RESEARCH – Division of Diabetes Translation/CDC – New Directions in Incidence and Prevalence of Diagnosed Diabetes in the U.S.A. – A study to determine whether diabetes prevalence and incidence has remained flat or changed direction during the past 5 years. After an almost 20-year increase in the national prevalence and incidence of diagnosed diabetes, an 8-year period of stable prevalence and a decrease in incidence has occurred. Causes of the plateauing and decrease are unclear but the overall burden of diabetes remains high and deserves continued monitoring and intervention.
RESEARCH – Migrant Clinicians Network – Motivational Interviewing: A Primer for Improving Outcomes for Patients With Diabetes – Motivational interviewing emphasizes empathetic listening, reflecting, querying, and affirming in order to reveal the discrepancy between a patient’s current behaviors that aggravate a health concern, and the patient’s personal values and goals. Rocio’s physician recognized that, for some patients, a run-down of diet and lifestyle changes, along with medication, may be enough to inspire change. As a mobile agricultural worker patient, however, Rocio may be unable to attend diabetes education classes or easily refill prescriptions as she moves; there may also be fewer food choices and food access; additionally, Rocio’s mobile lifestyle, rural location, and occupation may inhibit the recommended physical activity.
California Department of Public Health (CDPH)
RESOURCES: HSAG DEEP Diabetes Empowerment Education Program (DEEP) Curriculum: Train the Trainer Training DSME http://www.chronicdisease.org/?page=DiabetesDSMEresource
Stanford Diabetes Self Management Program
- Tools and Resources – Spanish
- Tools and Resources – English
- Diabetes Fact Sheet – Spanish
- Diabetes Fact Sheet – English
- Community Based Diabetes Programs – Spanish
- Community Based Diabetes Programs – English
- Action on DSME – Spanish
- Action on DSME – English
National Diabetes Prevention Program
California Technology Assessment Forum (CTAF)
- Institute for Clinical and Economic Review – DPP – Executive Summary
Lifetime of Wellness : Communities in Action
State and Local Public Health Actions to Prevent Obesity, Diabetes, Heart Disease, and Stroke (1422) Lifetime of Wellness: Communities in Action; Contact: Lisa E. Rawson Lisa.email@example.com
Mission: Support a statewide implementation of cross-cutting approaches to promote health and prevent and control chronic diseases and their risk factors, as well as to maintain coordination and collaboration across programs
Improving Diabetes Care and Outcomes with CHWs
Fam Pract. 2016 Oct;33(5):523-8. [Pubmed Abstract]
Improving diabetes care and outcomes with community health workers
Kane EP, Collinsworth AW, Schmidt KL, Brown RM, Snead CA, Barnes SA, Fleming NS, Walton JW
Type II diabetes continues to be a major health problem in USA, particularly in minority populations. The Diabetes Equity Project (DEP), a clinic-based diabetes self-management and education program led by community health workers (CHWs), was designed to reduce observed disparities in diabetes care and outcomes in medically underserved, predominantly Hispanic communities.
The purpose of this study was to evaluate the impact of the DEP on patients’ clinical outcomes, diabetes knowledge, self-management skills, and quality of life.
The DEP was implemented in five community clinics from 2009 to 2013 and 885 patients completed at least two visits with the CHW. Student’s paired t-tests were used to compare baseline clinical indicators with indicators obtained from patients’ last recorded visit with the CHW and to assess differences in diabetes knowledge, perceived competence in managing diabetes, and quality of life. A mixed-effects model for repeated measures was used to examine the effect of DEP visits on blood glucose (HbA1c), controlling for patient demographics, clinic and enrollment date.
DEP patients experienced significant (P < 0.0001) improvements in HbA1c control, blood pressure, diabetes knowledge, perceived competence in managing diabetes, and quality of life. Mean HbA1c for all DEP patients decreased from 8.3% to 7.4%.
Given the increasing prevalence of diabetes in USA and documented disparities in diabetes care and outcomes for minorities, particularly Hispanic patients, new models of care such as the DEP are needed to expand access to and improve the delivery of diabetes care and help patients achieve improved outcomes.
Lessons learnt in developing a peer support program to improve diabetes management in Anhui, China China Network of Peers for Progress & Anhui CDC, China Xuefeng Zhong
(c/f )Peers for Progress Newsletter Sept 24 2014
Integrating CHWs into a Patient-Centered Medical Home to Support Diabetes Self-Management among Vietnamese Americans: Lessons Learned
A community-based nonprofit, a patient-centered medical home (PCMH), and academic partners collaborated to develop and implement a program (PREP) to educate and support Vietnamese American patients with uncontrolled diabetes and/or hypertension. This article describes the successes and challenges associated with PREP delivery including patient recruitment, structuring/documenting visits, and establishing effective care team integration, work flow, and communication. Strategies for mitigating these issues are presented, as well as recommendations for other PCMHs seeking to integrate CHWs into care teams. [Abstract]
Cost-Effectiveness of CHWs in Controlling Diabetes Epidemic on the U.S.-Mexico Border
This study attempted to evaluate clinical outcomes and long-term cost-effectiveness of an intervention involving CHWs in assisting Mexican-American diabetes type-2 patients with controlling their condition. Incremental lifetime health outcomes and related expenditures were calculated using the CDC Diabetes Cost-Effectiveness Model (DCEM). The intervention group showed a significant improvement in glycemic control and cholesterol management after two years of intervention. The intervention is expected to reduce long-term complications, resulting in an increase in residual life-years and quality-adjusted life-years. The incremental cost-effectiveness ratio has been estimated to be $13,810, which is below the level of comparable studies. [Abstract]
Impact of a CHW-Led Structured Program on Blood Glucose Control Among Latinos with Type 2 Diabetes: The DIALBEST Trial
A total of 211 adult Latinos with poorly controlled type 2 diabetes were randomly assigned to a standard of healthcare (n = 106) or CHW (n = 105) group. The CHW intervention comprised 17 individual sessions delivered at home by CHWs over a 12-month period. CHWs had an overall significant effect on fasting glucose concentration that was more pronounced at the 12- and 18-month visits. There was no significant effect on blood lipid levels, hypertension, and weight. [Abstract]
‘Trust and Teamwork matter’: CHWs’ Experiences in Integrated Service Delivery in India
A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched in 2005 to revamp India’s rural public health system. This article discusses CHWs’ experiences in integrated service delivery through village-level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. The comprehensive NRHM primary health care ideology which the health workers espouse is in constant tension with the exigencies of narrow indicators of health system performance.
This ethnography shows how monitoring mechanisms, the institutionalized privileging of statistical evidence over field-based knowledge and the highly hierarchical health bureaucratic structure that rests on top-down communications mitigate efforts towards sustainable health system integration. [Abstract]
“Together on Diabetes” seeks to draw on the strengths of communities and support traditional and non-traditional public and private-sector partners coming together, collaboratively developing and expanding effective patient self-management programs, and broadly engaging and mobilizing affected communities in the fight against type 2 diabetes.
(c/f Peers for progress)
Peers for Progress and the National Council of La Raza convened a special meeting in San Francisco, California to honor the research of Peers for Progress investigators and invigorate the dialogue on the development of peer support programs around the world. With support from the Eli Lilly and Company Foundation and the Bristol Myers Squibb Foundation’s Together on Diabetes initiative, Peers for Progress has focused much of its work on
diabetes, in light of the global burden of diabetes and because it serves as an excellent model for the prevention and management of most chronic diseases…
…First, we agreed that “all peer support is local”, reflecting our fundamental need for real, human contact. One of peer support’s strengths is its ability to humanize healthcare and narrow the gap between patients and providers….
…With respect to chronic disease self-management, participants reminded us to think about
learning as a continuous process that doesn’t end at the conclusion of an instructional course…
…Security…We can think of peer support as a philosophy of care that allows people (with chronic disease) to live in a more secure environment…
…the indirect benefits of peer support, such as building social capital and improvements in family health…
…the potential of mobile health technology and social media to provide new channels of
exchanging peer support…
To read more go to: http://peersforprogress.org/wp-content/uploads/2014/06/20140624_june_meeting_spotlight.pdf
Peers for progress publications:http://peersforprogress.org/wp-content/uploads/2014/06/20140623_pfp_publications.pdf
Thomas S. Bodenheimer, MD, MPH and David H. Thom, MD, PhD
Center for Excellence in Primary Care Department of Family and Community Medicine
University of California San Francisco, CA
Matthew L. Goldman, MS
Amireh Ghorob, MPH
Stephen L. Eyre, PhD
Thomas Bodenheimer, MD, MPH
From the University of California Berkeley–University of California San
Francisco Joint Medical Program, Berkeley, California (Mr Goldman,
Dr Eyre); and the Center for Excellence in Primary Care, Department of
Family and Community Medicine, University of California, San Francisco,
California (Ms Ghorob, Dr Bodenheimer).
Correspondence to Matthew L. Goldman, ATTN: Amireh Ghorob,
University of California, San Francisco, San Francisco General Hospital,
Building 80, Ward 83, 995 Potrero Avenue, San Francisco, CA
94110-3518, USA (Matthew.Goldman@ucsf.edu).
Contact: Belinda Nelson PhD
The Alliance to Reduce Disparities in Diabetes, a national program launched and supported by the Merck Foundation, works to improve health care delivery among those populations most at risk for diabetes
The Alliance’s Dallas site established the “Diabetes Health Promoter,” a state-certified CHW who completes 160-hours of training and participates in continuing education.
This resource is a synopsis of the article “Community Health Workers: Part of the Solution” published in July 2010 issue of Health Affairs. In this article, the authors highlight approaches states have taken to expand CHWs’ roles and strengthen their financial support so that their positions are sustainable over time. The authors present two case examples, Massachusetts and Minnesota, both of which initiated comprehensive changes in policies and systems to support CHWs. Notably, Minnesota has legislation that makes CHW services reimbursable under Medicaid, and the state regulates CHW training, supervision, enrollment criteria,
and billing policy. In Massachusetts, broad-based policies combined with consistent and powerful advocacy from the leaders of the CHW workforce, together with state public health partners, have secured the ongoing integration of CHWs in state health reform efforts.
This CDC staff-authored paper evaluated the effectiveness of Community Health Workers in the care of diabetics and concluded that interventions involving Community Health Workers showed some improvements in participant knowledge, behavior and physiological measures and decreased hospital admissions, particularly in minority populations.
The Road to Health Toolkit resources were developed for community health workers and educators working with African American or Hispanic/Latino populations at risk for type 2 diabetes. Resources include the toolkit and all its components, a training guide and video, and an evaluation guide. Training and technical assistance resources are also available.
Kit El camino hacia la buena salud resources were developed for community health workers and educators working with African American or Hispanic/Latino populations at risk for type 2 diabetes. Resources include the toolkit and all its components, a training guide and video, and an evaluation guide. Training and technical assistance resources are also available.
NDEP collection of toolkits in diabetes prevention and control.
Community Health Representatives serve as bridges between the health care system and their communities, described by one CHR as “the in-between people.” This 21-minute podcast, developed by the Native Diabetes Wellness Program, documents the critical role of community health workers.
Respected members of American Indian and Alaska Native communities are a critical resource in helping communities mobilize efforts in diabetes prevention and care. Possessing cultural and historical knowledge and training in health promotion and social support, community health representatives (CHRs) are uniquely equipped to broker the needed relationship between a world shaped by culture and history and the world of conventional scientific knowledge. CHRs are bridges distinctively positioned to connect these two worlds.
CDC’s Division of Diabetes Translation’s position statement supporting Community Health Workers.
This Diabetes fotonovela describes simple ways to prevent or delay type 2 diabetes, especially if you have a family history of the condition.
Over the ages and across the cultures and continents, stories have served to reach, teach, and speak for people in times of hardship and illness. CDC’s Division of Diabetes Translation developed a guide: Stories to Reach, Teach, and Heal: A Guide for Diabetes Health Educators. The stories illustrate how health educators can use storytelling to share wisdom and inspiration.
The Health Is Life in Balance Diabetes Education in Tribal Schools (DETS) K–12 curriculum offers culturally relevant and scientifically based teachings for Grades K-4, 5-8, 9-12. The National Institutes of Health developed the curriculum in collaboration with eight tribal colleges and universities, the CDC Native Diabetes Wellness Program, and the Indian Health Service’s Division of Diabetes Treatment and Prevention.
Diabetes educational resources to support the work of Community Health Workers and other educators. Resources include audio and video recordings, curricula, and publications.
The four book Eagle Book series was written by Georgia Perez, a veteran Community Health Representative for the Nambe Pueblo. The books convey to Native children healthy ways of living that are rooted in traditional Native values. Additional resources which coordinate with the books are also available on this page.
Through The Eyes of The Eagle introduces Rain That Dances, a young boy who discovers an unhappy eagle. Mr. Eagle is tearful because many of the people in the community are developing type 2 diabetes. The wise eagle reminds the boy of his ancestors’ healthy ways
In Knees Lifted High, the second book, Rain That Dances introduces his best friend, Thunder Cloud, to Mr. Eagle, who encourages the boys to be physically active every day. Mr. Eagle shows how fun physical activity can be.
Plate Full of Color, the third book, introduces Miss Rabbit and the boys’ friends, Little Hummingbird and Simon. Miss Rabbit teaches the children the value of eating a variety of colorful and healthy foods.
Tricky Treats, the fourth children’s book, introduces Coyote, a trickster who attempts to trick the children into eating unhealthy foods. The children ultimately learn the importance of avoiding tricky treats when choosing foods to eat.
Books and materials on this page follow up to the original Eagle Book stories, a series of books for Native American children and youth and others interested in healthy living. The youth materials continue to promote type 2 diabetes prevention and encourage a respect for traditional ways, including physical activity and healthy eating.
Coyote and Turtle’s Dream is a follow up to the original Eagle Book stories, a series of books for Native American children and youth and others interested in healthy living. The books promote type 2 diabetes prevention and encourage a respect for traditional ways, including physical activity and healthy eating. Coyote and Turtle’s Dream includes a character who is a Community Health Navigator
Hummingbird’s Squash is a follow up to the original Eagle Book stories, a series of books for Native American children and youth and others interested in healthy living. The books promote type 2 diabetes prevention and encourage a respect for traditional ways, including physical activity and healthy eating. Hummingbird’s Squash includes a character who is a Community Health Navigator.
The Trickster of Two Rabbit Mountain is a follow up to the original Eagle Book stories, a series of books for Native American children and youth and others interested in healthy living. The books promote type 2 diabetes prevention and encourage a respect for traditional ways, including physical activity and healthy eating. The Trickster of Two Rabbit Mountain includes a character who is a Community Health Navigator.
The Youth Novels: Educators and Community Guide has been designed to assist teachers and communities by providing an array of activities that support the goals of the Eagle Books project and promote the health and educational messages in the youth novels. Most of the activities in the Guide for Coyote and the Turtle’s Dream can be applied to the graphic novel. The Eagle Books Youth Novels Educator Guide also contains additional lessons for the Health is Life in Balance, a Diabetes Education in Tribal Schools (DETS) curriculum for grades 5-8.
This page includes diabetes prevention and management resources designed specifically for people of Hispanic and Latino ancestry. These resources can be used by community health workers, and includes a music video called “Movimiento Por Su Vida Music Video” (Movement for Your Life).
This page includes diabetes prevention and management resources designed specifically for African Americans and people of African ancestry. These resources can be used by community health workers, and include a music CD called “Step by Step,” with three original songs helps people move more, and a music video.
The Community Preventive Services Task Force recommends diabetes self-management education (DSME) interventions implemented in community gathering places with adults who have Type 2 diabetes. Interventions are delivered by health professionals or community volunteers. This finding is based on a systematic review of evidence.
The Community Preventive Services Task Force recommends diabetes self-management education (DSME) interventions implemented in homes of children and adolescents who have Type 1 diabetes. Interventions are delivered by health providers, including community health nurses. This finding is based on a systematic review of evidence.
American Indian and Alaska Native communities across the country are reclaiming traditional foods as part of the global Indigenous food sovereignty movement that embraces identity, history, and traditional ways and practices to address health. This page lists resources that Community Health Representatives can use to educate their communities about traditional foods.
Community-Based Lifestyle Intervention Yields Weight Loss, Reduced Glucose Results Similar to Those in DPP
June 29, 2010
“In the Diabetes Prevention Program, professional behavioral specialists worked with participants with pre-diabetes in one-on-one sessions. We trained some of our patients with diabetes to work as lay community health workers with groups of participants with pre-diabetes, so we really didn’t expect to see quite as good a weight loss result as we did, but we were very pleased to see it,” said David Goff, MD, Chair of the Department of Epidemiology and Prevention at Wake Forest University School of Medicine, and lead researcher on the study. “Given that our weight loss results look as good as the DPP, this approach shows great promise for preventing diabetes. It’s a very translatable intervention to deliver in public health settings. We think this approach could be replicated at Diabetes Care Centers across the country.”
TALANCE: Diabetes and Prediabetes (D01-16B)
Empower your staff to help clients avoid or control diabetes. This comprehensive course is a must for non-clinical health staff. Diabetes and Prediabetes is the essential training that ensures your team’s success when addressing this chronic disease. With a handle on basics, participants can help patients and clients make positive diet and lifestyle changes that can help reduce risk.
- Community health worker
- Health educators
- Patient navigators
- Case managers
Instructor-Led, Private Virtual Classroom