Abstract
Background: There are well-documented disparities in diabetes care outcomes and technology usage, stemming from differences in healthcare access, distrust in healthcare providers, and other factors. This study evaluated patient-level outcomes of a diabetes support coach (DSC) intervention aimed at improving underserved adults’ diabetes technology use, diabetes distress, and HbA1c levels.
Methods: As part of a Project Extension for Community Healthcare Outcomes (ECHO) Diabetes program, a social support intervention involving 28 DSCs was piloted at 33 Federally Qualified Health Centers (FQHCs) in Florida and California from May 2021 to May 2022. DSCs, who were adults with diabetes, served in a capacity similar to peer mentors and community health workers and received uniform training/oversight by a clinical team. Intervention participants (n = 74 adults with insulin-requiring diabetes at FQHCs) self-enrolled and engaged with DSCs via text messages, phone calls, and events. Participants’ outcomes were evaluated cross-sectionally via the Diabetes Distress Scale (DDS-17) and a diabetes technology usage survey and longitudinally via HbA1c tests upon enrollment and at 6-month follow-up. A group of adults with insulin-requiring diabetes from the same FQHCs who did not receive the DSC intervention (n = 363) was used for comparison. Descriptive statistics were computed for all outcomes (n, percentage; mean, SD/95% CI). Between-group comparisons were evaluated via chi-squared and t-tests.
Results: DSC intervention participants reported significantly lower diabetes distress than the comparison group (DDS-17 score mean = 1.6 vs. 2.1, p < 0.001), and significantly more participants in the DSC intervention regularly used continuous glucose monitors (CGMs) than the comparison group (69.9% vs. 38.8%, p < 0.0001). There were no significant differences in insulin pump usage or HbA1c.
Conclusions: Lower diabetes distress and greater CGM usage among intervention participants suggest that the DSCs’ shared lived experiences and healthcare navigation support positively influenced underserved adults’ outcomes. These findings show DSCs’ potential for improving diabetes care and technology equity.
