Diabetes in the Latinx Community and Self-Care
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Diabetes is becoming one of the most significant health issues that affect a large population of the Latinx population within the United States, where the Latinx population has a higher incidence of Type 2 diabetes than any other population (Kopelowicz et al., 2022). As with any other chronic disease, it implies specific strategies in which patients can participate in disease management and self-care practices like taking medications, monitoring blood glucose levels, altering their lifestyle, etc. However, due to cultural, linguistic, and socioeconomic factors, Latinx cannot practice these habits (Talavera et al., 2021). The purpose of this paper is to determine the outcomes of culturally appropriate DSME programs for Latinx adults diagnosed with Type 2 diabetes, specifically glycemic control as well as self-care behaviors. The paper will describe the problem and its importance, formulate the PICO(T) question for the research, describe the search methods, and present the literature review of the highest level of evidence regarding the clinical question. Thus, in this paper, the author aims to study guidelines for implementing culturally sensitive DSME programs into routine care to improve diabetes-related outcomes in the Latinx population.
Emerging Background and Clinical Relevance of the Concern
Diabetes mellitus, especially Type 2 diabetes, is expected in the Latinx population and continues to rise in occurrence. The CDC reports that the Latinx population in the US is diagnosed with Diabetes 17% more often than non-Hispanic whites (Talavera et al., 2021). Further, one finds that Latinx adults are also about to be one in ten more affected by Diabetes; however, the overall figures could be much higher, and the more significant number of cases unidentified as they are endowed with Diabetes (Fallas et al., 2020). This raises its risk because of genetics, poor socioeconomic status, culture, and occasionally poor access to quality healthcare services. Thus, it is not very easy for healthcare providers to manage Diabetes appropriately in this group of people.
Education on self-management of Diabetes has been said to comprise the most valued aspect of diabetes management, which includes blood glucose monitoring, medication compliance, diet, and exercise. Latinx has been identified to be at the center of Diabetes, yet they struggle to manage the disease (Rosas, 2024). Such barriers are low levels of health literacy and cultural and language characteristics that may influence the comprehension of traditional diabetic management strategies (Fallas et al., 2020). For instance, the dietary code of conduct that does not incorporate ethnic foods may likely result in non-compliance. In addition, due to cultural endowment, many Latinx patients may have some incline towards the use of home remedies rather than the use of drugs that are prescribed to them to manage their Diabetes, thus worsening their poor diabetes control.
Some of the dangers that result from poor self-management of Diabetes include cardiovascular complications, neuropathy, renal failure, and retinopathy. Latinx holders are at a higher risk for such complications since diagnosis and glycemic control are usually delayed in this group, thus worsening the diseases (kopelowicz et al., 2022). Furthermore, it is worth stating that the gaps in access to healthcare services and their outcomes still amplify the gaps within this community in managing Diabetes.
In light of these challenges, responding to them from a clinician’s standpoint is critical. Primary care providers such as nurse practitioners in touch with clients with chronic diseases, including Diabetes, are always involved in educating them on managing their illnesses. Therefore, there is a requirement for culturally appropriate interventions to help Latinx patients be able to adhere to recommended self-care practices that are within their context (Fallas et al., 2020). Based on the data, culturally appropriate DSME with family participation, translated materials, and local dietetics can enhance compliance and glycemia.
Today, various clinical reference manuals released worldwide also stress the value and necessity of DSME to handle the condition successfully. Hence, there is a call for understanding the culture, social, and environmental settings to develop a triggering nursing care plan. If nurse practitioners managing Latinx individuals are to close the gap in Diabetes research studies, they should incorporate DSME into their practice (Ehrhardt et al., 2023). Thus, this paper’s literature review reveals a need to address the problem of diabetes management in the Latinx community in more culturally and structurally sensitive ways. Since Diabetes is widespread and its comorbidities are severe, it is essential to focus on this problem to improve patients’ quality of life and decrease inequalities in health care (Martinez et al., 2024). By integrating culturally appropriate DSME programs, nurse practitioners are poised to influence changed self-care patterns besides the quality of health among Latinx with Type 2 diabetes.
Clinical Question Identified
This evidence-based research’s clinical question concerns enhancing the management of Diabetes among Latinx people. To achieve a clear and concise research question, the PICO(T) framework is applied, which will be the foundation of further work and clinical practice.
PICO(T) Question:
In Latinx adults with Type 2 diabetes (P), does culturally tailored DSME (I) increase glycemic control and self-care behaviors when compared with standard diabetes education (C) (O) in six months (T)?
PICO Elements Defined:
Population (P):
The target is the Latinx adults diagnosed with type-2 Diabetes. This group is also most vulnerable to complications of Diabetes due to cultural, socioeconomic, and other factors that hamper their access to quality health care. Thus, by choosing this target population, the study elaborates on the challenges this group of patients has to deal with to maintain their condition under control.
Intervention (I):
Therefore, the intervention under intervention is culturally appropriate diabetes self-management education (DSME) programs. These culturally sensitive programs involve culturally appropriate language, family participation, and culturally suitable nutrition counseling to boost patients’ attendance and self-treatment compliance.
Comparison (C):
The control group will undergo the usual Diabetes self-management education and interventions, which will not address the cultural characteristics of the Latinx population. This standard approach usually comprises general directions to manage Diabetes apart from language and culture options.
Outcome (O):
The coursework also outlines the following parameters in listing measurable interventions: the difference in glycemic control, as indicated in the HbA1c levels, and the quality of self-management, including medication and diet compliance, exercise, and monitoring of the patient’s glucose levels.
Time (T):
The intervention’s effectiveness is measured over six months, as given above. This time provides an adequate window during which one can also notice improvements in glycemic control and self-management practices.
This PICO(T) question will help steer the research and determine the best approaches to managing the condition in the Latinx community. Nurse practitioners can help this high-risk population attain the best health status possible through evidence-based interventions.
Theoretical Model/Conceptual Framework
In this case, CCM will be employed as the theoretical framework for the given project. The CCM is a highly utilized model that can enhance the outcome of the care of patients with chronic diseases and make the process more patient-engaged. They include continuing and integrated health care services, self-management, other health resources, and evidence-based programs and policies to improve the health of patients with chronic diseases such as Diabetes.
An Explanation of the Chronic Care Model
The CCM consists of six core components that work together to improve the care of patients with chronic diseases: The CCM consists of six core components that work together to improve the care of patients with chronic diseases:
1.Health System: The model also calls for leadership engagement to support and coordinate high-quality chronic care. Health systems need to promote a culture of quality improvement and address chronic disease initiatives.
Delivery System Design: This component focuses on the engagement of the care team, active patient management, and the integration of processes of many healthcare workers to offer a continuous and diverse approach to the patient.
Decision Support: Decision support is based on evidence-based guidelines, meaning medical decision-making is built on current research and protocols to avoid resistance to change. This aids in incorporating background evidence in practice, culminating in positive patient results.
Clinical Information Systems: The goals and objectives of clinical information systems, like the EHR, guarantee that the provider has a recent and reliable patient record. This leads to enhanced patient records for monitoring, follow-up, and assessing results.
Self-Management Support: The CCM attaches considerable importance to patient education and patient-centeredness. It opens up stakeholders’ engagement with patients, especially healthcare providers, who empower patients with knowledge to manage their conditions.
Community Resources and Policies: Engaging patients with community activities can help them get related services in the future apart from health issues like exercise programs, nutrition, and support groups.
It is also important to note the utilization of the Chronic Care Model in the project.
As the over-arching theoretical framework on chronic illness management in primary care, the Chronic Care Model supports this project’s goal of increasing diabetes self-management among Latinx people through culturally responsive interventions. The components of self-management support, evidence-based decision, and the team-based approach are embedded in this model that, in turn, addresses the issues of glycemic control and self-care activities, which the project is concerned with.
Health System: Within this project, healthcare leaders and providers must address culturally sensitive DSME for Latinx people with T2DM. These programs need to be incorporated into everyday clinical practice, and therefore, there has to be support with institutional enforcement.
Delivery System Design: The project will include nurse practitioners, dietitians, CHWs, and culturally competent diabetes educators. This teamwork approach means that all aspects of patient care, from medication to diabetes care to diet, are covered based on the patients’ cultural backgrounds.
Decision Support: Culturally appropriate DSME programs will be employed, following research-based procedures geared towards the Latinx population as recommended for the disease. The providers will use the ADA and other research-based interventions to treat clients culturally and clinically competently.
Clinical Information Systems: EHRs will be employed to record the patient’s progress, changes in HbA1c, and self-care behaviors. This system will be constantly monitored, and the care plans can be changed based on observed changes.
Self-Management Support: To build upon the success of the previous wart, central to this project will be the notion of Shared Self-Management; indeed, the program will focus on helping Latinx patients manage their Diabetes. Thus, with culturally appropriate DSME, patients will have more capabilities, thus enhancing their understanding of their disease status, decision-making, and subsequent positive health behaviors.
Community Resources and Policies: Agencies will collaborate with Latinx organizations to provide services based on their needs, such as nutrition programs, diabetes support groups, and Latinx exercise programs. Diabetes in the Latin Community and Self-Care PICOT
It is appropriate to conclude that the Chronic Care Model can be applied as a useful reference model for implementing this project. It allows the patient to receive an intervention that is patient-oriented, team-facilitated, and built on evidence-based practice, resulting in better results among Latinx adults with type 2 diabetes.
Review of the Literature
Search Strategy and Method
This systematic review aimed to identify cultural interventions for improved diabetes self-management among Latinx adults; therefore, electronic databases were searched for relevant publications. This was done in several databases, and a strict literature review method was employed to ensure that only relevant and scientific-based research was used in the review process.
Search Words and Terms
More specifically, the search embraced keywords and key phrases such as Diabetes, self-management, Latinos, and culturally relevant interventions. The specific terms included:
“Type 2 diabetes”
“Latinx” OR “Hispanic”
“Self-management”
“Culturally tailored interventions”
“Diabetes education”
“Glycemic control”
“Health disparities”
“Patient outcomes”
These search terms were then connected using Boolean operators (AND, OR) to make the search more specific. The study examined diabetes care in regard to culture and the Latinx population.
Databases Used
The following databases were accessed to ensure a comprehensive literature search: The following databases were accessed to ensure a comprehensive literature search:
PubMed: Staring with the search, 135 articles were found, of which 25 were included based on title and abstract review.
CINAHL (Cumulative Index to Nursing and Allied Health Literature): This rationale was used to search for articles, and 84 articles were found, out of which only 18 met the criteria for inclusion in the study.
Cochrane Library: Overall, the study identified 42 systematic reviews, of which ten were most relevant to the developed PICO(T) question.
PsycINFO: A total of 47 articles were identified, of which 12 were reviewed. They focused explicitly on the psychosocial aspects of Diabetes in the Latinx population.
Google Scholar: This search seems to have included 130 articles, but only 15 articles met the inclusion criteria after refining the results based on relevance and research quality.
Inclusion and Exclusion Criteria
Inclusion criteria for selecting articles The inclusion criteria for selecting articles were:
Published in the last five years, from 2019 to 2024
Peer-reviewed research articles
Research on Latinxs diagnosed with type 2 diabetes in adulthood
Reviews on the impact of culturally appropriate diabetes self-management education intervention programs
Research paper’s description of clinical parameters, including HbA1c levels, self-care practices, or QoL.
Diabetes in the Latin Community and Self-Care PICOT
The exclusion criteria were:
As mentioned, the articles must be from professional journals and not be in English.
Anyone vulnerable in the general population or Focus: children or Type 1 diabetes
Researched investigations that involve animals and other non-human beings
Articles or posts that were not scientific research papers, such as reviews, commentary, or editorials.
Those that were conducted more than five years ago; another factor was if the studies were conducted on gestational Diabetes since they are irrelevant to the research question
The search results will include abstracts of the journal, issues relating to the journal in case of any, and the article selection.
Search Results
First, 506 relevant articles were found by applying the initial keywords, and after applying the inclusion and exclusion criteria, 80 articles were crossed for further evaluation. Studies included in each article were reviewed based on clinical questions and the strength of evidence and focused on culturally sensitive diabetes interventions in the Latinx population only. The final selection included:
5 Randomized Controlled Trial (RCTs)
3 Cohort Studies
2 Qualitative Studies
1 Systematic Review
Summary of Search Strategy
The final pool of studies comprises a diverse set of research methodologies, all of which help answer the clinical question of culturally tailored DSME programs’ effectiveness in enhancing glycemic control and self-care practices in Latinx adult T2DM patients. The search strategy aimed at including only the best quality evidence that would contribute towards developing the best clinical practice for culturally sensitive diabetes care by nurse practitioners.
References
Ehrhardt, N., Cedeno, B., Montour, L. T., Sinclair, K., Ferguson, G., Berberian, P., Comstock, B. A., & Wright, L. (2023). Effectiveness of a culturally tailored diabetes education curriculum with real-time continuous glucose monitoring in a Latinx population with type 2 diabetes: The CUT-DM with CGM for Latinx randomized controlled trial study protocol. BMJ Open , 13 (12), e082005–e082005. https://doi.org/10.1136/bmjopen-2023-082005
Fallas, C. R., Pereira, K., Padilla, B. I., Felsman, I., Allen, S., & Preik, C. (2020). Improving self-care management in low-income Latinos with type 2 diabetes using peer-led U.S. conversation maps: A quality improvement project in a free clinic. Clinical Diabetes , 38 (3), 213–221. https://doi.org/10.2337/cd19-0052
kopelowicz, alex, Nandy, K., Ruiz, M. E., Polzin, R., Kurator, K., & wali, soma. (2022). Improving self-management of Type 2 diabetes in Latinx patients: Protocol for a sequential multiple assignment randomized trial using community health workers, registered nurses, and family members (Preprint). JMIR Research Protocols . https://doi.org/10.2196/44793
Martinez, S., Nouryan, C. N., Williams, M. S., Patel, V. H., Barbero, P., Valeria Correa Gomez, Marino, J., Goris, N., Cigaran, E., Granville, D., Murray, L. F., Harris, Y. T., Myers, A., Guzman, J., Makaryus, A. N., McFarlane, S. I., Zeltser, R., Pena, M., Sison, C., & Lesser, M. L. (2024). Ensuring fidelity: key elements to consider in disseminating a diabetes telemanagement program for underserved Hispanic/Latinos living with type 2 diabetes. Frontiers in Clinical Diabetes and Healthcare , 5 . https://doi.org/10.3389/fcdhc.2024.1328993
Rosas. (2024). Randomized trial of an integrated care intervention among Latino adults: Sustained effects on diabetes management. Translational Behavioral Medicine , 14 (5). https://doi.org/10.1093/tbm/ibae001
Talavera, G. A., Castañeda, S. F., Mendoza, P. M., Lopez-Gurrola, M., Roesch, S., Pichardo, M. S., Garcia, M. L., Muñoz, F., & Gallo, L. C. (2021). Latinos understanding the need for adherence in diabetes (LUNA-D): A randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes. Translational Behavioral Medicine , 11 (9), 1665–1675. https://doi.org/10.1093/tbm/ibab052 Diabetes in the Latin Community and Self-Care PICOT
Appendix
Review of Literature Table
Summary of Primary Sources of Evidence
Citation of Evidence
Study Question or Hypothesis
Study Design
Sample/Setting
Independent and Dependent Variables & Tools Used
Data Collection & Analysis
Findings
Recommendation/
Implications
Level of
Evidence
Ehrhardt, N., Cedeno, B., Montour, L. T., Sinclair, K., Ferguson, G., Berberian, P., Comstock, B. A., & Wright, L. (2023). Effectiveness of a culturally tailored diabetes education curriculum with real-time continuous glucose monitoring in a Latinx population with type 2 diabetes: The CUT-DM with CGM for Latinx randomized controlled trial study protocol. BMJ Open , 13 (12), e082005–e082005. https://doi.org/10.1136/bmjopen-2023-082005
Diabetes in the Latin Community and Self-Care PICOT
Does real-time continuous glucose monitoring (RT-CGM) improve glycemic control and promote behavioral change in Latinx patients with type 2 diabetes compared to standard DSMES with blinded CGM?
Randomized controlled research design.
Researchers sampled 100 Latinx participants with T2D, based in a large federally funded healthcare system in Seattle, Washington.
Independent Variables: DSMES with real-time continuous glucose monitoring (RT-CGM) vs DSMES with blinded CGM. Dependent Variables: Glycemic control is measured by A1c, CGM metrics (e.g., mean glucose, time in range), and behavioral outcomes (lifestyle changes, medication adherence). Tools: Hemoglobin A1c (A1c) measurements, CGM devices (Dexcom G6), DSMES curriculum delivered via telemedicine.
Data collected at baseline, 12 weeks, and 24 weeks were analyzed using a random-intercept random-slope linear mixed-effects regression model.
Anticipated reduction in A1c by 0.4% or more in RT-CGM group; secondary outcomes include behavior changes in household members. Thus, the research demonstrates the impact of diabetes management education on enhancing the quality of life of persons from the minority groups Diabetes in the Latin Community and Self-Care PICOT
DSMES curriculum with RT-CGM improves glycemic control; ripple effect may influence household members’ behaviors. Implementing individualized and culturally competent education promotes adequate and effective skills for diabetes self-care.
Level II (Randomized Controlled Trial)
Fallas, C. R., Pereira, K., Padilla, B. I., Felsman, I., Allen, S., & Preik, C. (2020). Improving self-care management in low-income Latinos with type 2 diabetes using peer-led U.S. conversation maps: A quality improvement project in a free clinic. Clinical Diabetes , 38 (3), 213–221. https://doi.org/10.2337/cd19-0052
Does a peer-led, culturally sensitive DSME program using U.S. Conversation Maps improve self-efficacy, reduce diabetes distress (DD), and improve glycemic control in low-income Latinos with type 2 diabetes?
Quality improvement (QI) project with pre-/post-test intervention design.
The research sampled 38 Latino participants with uncontrolled type 2 diabetes (A1C > 7%), attending a community clinic in Charlotte, NC.
Independent Variables: Peer-led DSME with U.S. Conversation Maps. Dependent Variables: Self-efficacy (LSESLD), diabetes distress (DDS-17), and A1C levels.
Tools: LSESLD scale for self-efficacy, DDS-17 for diabetes distress, A1C measurements.
Pre- and post-intervention data collected over 6 months. Statistical analysis included paired t-tests and repeated measures ANCOVA to adjust for confounders (e.g., depression).
Self-efficacy significantly improved (P < 0.001). DD significantly reduced, and A1C levels improved from 9.51% to 8.79% (P = 0.043).
Peer-led, culturally tailored DSME programs can effectively improve self-efficacy and glycemic control in low-income Latino populations. Recommended for implementation in community clinics to reduce barriers to care.
Level III (Non-randomized study – quality improvement design)
Kopelowicz, alex, Nandy, K., Ruiz, M. E., Polzin, R., Kurator, K., & wali, soma. (2022). Improving self-management of Type 2 diabetes in Latinx patients: Protocol for a sequential multiple assignment randomized trial using community health workers, registered nurses, and family members (Preprint). JMIR Research Protocols . https://doi.org/10.2196/44793
Does the use of community health workers (promotors) or nurses in delivering diabetes self-management education (DSME) improve self-management behaviours in Latinx patients with type 2 diabetes (T2DM) when compared to a family-centred multifamily group (MFG) approach?
Sequential multiple assignment randomized trial (SMART)
This article included 330 Latinx patients with T2DM, recruited from Olive View-UCLA Medical Center outpatient clinics, Los Angeles, CA.
Independent Variables: DSME delivered by community health workers or nurses. Dependent Variables: Self-management behaviors (assessed by SDSCA), diabetes self-efficacy, HbA1c levels.
Tools: SDSCA, Stanford Self-Efficacy Scale, HbA1c test (A1C NOW kit), family support measure.
Data collected at baseline, 3, 6, and 12 months. Analyzed using generalized linear mixed models (GLMM) to account for repeated measures and covariates Diabetes in the Latin Community and Self-Care PICOT
Early results indicate that DSME programs improve self-management behaviors in Latinx patients with T2DM, and family involvement is critical for sustained behavior change. The MFG approach may offer additional benefits for patients who do not respond to initial interventions.
DSME delivered by community health workers or nurses shows efficacy in Latinx patients, but the involvement of family and tailored MFG strategies may optimize outcomes. Further studies are needed to explore long-term impacts.
Level II (Randomized trial with repeated interventions)
Martinez, S., Nouryan, C. N., Williams, M. S., Patel, V. H., Barbero, P., Valeria Correa Gomez, Marino, J., Goris, N., Cigaran, E., Granville, D., Murray, L. F., Harris, Y. T., Myers, A., Guzman, J., Makaryus, A. N., McFarlane, S. I., Zeltser, R., Pena, M., Sison, C., & Lesser, M. L. (2024). Ensuring fidelity: key elements to consider in disseminating a diabetes telemanagement program for underserved Hispanic/Latinos living with type 2 diabetes. Frontiers in Clinical Diabetes and Healthcare , 5 . https://doi.org/10.3389/fcdhc.2024.1328993
Does a diabetes telemanagement (DTM) program improve glycemic control and self-management among underserved Hispanic/Latino patients with type 2 diabetes compared to standard comprehensive outpatient management (COM)?
Randomized controlled trial (RCT)
This research involved 240 Hispanic/Latino patients with type 2 diabetes aged 18+, recruited from nine community clinics. Participants were randomized to COM or DTM.
Independent Variables: Diabetes telemanagement program (DTM) vs comprehensive outpatient management (COM). Dependent Variables: Glycemic control (HbA1c), blood pressure, self-management behaviors, medication adherence. Tools: Tablets, blood glucose meters, blood pressure monitors, and educational videos (culturally tailored).
Data collected at baseline, 3, 6, and 12 months. Analysis used mixed linear models to assess differences in HbA1c and self-management behaviors.
Patients in the DTM group showed improved glycemic control (reduction in HbA1c) and better self-management behaviors compared to the COM group. The use of culturally relevant telemanagement tools played a key role in patient adherence.
The DTM program is effective for improving glycemic control and self-management in Hispanic/Latino patients with type 2 diabetes. Incorporating culturally relevant materials and ensuring patient engagement through technology is essential for replication.
Level II (Randomized controlled trial)
Rosas. (2024). Randomized trial of an integrated care intervention among Latino adults: Sustained effects on diabetes management. Translational Behavioral Medicine , 14 (5). https://doi.org/10.1093/tbm/ibae001
Does an integrated care intervention (ICI) improve and sustain glycemic management and psychological well-being (anxiety and depression) in Latino adults with type 2 diabetes, compared to usual care, over a 12-month period?
Randomized controlled trial (RCT)
The research recruited and included 456 Latino adults with type 2 diabetes, mean age 55.7 years, 63.7% female, conducted between 2015 and 2019..
Independent Variables: Integrated care intervention (ICI) vs usual care. Dependent Variables: Glycemic control (HbA1c), anxiety symptoms, depression symptoms. Tools: HbA1c measurements, psychological assessments (anxiety and depression scales).
Data collected at baseline, 3, 6, 9, and 12 months. Analyzed using multilevel models and instantaneous rate of change analysis.
ICI group showed significant improvements in HbA1c and anxiety symptoms at 3 and 6 months, which were largely maintained at 9 and 12 months. Depression symptoms did not show significant changes. Usual care group showed minimal changes in anxiety and no significant changes in HbA1c.
Culturally adapted integrated care, including medical and behavioral health services, can produce and maintain improvements in clinical and psychological outcomes among Latino adults with type 2 diabetes. Implementation of such models should be considered in healthcare settings for underserved populations.
Level II (Randomized controlled trial)
Talavera, G. A., Castañeda, S. F., Mendoza, P. M., Lopez-Gurrola, M., Roesch, S., Pichardo, M. S., Garcia, M. L., Muñoz, F., & Gallo, L. C. (2021). Latinos understanding the need for adherence in diabetes (LUNA-D): A randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes. Translational Behavioral Medicine , 11 (9), 1665–1675. https://doi.org/10.1093/tbm/ibab052
Does the LUNA-D integrated care model improve diabetes clinical control (HbA1c, blood pressure, and lipid levels) among Latinos with type 2 diabetes in a Federally Qualified Community Health Center?
Randomized controlled trial (RCT) – parallel groups
The research team recruited 456 Latino adults aged 23–80 years with type 2 diabetes, recruited from a Federally Qualified Community Health Center in San Diego, CA.
Independent Variables: LUNA-D integrated care intervention (team-based, culturally appropriate). Dependent Variables: Glycemic control (HbA1c), blood pressure, lipid levels. Tools: HbA1c, blood pressure measurements, lipid profile analysis, diabetes self-management education.
Data collected at baseline, 3 months, and 6 months. Multilevel models were used to analyze changes over time in HbA1c and secondary outcomes. Sensitivity analyses were also conducted.
The LUNA-D intervention significantly improved HbA1c (ΔHbA1c = -0.35, p < 0.01) compared to usual care. Significant improvements were also observed in diastolic blood pressure and cholesterol levels.
Integrated care models like LUNA-D, which include medical and behavioral health components, can improve clinical outcomes in underserved Latino populations with diabetes. Policymakers and healthcare organizations should promote the adoption of such models in Federally Qualified Community Health Centers.
Level II (Randomized controlled trial)
Diabetes in the Latin Community and Self-Care PICOT
