Technology-enhanced, culturally-informed primary care results in sustained improvements in biomarkers for Indigenous patients with type 2 diabetes – a pilot study
Lynne M. Chepulis
1 * , Rebekah Crosswell 1 , Suzanne Moorhouse 2 , Helen Morton 3 4 , Michael Oehley 4 5 , Ryan Paul 1 6 , Hamish Crocket 1
1
2
3
4
5 Present: Medical Advisor,
6
Abstract
Type 2 diabetes disproportionately affects Indigenous Māori in New Zealand. The reasons for this are multifactorial but include a history of colonialism, barriers to health care access and a lack of culturally appropriate interactions/relationships with health care providers. There is currently a need to develop models of health care delivery that are tailored to the needs of this population.
This pilot study evaluates the use of technology, education and culturally-informed wrap-around care (including medication optimisation) to improve type 2 diabetes biomarkers and self-management in a high-needs, majority Indigenous population.
Twenty-three participants with HbA1c >80 mmol/L received 2–4 weeks of continuous glucose monitor (CGM) wear at baseline and at 3 months alongside culturally-informed type 2 diabetes education and clinical care. Clinical biomarkers and psychometric measures were recorded at 0, 3, 6 and 12 months and 0 and 3 months respectively. Medication changes were recorded throughout the study.
Mean (± s.d.) HbA1c significantly decreased from 93.4 ± 15.7 mmol/mol at baseline to 76.5 ± 14.8 mmol/mol at 3 months, with reductions maintained at 6 and 12 months by approximately three-quarters of participants (all P < 0.001 vs baseline). Diabetes self-management and LDL-cholesterol measures also improved significantly at 3 and 12 months, respectively.
CGM informed, culturally-appropriate care has the potential to lead to sustained improvements in glycaemia in high-risk, Indigenous populations managed in primary care.
Keywords: CGM, continuous glucose monitors, culturally-informed care, diabetes medications, general practice, health systems research, Indigenous, Māori, primary care, type 2 diabetes.
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