CHWs have a huge evidence base showing their contribution to preventing diabetes. Download our CHW Impact on Prediabetes fact sheet and share how CHWs make an impact!
THE PROBLEM
Approximately 86 million people in the US have prediabetes.1 Prediabetes is a condition in which blood glucose levels are higher than normal, but not high enough to be classified as overt Diabetes Mellitus (DM).2 Prediabetes progresses to overt DM at the rate of 5–10% annually. Individuals with prediabetes are at an increased risk of developing the same microvascular complications of diabetes, including retinopathy, neuropathy, and nephropathy when compared to those with normal glucose tolerance.1 Many studies have indicated that lifestyle interventions such as an improved diet and increased physical activity can significantly reduce an individual with prediabetes’ risk of developing DM and associated complications.1 However, making these changes can be very difficult for members of marginalized groups who face additional social, structural and environmental barriers.
The Role of CHWs in Combating Prediabetes
Community Health Workers (CHWs) are public health workers with strong connections to the communities they serve. Their close bonds with community members allow them to serve as liaisons between health/social services and the community, facilitating access to services and improving service delivery to better meet community needs.3 CHWs help patients navigate the healthcare system, communicate with providers, set goals, and adhere to lifestyle changes through meetings and home visits.3 Their deep community understanding uniquely positions CHWs to provide relevant education to their communities regarding diabetes prevention and control. CHWs also help prevent or delay the onset of diabetes through the promotion of healthy lifestyle changes by serving as lifestyle coaches for those at high risk.3
Innovative strategies are necessary to reach the 86 million people with prediabetes in the US. Promising research has shown that incorporating CHWs into translations of the national Diabetes Prevention Program (DPP) lifestyle interventions can result in significant reductions in blood glucose and insulin levels, insulin resistance, weight and waist circumference for community members with prediabetes.4 Improvements in BMI, waist circumference and body fat, and dietary outcomes were seen in Latinos with prediabetes or obesity.5 By promoting community education on nutrition, physical activity, weight management, and by providing social support, CHWs can augment existing programs that serve to help patients with prediabetes manage their health.4
CHWs have demonstrated the potential to be effective members of care teams, promoting other aspects of patient health, such as increased diabetes knowledge, medication adherence, and self-care behavior.6 In its 2009 Position Statement on Community Health Workers in Diabetes Management and Prevention, the American Association of Diabetes Educators (AADE) supported the role of CHWs in serving to bridge the gap between the health care system and people with and at risk for diabetes, particularly in underserved communities.7 In 2015, the AADE further recommended that diabetes educators acknowledge and support the role of the CHW in primary and secondary diabetes prevention.8 The Community Preventive Services Task Force recommends engaging CHWs in diabetes prevention, including with DPP classes.9
CHWs Addressing Prediabetes in Michigan
The Diabetes Prevention and Control Program (DPCP) at the Michigan Department of Health and Human Services (MDHHS) has recently been engaging CHWs to work with local health care providers to establish systems to identify patients with prediabetes and refer to DPCP and other community resources.10 Many agencies employ CHWs to lead DPP classes, too, including the National Kidney Foundation of Michigan. And MiCHWA continues to work to integrate CHWs into Michigan’s health and human service systems so they can better support individuals with prediabetes and their communities.
References
1 Ghody P, Shikha D, Karam J, Bahtiyar G.Identifying prediabetes – Is it beneficial in the long run? Maturitas. 2015;81(2):282-286.
2 What is Pre-diabetes? Pre-Diabetes Information | Joslin Diabetes Center. http://www.joslin.org/info/what_is_pre_diabetes.html. Accessed December 12, 2016.
3 Centers for Disease Control. Addressing chronic disease through community health workers. Retrieved from https://www.cdc.gov/dhdsp/docs/chw_brief.pdf. Published April 2015. Accessed December 20, 2016.
4 Katula JA, Vitolins MZ, Rosenberger EL, et al. One-year results of a community-based translation of the diabetes prevention program: Healthy-Living Partnerships to Prevent Diabetes (HELP PD) project. Diabetes Care. 2011;34(7):1451-1457.
5 Ruggiero L, Oros S, Choi YK. Community-based translation of the Diabetes Prevention Program’s lifestyle intervention in an underserved Latino population. The Diabetes Educator. 2011;37(4):564-572.
6 Ruggiero L, Castillo A, Quinn L, Hochwert M. Translation of the Diabetes Prevention Program’s lifestyle intervention: role of community health workers. Current diabetes reports. 2012;12(2):127-137.
7 American Association of Diabetes Educators. AADE position statement: community health workers in diabetes management and prevention. Diabetes Educ. 2009;35:48S–52S.
8 American Association of Diabetes Educators. Community Health Workers in Diabetes Management and Prevention. Retrieved from https://www.diabeteseducator.org/docs/default-source/default-document-library/community-health-workers-in-diabetes-management-and-prevention.pdf?sfvrsn=0. Last updated June 4, 2015. Accessed April 2, 2017.
9 Community Preventive Services Task Force. Diabetes prevention: interventions engaging community health workers. Retrieved from https://www.thecommunityguide.org/sites/default/files/assets/Diabetes-Prevention-Community-Health-Workers.pdf. Last updated January 25, 2017. Retrieved April 2, 2017.
10 Michigan Department of Health and Human Services: Diabetes Prevention and Control Program (DPCP). Michigan Diabetes Partners in Action Coalition. Retrieved from http://dpacmi.org/documents/DPCP-Update-9-9-15.pdf. Published November 6, 2015. Accessed December 13, 2016.
CHW Impact on Diabetes
The Role of CHWs in Combating Diabetes
Community Health Workers (CHWs) are public health workers with strong connections to the communities they serve. Their close bonds with community members allow them to serve as liaisons between health/social services and the community, facilitating access to services and improving service delivery to better meet community needs.4 CHWs help patients navigate the healthcare system, communicate with providers, set goals, and make lifestyle changes.4
Through healthcare navigation assistance, community education, informal counseling, social support, advocacy and the promotion of healthy lifestyle habits such as healthy eating and exercise, CHWs help reduce the prevalence and impact of diabetes in the communities that they serve.5,6Interventions by CHWs result in improved diabetes self-management5,6 including improved foot care,6 physical activity,6 appointment keeping,6 medication adherence,6 and healthcare utilization.6Numerous studies have shown that patients who receive support and health education from CHWs experience improvements in HbAlc,5,6,7 blood pressure,6 and lipid levels.6 The positive effect of CHWs on diabetes has been documented in a variety contexts, including high-risk African-American and Latino communities.5,6
In its 2002 report, the Institute of Medicine (IOM) recommends expanding the use of CHWs, especially among racial and ethnic minorities and other underserved populations, to improve health outcomes and reduce healthcare disparities.8 The Patient Protection and Affordable Care Act similarly recognizes CHWs as valuable members of care teams, and allocates funds to support and expand CHW programming.9 More recently, the American Association of Diabetes Educators issued guidance on the role CHWs can play in diabetes management and prevention, stating that, “Training and empowering CHWs to deliver current, accurate, and evidence based information can do much to benefit self-care behaviors, problem solving skills, and optimal outcomes in people affected by diabetes in their communities.”10
CHWs Addressing Diabetes in Michigan
CHWs have a long history of addressing diabetes in Michigan. In collaboration with the REACH Detroit Partnership, CHWs have helped people with diabetes patients achieve significant improvements in disease management and blood sugar control since the program began in the 2000s.5 Primary care practices and health centers are now integrating CHWs into interdisciplinary care teams, providing individual and group patient support. CHWs in Spectrum Health’s Core Health Program, Michigan Pathways to Better Health, Linking Clinical Care to Community Supports, MI Care Team, and the Southeast Michigan Beacon Project, among others, work directly with patients with diabetes.
References
1 Centers for Disease Control and Prevention. Diabetes Public Health Resource web page. Retrieved from http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm. Last updated December 1, 2015. Accessed February 20, 2017.
2 Centers for Disease Control and Prevention. Diabetes Report Card 2014. Retrieved from http://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2014.pdf. Published 2015. Accessed February 20, 2017.
3 National Institute of Diabetes and Digestive and Kidney Diseases. 4 steps to manage your diabetes for life. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/manage-monitoring-diabetes. Accessed February 20, 2017.
4 American Public Health Association. Support for community health workers to increase health access and to reduce health disparities. 2014. Retrieved from https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/09/14/19/support-for-community-health-workers-to-increase-health-access-and-to-reduce-health-inequities. Accessed December 1, 2016.
5 Spencer M, Rosland A, Kieffer E, Sinco B, Palmisano G, Anderson M, Guzman JR, Heisler M. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health. 2011;101(12): 2253-2260.
6 Hunt CW, Grant JS, Appel SJ. An integrative review of community health advisors in type 2 diabetes. J Community Health. 2011;36:883.
7 Palmas W, March D, Darakjy S, et al. Community health worker interventions to improve glycemic control in people with diabetes: a systematic review and meta-analysis. J Gen Intern Med. 2015;30(7):1004-1012.
8 Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC:Institute of Medicine;2002:17-18.
9 The Patient Protection and Affordable Care Act. U.S. Government Printing Office website. https://www.gpo.gov//fdsys/pkg/PLAW-111publ148/html/PLAW-111publ148.htm. Accessed December 1, 2016.
10 American Association of Diabetes Educators. Community Health Workers in Diabetes Management and Prevention. Retrieved from https://www.diabeteseducator.org/docs/default-source/default-document-library/community-health-workers-in-diabetes-management-and-prevention.pdf?sfvrsn=0. Last updated June 4, 2015. Accessed April 2, 2017.
In partnership with the Michigan Department of Health & Human Services and the Centers for Disease Control and Prevention, MiCHWA compiled resources that illustrate the vital role CHWs play in preventing, controlling, and managing chronic disease.