Author
School of Pharmacy, American University of Health Sciences, Signal Hill, California, USA
Abstract
Objective: Hawaii has diverse population made up of a cultural mix of different races.
Due to different cultural and social influences and language barrier, many of the
under‑served population who migrated to Hawaii and having diabetes mellitus may
be susceptible to long‑term complications due to uncontrolled hyperglycemia and
medication nonadherence. The purpose of this study was to evaluate the impact of a
diabetes education program on the clinical outcomes in patients with diabetes mellitus
in the Micronesian community of Hawaii.
Methods: This study included patients over age 18 years, with a diagnosis of type 2
diabetes mellitus. The diabetes education program was customized for its weekly
classes to fit to the under‑served population. Data were collected on participants on
the 1st day and then 6 months after attending the education program. Data on primary
and secondary endpoints were collected and analyzed.
Findings: The mean glycosylated hemoglobin A1c, fasting blood glucose, and triglyceride
levels of participants fell significantly from baseline after attending the diabetes
education program for 6 months. No significant changes were observed in other
secondary outcomes during the study time period.
Conclusion: Based on our findings, the diabetes education program that was tailored
to the Micronesian population was successful in achieving glycemic goals, enhancing
medication adherence, improving clinical outcomes, and also preventing long‑term
complications among its participants.
Keywords
Diabetes Statistics Report. This Document is Intended to
Provide Up‑to‑Date Scientific Data and Statistics on Diabetes
and its Burden in the United States; 2014.
2. Boyle JP, Honeycutt AA, Narayan KM, Hoerger TJ, Geiss LS,
Chen H, et al. Projection of diabetes burden through 2050:
Impact of changing demography and disease prevalence in
the U.S. Diabetes Care 2001;24:1936‑40.
3. Wagner EH, Sandhu N, Newton KM, McCulloch DK,
Ramsey SD, Grothaus LC. Effect of improved glycemic control
on health care costs and utilization. JAMA 2001;285:182‑9.
4. UK Prospective Diabetes Study Group. Intensive blood‑glucose
control with sulphonylureas or insulin compared with
conventional treatment and risk of complications in patients
with type 2 diabetes (UKPDS 33). Lancet 1998;352:837‑53.
5. UK Prospective Diabetes Study Group. Effect of intensive
blood‑glucose control with metformin on complications in
overweight patients with type 2 diabetes (UKPDS 34). Lancet
1998;352:854‑65.
6. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE,
Cull CA, et al. Association of glycaemia with macrovascular
and microvascular complications of type 2 diabetes (UKPDS
35): Prospective observational study. BMJ 2000;321:405‑12.
7. Knowler WC, Barrett‑Connor E, Fowler SE, Hamman RF,
Lachin JM, Walker EA, et al. Reduction in the incidence of
type 2 diabetes with lifestyle intervention or metformin.
N Engl J Med 2002;346:393‑403.
8. Rozenfeld Y, Hunt JS, Plauschinat C, Wong KS. Oral
antidiabetic medication adherence and glycemic control in
managed care. Am J Manag Care 2008;14:71‑5.
9. ADA. Standards of Medical Care in Diabetes – 2012: Diagnosis
of Diabetes. Diabetes Care 2012;35:511‑61.
10. Riklon S, Alik W, Hixon A, Palafox NA. The compact
impact in Hawaii: Focus on health care. Hawaii Med J
2010;69 6 Suppl 3:7‑12.
11. Shek D, Yamada S. Health care for Micronesians and
constitutional rights. Hawaii Med J 2011;70 11 Suppl 2:4‑8.
12. Fitzpatrick‑Nietschmann J. Pacific Islanders – Migration and
health. West J Med 1983;139:848‑53.
13. Choi JY. Seeking health care: Marshallese migrants in Hawai’i.
Ethn Health 2008;13:73‑92.
14. Zimmet P, Arblaster M, Thoma K. The effect of westernization
on native populations. Studies on a Micronesian community
with a high diabetes prevalence. Aust N Z J Med
1978;8:141‑6.
15. Reddy R, Shehata C, Smith G, Maskarinec GG. Characteristics
of Marshallese with type 2 diabetes on Oahu: Apilot study to
implement a community‑based diabetic health improvement
project. Calif J Health Promot 2005;3:36‑47.
16. Eason RJ, Pada J, Wallace R, Henry A, Thornton R. Changing
patterns of hypertension, diabetes, obesity and diet among
Melanesians and Micronesians in the Solomon Islands. Med
J Aust 1987;146:465‑9.
17. Balkau B, King H, Zimmet P, Raper LR. Factors associated with
the development of diabetes in the Micronesian population
of Nauru. Am J Epidemiol 1985;122:594‑605.
18. Ringrose H, Zimmet P. Nutrient intakes in an urbanized
Micronesian population with a high diabetes prevalence. Am
J Clin Nutr 1979;32:1334‑41.
19. Cortes LM, Gittelsohn J, Alfred J, Palafox NA. Formative
research to inform intervention development for diabetes
prevention in the Republic of the Marshall Islands. Health
Educ Behav 2001;28:696‑715.
20. ChongMT. Clinical outcomes of a diabetes education program:
A six‑month evaluation on a Marshallese patient in Hawaii.
Int J Pharm Teach Pract 2013;4:731‑4.
21. Chong MT, Shimabuku SS, Lai Hipp C, Kim CL. Marshallese
Mobile Screening Clinic Project (MMSCP). Int J Pharm Teach
Pract 2015;6:2609‑14.
22. Chong MT, Yamaki J, Harwood M, d’Assalenaux R,
Rosenberg E, Aruoma O, et al. Assessing health conditions
and medication use among the homeless community in Long
Beach, California. J Res Pharm Pract 2014;3:56‑61.
23. Thom DH, Willard‑Grace R, Hessler D, DeVore D, Prado C,
Bodenheimer T, et al. The impact of health coaching on
medication adherence in patients with poorly controlled
diabetes, hypertension, and/or hyperlipidemia: A randomized
controlled trial. J Am Board Fam Med 2015;28:38‑45.
24. Lee JK, Grace KA, TaylorAJ. Effect of a pharmacy care program
on medication adherence and persistence, blood pressure, and
low‑density lipoprotein cholesterol: A randomized controlled
trial. JAMA 2006;296:2563‑71.
25. DominguezK, Penman‑AguilarA, ChangMH, MoonesingheR, Castellanos T, Rodriguez‑Lainz A, et al. Vital signs: Leading
causes of death, prevalence of disease and risk factors,
and use of health services among hispanics in the United
States – 2009‑2013. MMWR Morb Mortal Wkly Rep 2015;64:1‑10.
26. Desborough JA, Sach T, Bhattacharya D, Holland RC,
Wright DJ. A cost‑consequences analysis of an adherence
focused pharmacist‑led medication review service. Int J Pharm
Pract 2012;20:41‑9.
27. The American College of Preventive Medicine. Medication
Adherence: Improving Health Outcomes Time Tool: AResource
from the American College of Preventive Medicine. Available
from: http://www.acpm.org/?MedAdhereTTProviders. [Last
accessed on 2016 Feb 20].
28. World Health Organization. Adherence to Long‑Term
Therapies: Evidence for Action; 2003. Available from: http://
www.who.int/chp/knowledge/publication/adherence_full_
report.pdf. [Last accessed on 2016 Feb 20].
29. Briesacher BA, Andrade SE, Fouayzi H, Chan KA. Comparison
of drug adherence rates among patients with seven different
medical conditions. Pharmacotherapy 2008;28:437‑43.
30. Brown MT, Bussell JK. Medication adherence: WHO cares?
Mayo Clin Proc 2011;86:304‑14.
31. Egede LE, Gebregziabher M, Dismuke CE, Lynch CP,
Axon RN, Zhao Y, et al. Medication nonadherence in diabetes:
Longitudinal effects on costs and potential cost savings from
improvement. Diabetes Care 2012;35:2533‑9