
U2 - 10.1093/cdn/nzaa074
DO - 10.1093/cdn/nzaa074
M3 - Article
AN - SCOPUS:85087455163
SN - 2475-2991
VL - 4
JO - Current Developments in Nutrition
JF - Current Developments in Nutrition
IS - 5
M1 - nzaa074
ER -