Significance: Hispanic adults have significantly higher rates of diabetes with earlier, more severe complications and death than non-Hispanic whites. They also have higher rates of homelessness which exacerbates complications of diabetes. Furthermore, those who primarily speak Spanish have significantly lower medication adherence than English-speaking Hispanics.
Objective: Adapt the Diabetes Homeless Medication Support (D-HOMES) behavioral treatment manual using culturally appropriate guidance to enhance medication adherence of Spanish-speaking Hispanic adults living with type 2 diabetes.
Method: Our open trial pilot study enrolled 12 Spanish-speaking participants from 1) interested participants from previous qualitative interviews, 2) referrals from a community partner organization, and 3) eligible patients at our urban health system. Inclusion criteria were self-reported diagnosis of type 2 diabetes, preferred Spanish language, recent homelessness, and willingness to work on diabetes self-care. They were offered 10 one-on-one sessions over 3 months (approx. weekly) delivered in-person or by phone from a Spanish-speaking, Hispanic diabetes wellness coach. The coach used motivational interviewing and behavioral activation to improve medication adherence, provide diabetes education, and support resource/care coordination. Assessments were done at baseline and 3 months by Spanish-speaking, Hispanic staff. Participants self-reported measures of mood, quality of life, problem areas in diabetes, medication adherence, homelessness plus physical measurements like HbA1c.
Results: We engaged and retained 11 participants, with most completing all sessions. Diabetes self-management and medication adherence improved from baseline to 3 months (DSMQ increased 2.7 points from 24.5 to 27.2, p = 0.11; ASK-12 improved 3.2 points from 34.7 to 37.9, p = 0.21; ARMS-D decreased -0.4 points from 14.6 to 14.2, p = 0.32; PAID-5 decreased -0.4 points from 5.2 to 4.8, p = 0.80). Glycemic control (Hb A1c) also improved changing -0.9%, from 9.1% at baseline to 8.2% at 3-months (p = 0.15).
Conclusions: Combined in-person & telehealth options supported robust participation and high retention. Early results indicate potentially important improvements in diabetes self-care, medication adherence, and glycemic control. The results combine with other treatment development work in English and Spanish to develop a feasible behavioral trial for fully powered testing in a larger clinical trial.