Long-Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa

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This timeline of the Diabetes Care in American Samoa (DCAS) study shows the three 1-year periods. In the DCAS period, participants in the experiment arm received the intervention while participants in the control arm received usual care. In the second period, the control participants received the intervention. In the third period, control participants were in their first year after the intervention and participants in the experiment arm were in their second year after the intervention. We evaluated change in HbA1c over time for all participants.

Figure 1. Timeline of study analysis. Change in HbA1c over time was evaluated by trial arm during 3 consecutive 1-year periods: 1) DCAS period; 2) first year after DCAS completion; and 3) second year after DCAS completion. Abbreviation: DCAS, Diabetes Care in American Samoa

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A total of 406 people were recruited and assessed for eligibility in the study. Of these, 94 were deemed ineligible. Of the 312 eligible recruits, 44 declined to participate, leaving a sample of 268 to be randomly assigned to the experiment arm or the control arm. There were 104 participants in the experiment arm; of these, 4 were lost to follow-up and 5 discontinued treatment. Of those in the control arm, 164 received usual care and 148 completed the 12-month follow-up; 7 were lost to follow-up, and 9 discontinued usual care.

Figure 2. Consolidated Standards of Reporting Trial (CONSORT) diagram of recruitment. In this intent-to-treat analysis, participants who did not complete 12-month follow-up were included in analysis until date of ineligibility. Abbreviations: CHW, community health worker; DCAS, Diabetes Care in American Samoa.

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