Diabetes Education

Helping people avoid complications

By Bob Nosbisch

An unhealthy diet, loaded with sweets, pushed Albino Amador’s glucose level so high in 2003 that his doctor said Amador had diabetes and ordered him to cut candy and carbonated drinks from his diet.

“I almost went blind,” Amador said.

Amador was not the first one in his family to get the disease. Ten years earlier, his wife, Adela, was told by her doctor that the severe headaches and palpitations she experienced were symptoms of diabetes.

Both of them have changed their eating habits.

“We had to start eating different than what we were eating, not eating fatty foods, eat a lot of vegetables, no sugar,” Adela said.

The Amadors, who live in Rincon, N.M., visit the Ben Archer Health Center in Hatch for checkups and to learn more about the disease.

Measuring effectiveness

New Mexico State University nursing professors Wanda Borges and Teresa Keller are using a two-year, $250,000 U.S. Department of Health and Human Services grant to measure the effectiveness of diabetes education programs.

Borges’ research team works with the Ben Archer centers throughout southern New Mexico to evaluate factors that affect the availability and usage of diabetes education resources. Ben Archer, which serves about 100,000 people in Alamogordo, Columbus, Deming, Doña Ana, Hatch and Truth or Consequences, uses community health workers, or promotoras, to deliver diabetes education. Since not all communities have promotoras, the data can be used to compare the delivery of health care education in different communities.

Next, an intervention is developed that considers the factors identified in the first part of the study. Glucose control, body mass index and self-care behaviors are compared in patients who receive the intervention to patients who receive the usual education provided at Ben Archer. Recommendations based on the findings will then be made to Ben Archer and the Centers for Medicare and Medicaid Services.

“We know that if we can get their glucose under control, then the conditions that are caused by their sugar or glucose being out of control because of diabetes will be decreased,” Borges said. “The thing about diabetes and all chronic diseases is that, even though we provide health care and medications, 90 percent of the management of the disease is self-management, so the patients need the education as well as the strategies to improve their self-care behaviors.”

Meanwhile, Keller provides expertise from an organizational or systems viewpoint. By studying different onsite systems in which diabetes education is dispensed, Keller expects to find some variation in teaching methods, depending on the health care provider. She also expects to find systems that effectively promote self-management education. This knowledge can be used to help improve diabetes programs in other health care systems.

A health disparity

Mexican-Americans are 1.7 times as likely to have diabetes as non-Hispanic whites of similar age. A recently completed five-year international study funded by the Centers for Disease Control and Prevention shows that 16 percent of people living on the U.S.-Mexico border have diabetes compared with 6 to 7 percent of New Mexicans living elsewhere in the state. Furthermore, it’s a health disparity issue for Hispanics, who experience a higher rate of complications associated with diabetes, including amputations of lower extremities, kidney failure and blindness.

With proper care, people with diabetes can learn to manage their disease. By keeping blood glucose, blood pressure and cholesterol levels in the target range, and by eating healthy foods, taking diabetes medicine as prescribed, being physically active, and testing blood glucose levels, the complications of diabetes can be reduced or delayed significantly.

Community education and support programs can help people with diabetes and their families manage the disease. It’s working for the Amadors, who say there is still a long way to go.