Disturbing Diabetes Trends

By Barbara Hesselgrave, Miller-McCune.com. Posted November 27, 2008.

Earlier this month, San Antonio Network participant Carol Zernial, director of Texas' Bexar Area Agency on Aging (local Area Agencies on Aging were the initial points of contact to introduce the Learning Network program), presented her challenges and successes from the program at AHRQ's annual meeting.

"As of October 2007, the National Association of County and City Health Officials reported San Antonio as having the second-highest diabetes-related death rate -- following New Orleans -- in the nation. Here in our community, we estimate the rate of diabetes in older Hispanics may be as high as 59 percent."

Zernial said that their biggest success was through the composition of their outreach and awareness team -- "we've never worked with physicians before" -- and emphasized the importance of "clinical wrap-around services."

"Patients spend, maybe if they're lucky, 10-15 minutes with their physician and the rest of their life in the community, so we have to reinforce the messages and information they hear in the doctor's office everywhere else."

After presenting the compelling federal data on health disparities, Zernial was able to enlist the support of local physicians, churches, community centers and other government social service agencies. (In August, Ryan Blitstein looked at another care initiative, Poder es Salud, that capitalized on social ties.)

Zernial stressed the value of engaging the entire public and private community, something she agrees would not have been possible without the federally provided data.

Meanwhile, through the Learning Network process, Zernial uncovered a variety of reasons why Hispanics were not receiving, or accessing, care for diabetes.

"Some are just resigned, saying it is inevitable as 'everyone in their family has it,'" she said. "This age group also has more difficulty getting transportation to care. Once they get to the office, they are also generally less willing to question the doctor, particularly if there is a cultural or language barrier, to ask for more explanation."

She also described how individuals are likely to have one doctor until they're 65, but once older than 65, they "transition to Medicare and may see a variety of doctors in the system." When the paper trail of care is more difficult to follow, it is harder to ensure proper health needs are being met.

Now, after a little more than a year, Zernial believes this model holds great promise for reducing the health disparity of diabetes in older Hispanics. She hopes to make this program a benchmark to use for other diseases that affect elderly populations in her community.

Moy said while the program lacks "real numbers now" about measureable outcomes, what we can expect is that, first, the processes of care delivery will change, and we will see in the short term a change in attitudes among doctors and also their patients concerning the standards of care for this disease, such as better monitoring of A1C test, more frequent eye/retina screens and more foot exams.

After changes in health-delivery processes, he expects to see more changes with the patient in self-care. For example, people who might have had difficulty keeping the message about eating right and watching sweets will now be reinforced by community-based messages, so they will pay more attention to daily finger sticks, better food choices, exercising.
Ultimately, he believes, we will see fewer diabetes-related deaths, amputations and hospitalizations.

Miller-McCune magazine and Miller-McCune.com draw on academic research and other definitive sources to provide reasoned policy options and solutions for today's pressing issues.

See more stories tagged with: health, health care, diabetes, health disparities, hispanic populations

Barbara Hesselgrave is a freelance writer in Virginia specializing in issues of community medicine, science and international health.

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