The increasing prevalence of diabetes and obesity, growing health disparities, and shortage of bilingual and culturally trained health care professionals underscore the role of trained community health workers (CHWs) to provide economically sustainable and culturally relevant services. This prospective randomized design evaluated the relative effectiveness of a CHW intervention among Hispanic persons with newly diagnosed type 2 diabetes, as compared with usual clinic practice in three inner-city health centers. In sum, 189 Hispanic patients newly diagnosed with type 2 diabetes were randomly assigned to one of three 6-month diabetes management approaches--CHW, case management, and standard provider care--and assessed for diabetes-related health measures and clinical indicators at baseline and postintervention. Participants in the CHW group achieved greater improvements than did the controls in program measures: health status, emergency department utilization, dietary habits, physical activity, and medication adherence. They also had 2.9 times greater odds of decreasing body mass index. (Contains 3 tables and 1 figure.)