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Outcomes of Project Dulce: a culturally specific diabetes management program
Todd P Gilmer1, Athena Philis-Tsimikas, Chris Walker
1Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093-0622, USA. tgilmer@ucsd.edu
The Annals of Pharmacotherapy
|March 17, 2005
Summary
Project Dulce improved diabetes management in minority populations, significantly reducing HbA1c, blood pressure, and cholesterol. While initial costs were higher, the program showed clinical effectiveness for this high-risk group.
Area of Science:
- Public Health
- Chronic Disease Management
- Health Disparities
Background:
- Diabetes mellitus is a prevalent, costly chronic disease disproportionately affecting minority populations.
- Limited evidence exists on the effectiveness and cost of culturally tailored diabetes management programs.
- Minority populations often face unique barriers to effective diabetes care.
Purpose of the Study:
- To evaluate the clinical outcomes and associated costs of Project Dulce.
- Project Dulce integrates stepped-care diabetes nurse case management with culturally oriented peer support.
- The study aimed to assess a novel intervention for a medically underserved, diverse population.
Main Methods:
- A pre-post analysis compared 348 diabetes patients in Project Dulce with historical controls over one year.
- Clinical outcomes (HbA1c, blood pressure, cholesterol) and costs were analyzed using generalized regression models.
- Participants received services at community health centers in San Diego, CA.
Main Results:
- Significant reductions observed in HbA1c (0.8%), systolic (5.4 mm Hg) and diastolic (8.0 mm Hg) blood pressure, total cholesterol (28.1 mg/dL), and LDL cholesterol (15.6 mg/dL).
- Increased expenditures for pharmacy and disease management were noted.
- Total first-year costs were higher for Project Dulce participants ($5711 vs $4365 control).
Conclusions:
- Project Dulce effectively improved clinical control of diabetes and related conditions in a medically indigent, culturally diverse population.
- Reduced hospital expenditures, though not statistically significant, suggest potential clinical and economic benefits.
- The intervention demonstrates promise for immediate benefit in high-risk populations.