Puentes hacia una mejor vida (Bridges to a Better Life): Outcome of a Diabetes Control Peer Support Intervention

Article Figures & Data

Table 1

Patient Characteristics Overall and by Study Group (N = 304)

	Total (N = 304)	Intervention (n = 149)	Usual Care (n = 155)
Demographic characteristics
Age in years, mean (SD)	56.3 (11.9)	56.7 (11.8)	55.9 (12.1)
Female, No. (%)	193 (63)	98 (66)	95 (61)
6th grade education or less, No. (%)	126 (41)	61 (41)	65 (42)
Married, No. (%)	188 (62)	94 (63)	94 (61)
Employed, No. (%)	71 (23)	34 (23)	37 (24)
Household size, mean (SD)	3.5 (1.8)	3.5 (1.9)	3.6 (1.8)
Living in poverty, No. (%)^a	189 (62)	85 (57)	104 (67)
Sociocultural characteristics
Latino/Hispanic, No. (%)	292 (96)	145 (97)	147 (95)
Foreign born, No. (%)	233 (77)	112 (75)	121 (78)
If foreign born, age at arrival, mean (SD)	26.8 (14.4)	28.1 (15.4)	25.7 (13.3)
If foreign born, y in United States, mean (SD)	28.6 (14.6)	27.1 (15.2)	30.0 (13.9)
Health care characteristics
Any health insurance, No. (%)	207 (68)	107 (72)	100 (65)
Have a personal doctor, No. (%)^b	206 (68)	108 (72)	98 (63)
Cost is a barrier to health care, No. (%)	78 (26)	39 (26)	39 (25)
Years with diabetes diagnosis, mean (SD)	12.5 (10.2)	12.8 (9.8)	12.3 (10.6)

Table 2

Puentes Intervention Delivery (n = 149)

Contact data
Number of interpersonal contacts per participant, median (range)	4 (1–24)
Participants with no interpersonal contact, No. (%)	10 (7)
Participants who received interpersonal contacts, by type of contact, No. (%)^a
Telephone	137 (92)
One-on-one	76 (51)
Support Groups	27 (18)
Clinic visits	12 (8)

Table 3

Baseline, Intermediate and Long-Term Clinical and Behavioral Outcomes by Study Condition (N = 304)

	Intervention			Control

	Baseline N = 149	6 mo n = 133	12 mo n = 122	Baseline N = 155	6 mo n = 142	12 mo n = 141
Health status (medical record)
HbA_1c, mean (SD)	8.7 (1.6)	8.6 (2.0)	8.3 (1.9)	8.7 (1.5)	8.6 (1.9)	8.7 (2.0)
Systolic blood pressure, mean (SD)	131.5 (17.7)	130.5 (19.0)	131.3 (20.1)	127.9 (18.8)	131.3 (20.3)	131.1 (21.5)
Diastolic blood pressure, mean (SD)	74.9 (9.0)	73.9 (9.0)	74.2 (9.5)	74.2 (8.6)	74.9 (8.6)	73.6 (9.6)
Health care use (medical record)
Dilated eye exam, No. (%)	62 (42)	–	54 (36)	69 (45)	–	45 (29)
Foot exam, No. (%)	32 (21)	–	37 (25)	32 (21)	–	36 (23)
Diabetes/Nutrition education, No. (%)	82 (55)	–	29 (19)	86 (55)	–	31 (20)
Health care use (interview)
Planned diabetes care visits, mean (SD)	3.8 (2.2)	3.4 (2.2)	3.5 (4.1)	3.6 (2.8)	3.4 (2.4)	3.4 (2.7)
Unplanned diabetes care visits, mean (SD)	0.6 (0.9)	0.4 (1.0)	0.3 (0.9)	0.9 (1.7)	0.4 (1.1)	0.4 (0.9)
Diabetes management behaviors (interview)
Days in past week …
5+ fruits & vegetables consumed, mean (SD)	3.6 (2.5)	3.8 (2.7)	4.0 (2.9)	4.0 (2.5)	3.7 (2.9)	3.8 (2.8)
High fat foods consumed, mean (SD)	2.5 (1.9)	2.4 (2.0)	2.1 (1.7)	2.4 (2.0)	2.4 (2.1)	2.4 (2.1)
30 minutes of physical activity, mean (SD)	2.5 (2.7)	3.3 (2.8)	2.7 (2.7)	3.1 (3.0)	3.4 (2.9)	3.3 (3.0)
Blood sugar checked, mean (SD)	4.6 (2.8)	4.7 (2.7)	5.0 (2.6)	4.8 (2.9)	5.0 (2.9)	5.2 (2.6)
Feet checked, mean (SD)	5.3 (2.8)	5.8 (2.3)	5.6 (2.4)	5.1 (2.9)	5.8 (2.4)	6.4 (1.7)
Medication adherence, No. (%)^a	62 (42)	67 (55)	62 (53)	57 (37)	77 (57)	70 (53)

↵a Based on the 4-item Morisky scale; figures represent proportions of patients who reported no barriers to medication use.

Table 4

Intervention Effects on HbA_1c, Blood Pressure, Health Care Use, and Diabetes Management Behaviors (N = 304)

	Baseline			Time (Baseline to 12 Months)			Group*Time

	Beta Estimate	SE	P Value	Beta Estimate	SE	P Value	Beta Estimate	SE	P Value
Health Status (medical record)
HbA_1c^a	0.0163	0.0257	.53	0.00002	0.00004	.15	−0.00012	0.00006	.05
Systolic blood pressure^a	0.0302	0.0195	.12	0.00005	0.00003	.30	−0.00004	0.00005	.38
Diastolic blood pressure^a	0.0139	0.0161	.39	−0.00003	0.00003	.18	0.00000	0.00004	.92
Health care use (interview)
Planned diabetes care visits^b	−0.0170	0.0959	.86	−0.00050	0.00023	.02	0.00020	0.00034	.56
Diabetes management behaviors (interview)
Days in past week …
5+ fruits & vegetables consumed^b	−0.1472	0.0929	.11	−0.00020	0.00018	.87	0.00044	0.00026	.09
High fat foods consumed^b	0.1514	0.1115	.18	0.00004	0.00018	.52	−0.00025	0.00027	.35
30 minutes of physical activity^b	−0.1199	0.1289	.35	0.00011	0.00025	.41	0.00010	0.00038	.80
Blood sugar checked^b	−0.0432	0.0871	.62	0.00022	0.00011	.02	−0.00006	0.00017	.74
Feet checked^b	0.0169	0.0683	.81	0.00053	0.00012	<.001	−0.00037	0.00017	.03
Medication adherence^c	−0.1611	0.2830	.57	0.00163	0.00051	<.001	−0.00034	0.00074	.64

The Beta estimate can be interpreted as follows: Group: the adjusted mean difference in the outcome between intervention and usual care participants at baseline. Time: the adjusted rate of change per day in the outcome among all participants. Group*Time: the adjusted rate of change (per day) in the outcome among intervention vs usual care participants. For example, log-transformed HbA_1c was 0.0163 points higher among intervention participants than among usual care participants at baseline (P = .53). Among all participants, log-transformed HbA_1c increased from baseline to 12 months by 0.00002 points per day (P = .15). From baseline to 12 months, log-transformed HbA_1c decreased by −0.00012 more points per day among intervention participants than among usual care participants (P = .05).
↵a Fitted 3 level linear mixed models for log-transformed outcomes, adjusting for clustering at individual and clinic levels, and the following covariates: poverty status, having a personal doctor, medication adherence, and intervention dose.
↵b Fitted 3 level Poisson regression for counts, adjusting for clustering at individual and clinic levels and for the following covariates: poverty status, having a personal doctor, medication adherence, and intervention dose.
↵c Fitted 3 level logistic regression model for a binary outcome, adjusting for clustering at individual and clinic levels and for the following covariates: poverty status, having a personal doctor, and intervention dose.