A community-academic partnership to adapt a curriculum for people with serious mental illnesses and diabetes.

BACKGROUND: Individuals with serious mental illnesses (SMI) represent a high-risk health disparities population disproportionately affected by diabetes and obesity. OBJECTIVES: This paper describes a community-based participatory research (CBPR) approach to adapting a well-known evidence-based behavioral change protocol, the Diabetes Prevention Program (DPP) lifestyle intervention, for individuals with diabetes and SMI in the community setting. METHODS: A committee composed of university researchers and representatives from the recovery community modified the DPP following three criteria: Person centeredness, practicality, and empowerment. LESSONS LEARNED: Major modifications to the DPP were made in light of barriers and challenges faced by individuals with diabetes and SMI. CONCLUSIONS: The adaptations made to the DPP, and the process through which the modifications were made, may be used by physicians, mental health practitioners, and health educators to engage individuals confronting self-management of diabetes and mental illness.

Telephonic nurse case management for patients with diabetes and mental illnesses: a qualitative perspective.

OBJECTIVES: Gold Choice, a partially capitated Medicaid managed care programme for individuals with a behavioural health diagnosis, implemented a telephonic nurse case management (TNCM) programme to improve diabetes self-management. We sought to identify issues faced by patients with co-morbid behavioural health diagnoses and diabetes as documented in the telephonic nurse case manager's progress notes. We also explored the role of the TNCM in addressing members' needs. METHODS: We undertook a qualitative analysis of 853 de-identified progress notes from 539 Gold Choice members and conducted a semi-structured interview with the TNCM. RESULTS: Seven major themes emerged reflecting the nurse's perspectives on challenges faced by Gold Choice members and addressed by the TNCM: (1) Transience of the population. (2) Complex needs, involving not only medical and psychiatric conditions but also housing, transportation and survival. (3) Confusion regarding diabetes diagnosis. (4) Mistrust and suspicion. (5) Difficulties with medical care. (6) Need for diabetes self-management education/skills. (7) Marked appreciation that the TNCM would initiate contact and care about the patient. DISCUSSION: Members with co-morbid behavioural health diagnoses and diabetes constitute a complex population with extensive needs. The TNCM's role extends beyond diabetes care and entails social support as well as navigation of the healthcare and social service systems.

An adaptation of the diabetes prevention program for use with high-risk, minority patients with type 2 diabetes.

PURPOSE: The purpose of this pilot study was to determine the effectiveness of an edited Diabetes Prevention Program (DPP) Lifestyle Resources Core Teaching Plan for managing patients with type 2 diabetes in an urban underserved setting. Modifications were made to attempt to cut to the bare essentials to work within the constrained budgets of safety net providers. The primary aim was to achieve a mean absolute reduction in HbA1c level of 1 percentage point. METHODS: The authors conducted a randomized controlled trial of 9 months' duration for patients with type 2 diabetes with an HbA1c>or=8.0%. A total of 67 patients randomized into usual-care and case management groups were evaluated with an intention-to-treat analysis. A modified DPP workbook was used during 7 monthly visits with a nurse case manager. RESULTS: As compared with the usual-care group, those in the case management group experienced a greater reduction in HbA1c level (-1.87 vs -0.54; P=.011) and weight (-2.47 kg vs +0.88 kg; P=.011). CONCLUSION: Use of an edited version of the DPP workbook in an urban, low-income, minority population with type 2 diabetesproduced a significant absolute reduction in HbA1c percentage and weight.