A pilot study for an integrated diabetes screening, referral, and care program within a low-income community in Mexico.

Objective: To determine the feasibility and acceptability of a coordinated community-based intervention for low-income adults with type 2 diabetes (T2D) that included (1) screening and referral, (2) shared decision-making (SDM), and (3) diabetes self-management education and support (DSMES). Methods: Participants were screened for T2D through a mobile health unit in a low-income community in Guadalajara, Jalisco, Mexico, and referred for follow-up in a primary care health center serving that community. Primary care physicians (PCPs) within the health center were trained on SDM for T2D, and community health workers (CHWs) were trained to deliver DSMES. Feasibility was measured by the number of community members screened and referred for care, the number of PCPs implementing SDM, and the number of CHWs hired and trained on DSMES. Acceptability was assessed by the percentage of participants who completed the 3-month DSMES program. Potential clinical impact was determined by effect sizes of changes in HbA1c between baseline and 3 months. Other measurements included waist circumference (WC), body weight, diabetes distress, and diabetes self-care activities, assessed at baseline, and at 1 and 3 months during the study period. Results: With respect to feasibility, all PCPs from the clinic completed the SDM training and were able to implement it in their primary practice. The DSMES training was completed by 4 (50%) of CHWs, and 3 were selected to deliver the course to study participants. Related to acceptability, 182 community members were screened, of which 42 were eligible for participation and 23 were successfully enrolled. Out of six programmed sessions, average participant attendance was 80% with 60.9% of participants retained at three months. Changes in HbA1c from baseline to 3 months were 10.1 ± 2.7 to 9.4 ± 3.1. Discussion: The use of community screening to refer low-income people living with T2D to a clinic-based SDM and DSMES intervention was feasible with large effect sizes for changes in HbA1c. The high attrition rates suggest that alternative strategies may be necessary to keep patients engaged in care.