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Hispanic Diabetes Interventions

Rural Project Examples: Hispanics And Latinos

Rural Project Examples: Hispanics And Latinos

Rural Project Examples: Hispanics and Latinos Need: Hispanic women have the highest incidence rates of cervical cancer among any ethnicity in the United States. Intervention: The development of a lay health worker (promotora) curriculum that provides information on cervical cancer, HPV, and the HPV vaccine to Hispanic farmworker women living in rural southern Georgia and South Carolina. Results: Significant increases in post-test scores relating to cervical cancer knowledge and increases in positive self-efficacy among promotoras. Need: To reduce the risk of HIV/STDs among Latino men living in rural regions of the United States. Intervention: Soccer team leaders are elected and trained as lay health advisors to promote sexual health education among team members. Results: Program participants report an increase in HIV testing, an increase in condom use, and an increase in awareness of how to prevent the transmission of HIV. Need: More mental health and substance abuse prevention and treatment services in rural Texas. Intervention: A network was formed to bring counseling services through telehealth systems and community health workers to Brazos Valley, Texas. Results: The program improved health outcomes, increased general knowledge of the impact of substance abuse, and raised awareness of services among Hispanic residents. Need: To reduce health disparities in two rural/frontier counties in southwest New Mexico. Intervention: Community health workers work with clients to help them better manage their health and promote awareness of healthy lifestyle options in the community. Results: Better health outcomes for patients. Need: To address high rates of diabetes in rural Hispanic/Latino populations near the U.S.-Mexico border. Intervention: A comprehensive, culturally com Continue reading >>

Behavioral Lifestyle Interventions For The Primary Prevention Of Type 2 Diabetes And Translation To Hispanic/latino Communities In The United States And Mexico

Behavioral Lifestyle Interventions For The Primary Prevention Of Type 2 Diabetes And Translation To Hispanic/latino Communities In The United States And Mexico

Behavioral lifestyle interventions for the primary prevention of type 2 diabetes and translation to Hispanic/Latino communities in the United States and Mexico E.M. Venditti is with the Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. Search for other works by this author on: Nutrition Reviews, Volume 75, Issue suppl_1, 1 January 2017, Pages 8593, Elizabeth M. Venditti; Behavioral lifestyle interventions for the primary prevention of type 2 diabetes and translation to Hispanic/Latino communities in the United States and Mexico, Nutrition Reviews, Volume 75, Issue suppl_1, 1 January 2017, Pages 8593, Lifestyle behaviors in overweight and obese individuals are closely linked to the development, course, and outcomes of type 2 diabetes and multiple comorbid health conditions. Behavior change theory and many randomized controlled studies offer strong support for screening and identifying adults at increased cardiometabolic risk and for providing early intervention to mitigate risk factors to prevent or delay the onset of disease. The current article reviews key lifestyle intervention efficacy and dissemination trials conducted with individuals deemed to be at increased risk for diabetes and describes the rationale for training teams of professionals and community health workers (e.g., promotores [in Spanish]) to implement comprehensive programs, with fidelity, in a variety of medical care and community settings. This evidence-based road map may be used to facilitate the design and implementation of strategies for structured behavioral diabetes risk reduction programs in the public and private healthcare sectors and other relevant community-based platforms serving individuals of Hispanic/Latino origin in the United States and Mexico. Continue reading >>

Overview

Overview

The importance of both diabetes and these comorbidities will continue to increase as the population ages. Therapies that have proven to reduce microvascular and macrovascular complications will need to be assessed in light of the newly identified comorbidities. Lifestyle change has been proven effective in preventing or delaying the onset of type 2 diabetes in high-risk individuals. Based on this, new public health approaches are emerging that may deserve monitoring at the national level. For example, the Diabetes Prevention Program research trial demonstrated that lifestyle intervention had its greatest impact in older adults and was effective in all racial and ethnic groups. Translational studies of this work have also shown that delivery of the lifestyle intervention in group settings at the community level are also effective at reducing type 2 diabetes risk. The National Diabetes Prevention Program has now been established to implement the lifestyle intervention nationwide. Another emerging issue is the effect on public health of new laboratory based criteria, such as introducing the use of A1c for diagnosis of type 2 diabetes or for recognizing high risk for type 2 diabetes. These changes may impact the number of individuals with undiagnosed diabetes and facilitate the introduction of type 2 diabetes prevention at a public health level. Several studies have suggested that process indicators such as foot exams, eye exams, and measurement of A1c may not be sensitive enough to capture all aspects of quality of care that ultimately result in reduced morbidity. New diabetes quality-of-care indicators are currently under development and may help determine whether appropriate, timely, evidence-based care is linked to risk factor reduction. In addition, the scientific evid Continue reading >>

Diabetes Self-management Education Interventions And Glycemic Control Among Hispanics: A Literature Review

Diabetes Self-management Education Interventions And Glycemic Control Among Hispanics: A Literature Review

With the Compliments of Springer Publishing Company, LLC Hispanic Health Care International, Vol. 11, No. 4, 2013 The University of North Carolina at Chapel Hill School of Nursing Diabetes self-management education interventions have been shown to improve glycemic control in Whites and African Americans with type 2 diabetes. Hispanic women and men, however, sometimes have barriers to management including lack of access to care, low English proficiency, low literacy, and cultural differences. This review examined the state of the science related to the effects of diabetes self-management education interventions on glycemic control in Hispanics. The 8 of 9 studies showed a significant decrease in glycated hemoglobin in experimental patients. The interventions also demonstrated the success of using community health workers, bilingual interventionists, culturally sensitive designs, and accessible interventions. Limitations included weak study designs, high attrition Intervenciones de educacin para el autocontrol de la diabetes han demostrado un mejoramiento en el control glucmico en los caucsicos y los afroamericanos con diabetes tipo 2. Las mujeres y los hombres hispanos, sin embargo, a veces enfrentan barreras en el manejo de la enfermedad, como la falta de acceso al cuidado mdico, dificultades con el idioma Ingls, bajo nivel de alfabetizacin, y las diferencias culturales. Esta revisin examin el estado de la ciencia relacionada con los efectos de las intervenciones de educacin de autocuidado de la diabetes en el control glucmico en los hispanos. Ocho de los nueve estudios mostraron una disminucin significativa en la hemoglobina glucosilada en pacientes experimentales. Las intervenciones tambin demostraron el xito de la utilizacin de los agentes comunitarios de salud, int Continue reading >>

Diabetes Prevention Programs For Hispanics

Diabetes Prevention Programs For Hispanics

Diabetes prevention programs for Hispanics Significant health disparities exist in the Hispanic community compared with their non-Hispanic counterparts in the United States. In terms of diabetes, specifically, recent data from the CDC indicate that Hispanics are 65% more likely to have diabetes, 55% more likely to be diagnosed with end-stage renal disease and 45% more likely to die of diabetes. The health care challenge posed by these statistics becomes even more alarming because Hispanics are one of the fastest growing ethnic groups in the United States and may constitute 30% of the population by 2060. Besides these disparities around diabetes diagnoses and outcomes, the Hispanic population is also at greater risk for prediabetes. Based on fasting glucose or HbA1c levels, it is estimated that nearly 38% of Hispanics aged 20 years or older have prediabetes. It seems as if a Hispanic diabetes time bomb is waiting to explode unless culturally sensitive and targeted interventions are developed and implemented in this community to improve diabetes awareness and emphasize its prevention. The National Institute of Diabetes and Digestive and Kidney Diseases was working with a budget of nearly $2 billion for fiscal year 2016, and a large portion of this amount generally funds development of community-based diabetes programs targeting diabetes prevention and/or improving diabetes-related outcomes in underserved communities. However, it is disappointing that these funds fail to translate into significant improvements in diabetes-related health outcomes in high-risk communities. Although there is no denying the role of biological and lifestyle factors in the growing numbers of prediabetes cases in this community, we are probably discounting the role of a few other important facto Continue reading >>

Peer Support Interventions For Adults With Diabetes: A Meta-analysis Of Hemoglobin A1c Outcomes

Peer Support Interventions For Adults With Diabetes: A Meta-analysis Of Hemoglobin A1c Outcomes

Peer Support Interventions for Adults With Diabetes: A Meta-Analysis of Hemoglobin A1c Outcomes 1Department of Family and Community Medicine, University of Missouri, Columbia, Missouri 2Sinclair School of Nursing, University of Missouri, Columbia, Missouri CORRESPONDING AUTHOR: Sonal J. Patil, MD, Curtis W. and Ann H. Long Department of Family and Community Medicine, MA306 Medical Sciences Building, DC032.00, University of Missouri Columbia, MO 65212, patilso{at}health.missouri.edu PURPOSE Peer support intervention trials have shown varying effects on glycemic control. We aimed to estimate the effect of peer support interventions delivered by people affected by diabetes (those with the disease or a caregiver) on hemoglobin A1c (HbA1c) levels in adults. METHODS We searched multiple databases from 1960 to November 2015, including Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, and Scopus. We included randomized controlled trials (RCTs) of adults with diabetes receiving peer support interventions compared with otherwise similar care. Seventeen of 205 retrieved studies were eligible for inclusion. Quality was assessed with the Cochrane risk of bias tool. We calculated the standardized mean difference (SMD) of change in HbA1c level from baseline between groups using a random effects model. Subgroup analyses were predefined. RESULTS Seventeen studies (3 cluster RCTs, 14 RCTs) with 4,715 participants showed an improvement in pooled HbA1c level with an SMD of 0.121 (95% CI, 0.0260.217; P = .01; I2 = 60.66%) in the peer support intervention group compared with the control group; this difference translated to an improvement in HbA1c level of 0.24% (95% CI, 0.05%0.43%). Peer support interventions showed an HbA1c improvement of 0.48% (95% CI, 0.25%0.70%; Continue reading >>

Preventing Chronic Disease | Diabetes Prevention In Hispanics: Report From A Randomized Controlled Trial - Cdc

Preventing Chronic Disease | Diabetes Prevention In Hispanics: Report From A Randomized Controlled Trial - Cdc

Diabetes Prevention in Hispanics: Report From a Randomized Controlled Trial Catherine Duggan, PhD; Elizabeth Carosso; Norma Mariscal; Ilda Islas; Genoveva Ibarra; Sarah Holte, PhD; Wade Copeland, MS; Sandra Linde; Beti Thompson, PhD Suggested citation for this article: Duggan C, Carosso E, Mariscal N, Islas I, Ibarra G, Holte S, et al. Diabetes Prevention in Hispanics: Report From a Randomized Controlled Trial. Prev Chronic Dis 2014;11:130119. DOI: . Hispanics are at increased risk of developing type 2 diabetes. Lifestyle interventions are effective in preventing diabetes and restoring glucose regulation. We recruited Hispanic men and women (N = 320) who were residents of the Lower Yakima Valley, Washington, aged 18 years or older with hemoglobin A1c (HbA1c) levels higher than 6% to a parallel 2-arm randomized-controlled trial conducted from 2008 through 2012. The trial compared participants in the intervention arm, who received an immediate educational curriculum (n = 166), to participants in the control arm, who received a delayed educational curriculum (n = 154). The home-based curriculum consisted of 5 sessions led by community health workers and was designed to inform participants about diabetes, diabetes treatment, and healthy dietary and physical activity behaviors. Participants were randomly assigned to the intervention and control arms, and analysts were blinded as to participant arm. We evaluated intervention effects on HbA1c levels; frequency (times per week) of fruit and vegetable consumption; and frequency (times per week) of mild, moderate, and strenuous leisure-time physical activity. At baseline, 3 months, and 6 months after randomization, participants completed a questionnaire and provided a blood sample. Analysts were blinded to intervention arm. The Continue reading >>

Dulce Digital-me: An Adaptive Mhealth Intervention For Underserved Hispanics With Diabetes Philis-tsimikas, Athena Gallo, Linda C. Scripps Health, San Diego, Ca, United States

Dulce Digital-me: An Adaptive Mhealth Intervention For Underserved Hispanics With Diabetes Philis-tsimikas, Athena Gallo, Linda C. Scripps Health, San Diego, Ca, United States

Dulce Digital-Me: An Adaptive mHealth Intervention for Underserved Hispanics with Diabetes . Individuals of low socioeconomic (SES) and ethnic minority status, including Hispanics, the largest U.S. ethnic minority group, are disproportionately affected by diabetes. Poor healthcare access and cultural barriers prevent optimal care, adherence, and clinical benefit, thus placing Hispanics at high risk for costly diabetes complications. Our established academic-healthcare-community partnership has unique experience in developing and testing innovative, cost-effective, and sustainable chronic care interventions to reduce disparities and improve health in underserved communities. We recently developed Dulce Digital (i.e., ?one- size-fits-all? educational text messages, with nurse monitoring of patient-transmitted blood glucose values), which improved glycemic control across 6 months, relative to usual care in a recent randomized controlled trial (RCT) of N=126 Hispanic patients with poorly controlled type 2 diabetes (T2DM). Our process evaluation indicated that Dulce Digital was both feasible and acceptable from patient and provider perspectives; however, patients expressed a preference for a more individualized intervention, and providers requested an even greater focus on health behavior change. Thus, the proposed RCT will examine the comparative effectiveness of Dulce Digital versus ?Dulce Digital-Me? (DD-Me) in N=414 Hispanic adults of low SES with poorly controlled T2DM from Neighborhood Healthcare, a San Diego Federally-Qualified Health Center. Guided by patient and provider feedback, DD-Me includes Dulce Digital components plus personalized goal-setting and feedback that is responsive to the individual?s needs and preferences. The DD-Me adaptive feedback component wil Continue reading >>

Preventing Diabetes In Obese Latino Youth With Prediabetes: A Study Protocol For A Randomized Controlled Trial

Preventing Diabetes In Obese Latino Youth With Prediabetes: A Study Protocol For A Randomized Controlled Trial

Preventing diabetes in obese Latino youth with prediabetes: a study protocol for a randomized controlled trial Obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes. Participants will be randomized to a lifestyle intervention or usual care group. Participants in the intervention group will attend weekly nutrition and wellness sessions and physical activity sessions twice a week for six months, followed by three months of booster sessions. The overall approach of the intervention is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence. The intervention is also guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. We will test intervention effects on quality of life, explore the potential mediating effects of changes in body composition, total, regional, and organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost effectiveness of the interventio Continue reading >>

Effective, Culturally Adapted Interventions Needed To Tackle Diabetes Inhispanics

Effective, Culturally Adapted Interventions Needed To Tackle Diabetes Inhispanics

Home Featured News Effective, culturally adapted interventions needed to tackle diabetes inHispanics Effective, culturally adapted interventions needed to tackle diabetes inHispanics Posted on November 14, 2017 in Featured News , Health // 0 Comments The researchers reviewed scientific studies on diabetes prevalence, causes, treatment and prevention in Hispanics in the U.S. and Latin America. Image: Shutterstock. Hispanics form the largest minority group in the US, and are twice as likely to have diabetes compared with non-Hispanic whites yet a new review highlights that nearly 40% of US Hispanics with diabetes have not been formally diagnosed. Published in Frontiers in Endocrinology ahead of World Diabetes Day, the study also finds that diabetes prevalence varies widely among different Hispanic heritage groups and in different Latin American countries. The findings indicate that further research and more effective, adaptable interventions are needed to prevent and manage diabetes in Hispanics. The prevalence of diabetes continues to increase not only in the US, but also in Latin America, says Larissa Avils-Santa of the National Heart Lung and Blood Institute and one of the studys authors. The problem is both serious and complex. Although the specific causes of type 2 diabetes (the most common type of diabetes) in Hispanics/Latinos are not completely understood, genetic , biologic, environmental, socioeconomic, lifestyle and cultural factors could be playing different roles in increasing its prevalence and could underlie the differences observed among different Hispanic heritage groups. The US Census Bureau defines Hispanics (or Latinos) as persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture regardless of race, although this def Continue reading >>

De Por Vida: A Diabetes Risk Reduction Intervention For Hispanic Women

De Por Vida: A Diabetes Risk Reduction Intervention For Hispanic Women

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. De Por Vida: A Diabetes Risk Reduction Intervention for Hispanic Women The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT03113916 Recruitment Status : Active, not recruiting Information provided by (Responsible Party): Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information This pragmatic randomized clinical trial will assess the efficacy, cost, and sustainability of a culturally tailored weight-loss program targeting obese Hispanic women with pre-diabetes or T2D. The intervention will be integrated into patient care at a Federally Qualified Health Center serving over 30,000 low-income patients, and will be delivered by trained clinic staff, with minimal support from research staff. After the effectiveness clinical trial, two cohorts of clinic patients will receive the intervention in a sustainability test. Behavioral: Behavioural Lifestyle Intervention Hispanic women have the highest estimated lifetime risk of developing diabetes of all ethnic/gender groups in the US, and their prevalence rates of overweight and obesity are among the highest in the US. Currently, nearly 90% of Hispanic women aged 40-59 are overweight or obese. If diagnosed with Type 2 diabetes (T2D) at age 40, Hispanic women are projected to lose 12.4 life-years, and 21.5 quality-adjusted life-years. Several clinical trials have produced compelling evidence demonstrating the benefits of weight-loss interven Continue reading >>

Diabetes In Us Hispanic/latinos: Disparities And Interventions

Diabetes In Us Hispanic/latinos: Disparities And Interventions

Diabetes in US Hispanic/Latinos: Disparities and Interventions University of Arizona Department of Psychology, Room 306 THE PSYCHOLOGY DEPARTMENT IS PLEASED TO ANNOUNCE: TOPIC:Diabetes in US Hispanic/Latinos: Disparities and Interventions SPEAKER: Linda C. Gallo, PhD, Professor, San Diego State University To view, download, post and share the flyer for this event, click here: click here [PDF] or on the image at left. Diabetes affects more than 30 million U.S. individuals, with disproportionate impact in ethnic/racial minority groups and people with low socioeconomic status. Hispanics/Latinos are at higher risk for diabetes than non-Hispanic whites, and also have poorer risk factor control and worse outcomes once diagnosed with diabetes. In the current talk, Dr.Gallowill present findings regarding diabetes prevalence and control from the landmark Hispanic Community Health Study/Study of Latinos (HCHS/SOL) , an epidemiological cohort study of >16,000 adults of Hispanic/Latino descent from four U.S. cities. Following, she will address the potential role of culturally appropriate interventions in promoting better diabetes self-management and clinical outcomes among Hispanics/Latinos with diabetes, discussing recent clinical trials that are testing the effectiveness of healthcare system and patient focused, technology-enhanced interventions in real-world primary care environments. Dr. Linda Gallo is a professor in the Department of Psychology at San Diego State University (SDSU), Core faculty member in the SDSU/UCSD joint Doctoral Program in Clinical Psychology, Adjunct Professor of Public Heath, and Co-Director of the South Bay Latino Research Center. Her areas of expertise include developing innovative models to understand health disparities, elucidating psychosocial fact Continue reading >>

Diabetes Self-management Education Interventions And Glycemic Control Among Hispanics: A Literature Review

Diabetes Self-management Education Interventions And Glycemic Control Among Hispanics: A Literature Review

@article{c38b2d24f93b4a68882bfe628140a813, title = "Diabetes self-management education interventions and glycemic control among hispanics: A literature review", abstract = "Diabetes self-management education interventions have been shown to improve glycemic control in Whites and African Americans with type 2 diabetes. Hispanic women and men, however, sometimes have barriers to management including lack of access to care, low English proficiency, low literacy, and cultural differences. This review examined the state of the science related to the effects of diabetes self-management education interventions on glycemic control in Hispanics. The 8 of 9 studies showed a significant decrease in glycated hemoglobin in experimental patients. The interventions also demonstrated the success of using community health workers, bilingual interventionists, culturally sensitive designs, and accessible interventions. Limitations included weak study designs, high attrition rates, and short duration of studies.", keywords = "Glycemic control, Interventions, Self-management, Type 2 diabetes", author = "Gonzalez, {Lisanna Stamos} and Berry, {Diane C.} and Davison, {Jean Ann}", N2 - Diabetes self-management education interventions have been shown to improve glycemic control in Whites and African Americans with type 2 diabetes. Hispanic women and men, however, sometimes have barriers to management including lack of access to care, low English proficiency, low literacy, and cultural differences. This review examined the state of the science related to the effects of diabetes self-management education interventions on glycemic control in Hispanics. The 8 of 9 studies showed a significant decrease in glycated hemoglobin in experimental patients. The interventions also demonstrated the success o Continue reading >>

A Systematic Review Of Interventions For Hispanic Women With Or At Risk Of Gestational Diabetes Mellitus (gdm) - Sciencedirect

A Systematic Review Of Interventions For Hispanic Women With Or At Risk Of Gestational Diabetes Mellitus (gdm) - Sciencedirect

A systematic review of interventions for Hispanic women with or at risk of Gestational diabetes mellitus (GDM) Author links open overlay panel MaryCarolan-Olaha Hispanic women incur high rates of gestational diabetes mellitus. There is limited literature reporting on GDM interventions for this population and limited information to guide health professionals providing care to this group. Culturally tailored interventions offering dietary counselling over a prolonged period may prove effective. Gestational Diabetes Mellitus (GDM) is a serious health concern for pregnant women, with Hispanic women at particular risk for developing the condition. The aim of this review was to critically examine GDM intervention programs for Hispanic women, in the United States of America (US). English and Spanish electronic databases were searched for relevant studies published between 1995 and 2015. Eligible study designs included randomized controlled trial, pre/post-test and quasi experimental methods. Findings indicated that there was a dearth of literature reporting on GDM interventions for Hispanic women and just seven papers met inclusion criteria. These seven studies were included in the review and they reported on interventions for: (1) pregnant women at high risk of developing GDM; (2) pregnant women with GDM. Results suggest that a combination of intensive counselling over a prolonged period of time, together with a low calorie, possibly low glycemic index diet, produces best results. The review found that intensive nutritional counselling approaches which promote low calorie/low GI diets appear to be most effective in BGL management in this population. Interventions that are delivered in Spanish and culturally tailored may be more acceptable to participants. More research is ne Continue reading >>

A Family-based Diabetes Intervention For Hispanic Adults And Their Family Members

A Family-based Diabetes Intervention For Hispanic Adults And Their Family Members

A Family-Based Diabetes Intervention for Hispanic Adults and Their Family Members Debra Wallace , Professor, Thomas McCoy , Visiting Assistant Professor, Statistician, and Karen Amirehsani , Assistant Professor Center for the Health of Vulnerable Populations University of North Carolina at Greensboro, School of Nursing Greensboro, NC 27402-6170, USA Jie Hu, University of North Carolina at Greensboro, School of Nursing Greensboro, NC 27402-6170, USA [email protected]_eij ; The publisher's final edited version of this article is available at Diabetes Educ See other articles in PMC that cite the published article. The purpose of this quasi-experimental one group longitudinal study is to examine the effects of a family-based intervention program on diabetes self-management behaviors, HbA1c, other biomarkers, psychosocial factors and health-related quality of life in Hispanics with diabetes. Adult patients with diabetes (n = 36) and family members (n = 37) were recruited from a community clinic in rural central North Carolina. Patients and family members attended an 8-week culturally tailored diabetes educational program taught in Spanish. Data was collected pre and post intervention for both patients and family members, with an additional data collection for patients 1 month post intervention. Most patients and family members were female and almost all were immigrants. HbA1c dropped by 0.41% on average among patients from pre-intervention to 1 month post intervention. Patients showed significant improvements in systolic blood pressure, diabetes self-efficacy diabetes knowledge, and physical and mental components of health-related quality of life. Higher levels of intake of healthy foods and performance of blood sugar tests and foot inspections were reported. Family members signi Continue reading >>

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