(1052) Addressing Sociocultural Barriers to Medication Adherence: A Randomized Feasibility Pilot Trial of a Tailored Peer Support and Self-management Intervention for Black Adults with Type 2 Diabetes

Objectives: About 4 million Black adults are diagnosed with diabetes and have a prevalence of type 2 diabetes 1.6 times higher than the general US population. Rates of diabetes complications such as stroke, kidney disease, and amputations are also higher for Black adults compared to other racial and ethnic groups. Current diabetes self-management programs are limited in addressing Black adults’ diabetes and medicine beliefs, distrust of providers and sociocultural barriers to taking diabetes medications. Thus, we developed an 8-week intervention, incorporating culturally tailored group education sessions on beliefs about diabetes, medicines, and provider mistrust, and race-congruent phone peer support into an evidence-based diabetes self-management program. This study evaluated a signal of change in Hemoglobin A1c (A1c), medication adherence and psychosocial outcomes in the 8-week intervention versus the standard 6-week diabetes program.

Methods: Fourteen participants with uncontrolled type 2 diabetes (A1c > 7.5%) were randomized into intervention (n=7) and control groups (n=7). The intervention group received: (1) six weeks of evidence-based diabetes self-management content, (2) two additional provider-led sessions on diabetes and medication beliefs, and provider communication/mistrust, and (3) phone-based race-congruent support from peers with controlled diabetes (A1c < 7.5%). Hemoglobin A1c was measured using A1cNow+. Medication adherence and other psychosocial outcomes were measured in a 20-minute, self-reported longitudinal survey. Primary clinical outcome (A1c), secondary outcome (medication adherence) and psychosocial outcomes were measured at baseline, 3-months, and 6-months. Between-group difference was compared using Mann-Whitney U test and within-group difference was analyzed using Wilcoxon Signed-Rank test. All statistical analysis was performed using SPSS version 28.0.

Results: A total of twelve participants completed surveys and A1c measurements at baseline, 3 months, and 6 months. The mean age of participants was 54.6 years old (SD = 17.4) and seven (54%) identified as female. The average years of diabetes diagnosis was 14.7 (SD = 9.6) and average number of diabetes medications taken was 1.9 (SD = 1.2). At 6 months, A1c was significantly lower in the intervention group (7.9% (SD = 0.9); n=7) compared to the control group (10.6% (SD = 1.6); P = .01; n = 5). As for medication adherence, we did not find any statistically significant between-group differences (p = 0.16) nor within-group differences (p = 0.32). Related to participants’ self-reported psychosocial outcomes, the intervention group showed a 58% higher perception of necessity of taking medicines (d = 0.52), 23% higher patient-provider communication (d = 0.28), and 52% lower diabetes distress (d = 0.53) compared to the control group. Within the intervention group, we also found a signal of change from baseline, with a clinically meaningful decrease (-0.43%, d = 0.24) in mean A1c. As well, there was a reduction in participants’ perception of negative beliefs about diabetes (-20%, d = 0.64) and reduction in diabetes distress (+47%, d = 0.69), each with medium effect sizes.

Conclusions: Black adults with uncontrolled type 2 diabetes may benefit from a culturally tailored diabetes self-management program that could reduce A1c, reframe negative beliefs and decrease diabetes distress. Our findings highlight opportunities to incorporate interventions that target diabetes and medicine beliefs, and provider distrust and include race-congruent peer support into standardized diabetes self-management program for Black adults. There are ongoing efforts to conduct a fully powered randomized controlled effectiveness trial to demonstrate statistically significant improvements in A1c and medication adherence.