Success seen with tailored diabetes education

A review shows that the use of community-based health advocates and the adaptation of dietary and lifestyle advice were effective tools.

By Susan J. Landers — Posted Aug. 4, 2008

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Diabetes education that is tailored to a specific population goes a long way toward improving blood sugar control among those with type 2 diabetes, according to a review published July 15 by The Cochrane Library.

Such targeted education has long been encouraged by the American Medical Association and many other medical groups. Still, knowing that the bottom-line result -- better control over A1c levels is being achieved -- is welcome news.

The research team from Cardiff University in the United Kingdom was assembled by the Cochrane Collaboration, an international, nonprofit organization that reviews health interventions, to examine 11 randomized controlled trials involving 1,603 people.

Researchers found that the use of community-based health advocates, the delivery of information within same-gender groups, or the adaptation of dietary and lifestyle advice to fit a particular community's needs were effective tools in the effort to gain control of the disease.

Diabetes is a problem throughout the world and, with rising obesity rates, is expected to become even more pervasive. Nearly 8% of the U.S. population already has type 2 diabetes, and the rate is increasing especially sharply for members of minority populations, according to the Centers for Disease Control and Prevention and others.

Type 2 diabetes is a particular problem for members of minority ethnic groups who move from poorer nations to high-income countries where they confront many physical, communication and cultural barriers that make it difficult to access health care effectively, said the researchers.

Hispanics, blacks, and Asian and Pacific Islanders all experience higher rates of diabetes than do whites. Among those younger than 20, American Indians have the highest rate of type 2 diabetes among all groups, according to the CDC.

Making programs appropriate

"With such a large proportion of the U.S. population composed of minority groups, which are only going to increase over time, and with diabetes being more prevalent among those groups, it makes sense to step back and see if culturally appropriate programs work," said Leonard Jack Jr., PhD, professor in the behavioral and community health sciences program at Louisiana State University Health Sciences Center in New Orleans. "I was happy to see that they do work."

Jack coordinated the development of the American Assn. of Diabetes Educators' 2007 position statement on Cultural Sensitivity and Diabetes Education. Among the recommendations: "Practice active listening, which may permit identification of what is meaningful to people."

In findings from their review, the Cochrane researchers noted improvements in blood-sugar control within three months of the start of education programs that were deemed culturally appropriate. The benefit still was seen when the six-month trial period ended. But one year later, the benefits had not been retained, indicating the need for a refresher course.

"That is predictable," said John B. Buse, MD, PhD, president for medicine and science at the American Diabetes Assn. "It's remarkable how often people fall off the wagon, despite how well they understand. People need coaching to sustain something like diabetes management, to sustain physical activity and watch their diet."

The findings aren't shockingly new but bear repeating, said Dr. Buse, who also is professor of medicine at the University of North Carolina School of Medicine in Chapel Hill. "If you talk to people about foods that are not a part of what they normally eat, they are not likely to follow suggestions," he said. "If you suggest joining a health club and they can't afford a health club, that's not going to be very effective."

The Cochrane researchers also cautioned that all minority communities are not the same, and that programs should be developed in partnership with a community.

They defined culturally appropriate health education as any type of diabetes education that has been specifically tailored to the cultural needs of a target minority group.

Although education in general is key to the successful management of diabetes, it's not enough, said Michele Heisler, MD, MPH, associate professor of internal medicine at the University of Michigan in Ann Arbor. "You need to be motivated to do something, you have to have the confidence that you can do something, and the social support as well," she said.

"Culturally appropriate education is much more likely to tap into and resonate with people's lifestyles and values," she added.

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Culturally tailored talk

The American Assn. of Diabetes Educators published a position paper last year offering a set of recommendations for providing culturally sensitive diabetes counseling. Among them:

  • Develop a basic understanding of key terminology, such as "cultural sensitivity," "cultural competence," and "multicultural," "racial" and "ethnic identity."
  • Practice active listening, which may permit identification of what is meaningful to people.
  • Become familiar with cultural variations in diabetes patients' families, health beliefs, socioeconomic status, and residential settings. Also, work to expose patterns of community practice as well as medical practice that enhance or undermine good diabetes management.
  • Respect and understand how patients, as members of an ethnic group, view themselves, regardless of how the group is classified or viewed by others.

Source: "AADE Position Statement: Cultural Sensitivity and Diabetes Education: Recommendations for Diabetes Educators," The Diabetes Educator, January/February 2007

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Study shows gap in diabetes eye knowledge

A recent study found that there were gaps in knowledge about ocular complications from diabetes among a Hispanic population in Baltimore that made its members more susceptible to serious eye diseases.

The researchers interviewed 204 Hispanics with diabetes and found that fewer than 30% had an eye exam in the previous year. In addition, 13% of those newly diagnosed with diabetes and 34% of those diagnosed more than a year earlier knew that strict control of diabetes could prevent eye problems.

The American Diabetes Assn. recommends annual eye exams for people with type 2 diabetes. The Baltimore group was not broken down by diabetes type.

The findings demonstrate a need for culturally appropriate health education for this group of patients, concluded researchers from the Wilmer Eye Institute at Johns Hopkins Hospital in Baltimore.

Their study is in the July Archives of Ophthalmology.

Diabetes is a growing problem among the nation's Hispanic population. One in five Hispanics older than 40 currently has diabetes, and almost half of them also have diabetic retinopathy, a related eye disease, the researchers said.

"The lack of correct information about diabetes and diabetic eye disease in this population of Hispanic individuals should be of great concern," they said. "The frequency of dilated eye examinations among people with diabetes was unacceptable and places this population at risk of visual loss."

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