Together on Diabetes: A Closer Look
At first glance, Tommy James*, 17, looks like a picture of good health. Although both his mother and maternal grandmother have diabetes, James – an avid basketball player– never suspected he would follow in their footsteps. But when pick-up games left him exhausted and skipping meals left him feeling shaky, James’ grandmother urged him to see a doctor. The diagnosis: James, a member of the White Mountain Apache tribe, has type 2 diabetes. He and his family will work with a family health coach and draw on Apache culture and traditions of health to manage his disease.
Across the country, Linda Hardemon-Fulks approaches a fellow shopper and community member in the snack aisle of a local supermarket in the Roxbury section of Boston, Massachusetts. Her purpose: to nudge the shopper to the produce aisle.
These are two tactics used by community-based organizations across the U.S. in the fight against diabetes – part of the Bristol-Myers Squibb Foundation’s Together on Diabetes program. The five-year, $100 million initiative, launched on World Diabetes Day 2010, aims to improve health outcomes of people living with type 2 diabetes by strengthening patient self-management education, community-based supportive services and broad-based community mobilization. In line with the Bristol-Myers Squibb Foundation’s mission to reduce health disparities, Together on Diabetes targets populations disproportionately affected by type 2 diabetes.
“The incidence of diabetes is reaching epidemic proportions in this country and demands a more scaled and broadbased response,” says Patricia Doykos, Ph.D., director, Bristol-Myers Squibb Foundation. ”Together on Diabetes is helping to bring together academic, government, business and community partners interested in joining forces to try to bend the curve on the impact of diabetes in their communities.”
Since its inception, Together on Diabetes has awarded $32.5 million in grants to a range of community groups -- from the hollers of Appalachia to vast stretches of Shipock, New Mexico -- to support diabetes prevention, care and support programs. A $2.25 million Together on Diabetes grant for the Center for American Indian Health (JHCAIH) at Johns Hopkins Bloomberg School of Public Health was among the new grants announced on November 14, World Diabetes Day 2011.
Together on Diabetes® will partner with the Johns Hopkins Center for American Indian Health to pioneer intergenerational, family- and community-focused interventions for type 2 diabetes in four tribal communities in the Southwestern United States.
JHCAIH will use the grant to support family health coaches who will develop care plans to help Native Americans guide themselves and their family members through effective diabetes treatment programs and make necessary changes in dietary and exercise routines. The family health coaches will serve at least 250 Navajo and White Mountain Apache families living in four communities.
“This is our first foray into directly working on diabetes care and prevention within Native American communities,” said Mathuram Santosham, M.D., MPH, director of JHCAIH. “We see this grant as laying the groundwork for a much larger diabetes program in our Center that could eventually serve as a model for other populations around the globe.”
That’s in keeping with the Foundation’s goal of developing community-based models that can be replicated where needs are greatest.
JCAIH has gained trust and established itself as a reliable community partner through its work on other health initiatives for the past 30 years so the team will be able to hit the ground running.
The Foundation grant will be used over two years to build a diabetes education, care and support program within the communities JHCAIH serves across Arizona and New Mexico where as many as 33.5 percent of Native Americans have been diagnosed with the disease. While American Indians and Alaska Natives suffer the highest rates of diabetes in the nation, Native American youth have the fastest increasing prevalence of type 2 diabetes of any group in the U. S.
Mathuram and his team are eager to get started. The family health home visitor is a proven model that JHCAIH has used successfully to increase awareness and treatment for infectious diseases and behavioral health promotion among Native Americans.
JHCAIH has found that family-based outreach works because family life is so important to Native Americans, says Allison Barlow, the Center’s associate director.
“We know we need to develop a more comprehensive approach to ensuring there’s a safety net for those diagnosed with diabetes within these communities,” she says. “Families are the center of strength among Native American peoples and this is about providing circles of care for individuals at risk.”
While Native American young people are increasingly at risk for obesity, a lack of resources means that sustained wellness programs are rare within schools and communities. There are also few extracurricular sports programs available to help keep kids in shape.
”And the current treatment protocols are for adults, not children,” Barlow adds. “This means parents and primary care providers need to be engaged to reverse the trend in children and young adults.”
Family health coaches will connect patients and their families with needed services. The coaches may provide transportation to physician visits, which can sometimes be an hour away for some families; or work with parents to buy more fresh fruit and vegetables -- a challenge because processed foods from convenience stores are prevalent throughout the community. Coaches may also organize basketball leagues to ensure teens exercise with other teens.
An added bonus of working with young people, Barlow says, is that they often live not only with their parents, but grandparents too. As the teen learns about living with diabetes and managing the disease, the family health coaches can also teach the older generations to adopt healthier lifestyles and get regular diabetes screenings, and help younger siblings avoid risks for diabetes.
When Tommy James learned that he had type 2 diabetes, he says the news was hard to take. “At first I didn’t really take it seriously,” says James, who admits his eating habits would often consist of fast food for lunch and dinner. “But now I realize you have to make changes if you want to be healthy.”
The Whittier Street Health Center’s outreach in Boston, Massachusetts, includes home visits to encourage patients with type 2 diabetes to continue follow-up care and provide other information – such as healthy eating tips.
Meanwhile, in Boston, Linda Hardemon-Fulks, is spreading the word about the power of healthy eating. She is one of three Whittier Street Health Center ambassadors currently pounding the pavement, speaking up in stores and visiting people in their housing developments and homes to deliver key messages about diabetes and the importance of managing the disease.
A year ago, Hardemon-Fulks, 47, a wife and mother of two adult daughters, learned that she was borderline diabetic after an hemoglobin A1c test she took at Whittier Street Health Center revealed that her blood sugar level was high. Although her mother has diabetes, Hardemon-Fulks says she was still surprised to learn she was at risk and needed to make some changes.
Hardemon-Fulks experienced a little depression after first being told to change her diet and to start exercising, but she quickly sprang into action. She joined a gym and started exercising on a regular basis. In the kitchen, she replaced her favorite fried chicken recipe with a healthier baked chicken option. She managed to kick her self-described “cola habit.” Not only did a follow-up A1c test show an improved blood sugar level, but Linda also had lost 13 pounds, one of the key ways to reduce the risk or delay the onset of diabetes according to the U.S. Centers for Disease Control and Prevention (CDC).
But what she feels best about is the ability to help others. “I feel very rewarded when I help someone else,” Hardemon-Fulks says. ”If I can do it, I know other women can do it.”
The Whittier Street Health Center received a $300,000 grant in June –part of $1.5 million in grants to four organizations to help empower African American women with type 2 diabetes. The CDC estimates that one in 10 African American women age 20 and older has diabetes, a rate that more than doubles to one in four for African American women over 55. African Americans also suffer high rates of diabetes’ most serious complications such as blindness, kidney failure and amputation.
Like JHCAIH, the Whittier Street Health Center is also a mainstay in the area it serves. Roxbury is a predominantly low-income, racially and ethnically diverse neighborhood with several public housing developments. Research shows that the incidence of people with diabetes living in public housing in Roxbury runs at a rate of 19 percent compared with 6 percent for the city of Boston.
The Whittier Street Health Center is using a patient-to-patient model in its fight against diabetes, using the Foundation’s grant to recruit health ambassadors -- African American women with diabetes who are now able to control their disease -- to reach out to other women in the community who have been diagnosed at the Center. Outreach efforts will include home visits to encourage patients to continue follow-up care and provide other information – such as healthy eating tips.
The grant will be used over two years to recruit 150 African American women who live in Boston public housing who have been diagnosed with diabetes, newly diagnosed with diabetes and also patients at Whittier Street Health Center who were lost to follow-up care for more than six months. The grant will also be used to reach 500 African American Women in the community through diabetes prevention initiatives that include diabetes screenings, workshops and tailored exercise in partnership with the YWCA.
“Our ambassadors can talk to women about the barriers they had when they were first diagnosed with diabetes and how they were able to overcome it,” says Adeola Ogungbadero, director of clinical operations at the Whittier Street Health Center. “These women will be a huge resource to the community because they are ready to tell their story to women who will be able to relate to them.
“Without the grant we wouldn’t be able to conduct this program,” Ogungbadero adds. “We have established strong community relations, but this grant allows us to focus specifically on patients with diabetes.”
* Patient’s real name not used.