ABSTRACT

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ABSTRACT
Diabetes is a public health issue of growing
magnitude. It currently ranks among the top ten
leading causes of death in the United States. To
address this problem in Philadelphia, the Health
Promotion Council of Southeastern Pennsylvania,
Inc. (HPC) developed Taking Control Diabetes
Education, a health education intervention
program. This program aims to change health
behaviors among African-American and Latino
diabetics through education. Short-term
modifications have been demonstrated in
glycosylated hemoglobin (HbA1C), blood pressure,
and knowledge following completion of Taking
Control. To assess the long-term impact of this
program on its participants, an outcomes
evaluation was conducted. A total of 150 patients
with Non-Insulin Dependent Diabetes Mellitus
(NIDDM) were randomly selected. Medical charts
were reviewed to abstract data including weight,
blood pressure, cholesterol, glycosylated
hemoglobin (HbA1C), religion, home environment,
and documentation of ophthalmologist and
podiatrist visits. Data collection covered a
period of three years following the completion of
Taking Control program. For subjects who had
cholesterol and HbA1C tests before the program
and during Year 3, mean levels decreased
(plt0.01). There was no statistically significant
change in systolic blood pressure, diastolic
blood pressure, and weight (p 0.25, 0.32, and
0.88 respectively). Due to the lack of
sufficient information on religion and home
environment, a qualitative analysis of these data
was not possible. The percentage of participants
that had an eye exam increased from Year 1 to 2
after follow-up, while those who had a foot exam
decreased. This evaluation demonstrated that
Taking Control is successful at decreasing
cholesterol and HbA1C levels in the long-term.
Recommendations have been made to assist in the
improvement of other health outcomes for
participants. Additional areas of study have
also been suggested to gain a greater
understanding of this chronic public health
problem.
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Background

• Diabetes Mellitus (DM) an endocrine disorder
  that results in increased blood glucose levels
• Risk Factors for Type 2 Diabetes Mellitus

• Obesity
• Thrifty Gene
• Low Socioeconomic Status

• Family History
• History of Gestational a Diabetes

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Statement of the Problem

• Diabetes afflicts 800,000 new people each year in
  the United States (CDC, 2000)
• Disproportionately affects the minority community
• 7th leading cause of mortality in the United
  States
• Lack of sufficient information regarding the
  effectiveness of smaller programs

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Diabetes in Philadelphia

• 5th leading cause of death among 45-64 year old
  age group
• More than 6,000 diabetics receive treatment from
  the Philadelphia Department of Public Health
  (Philadelphia Department of Public Health, 2001)
• Total number of diabetics from 5.7 ? 9.4 of
  the population since 1991(Philadelphia Health
  Management Corporation, 2000)

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Taking ControlDiabetes Education

• Sponsored by the Health Promotion Council of
  Southeastern Pennsylvania, Inc. (Part of
  Pennsylvanias Diabetes Control Program)
• Target audience Low-income African-American and
  Latino diabetics
• Health Centers 4, 5, 6, 9 10 of the
  Philadelphia Department of Public Health
• Classes- diet, exercise, reading food labels, use
  of blood glucose monitors, and meal preparation

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Aims

• Assess the effectiveness of Taking Control
  beyond the 1-year follow-up period
• Identify the effect of Taking Control on specific
  mediators (Blood Pressure, Cholesterol, LDL, and
  HbA1C )
• Determine the impact of social support on the
  ability of participants to maintain successful
  changes upon completion of the program- (home
  environment and religion)

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Research Design Methods

• Theoretical Framework MATCH (Multilevel Approach
  to Community Health)
• A. Measure Impact
• Mediators
• Behavior outcomes Retinal and foot exams, and
  weight loss/maintenance
• B. Monitor Outcomes
• Health Outcomes Complications of diabetes

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Evaluation Process

• Time period involved 3 years
• Health Centers- 4, 5, and 6
• 150 charts reviewed
• Random selection using a stratified sampling
  technique
• Proportional sampling of participants from each
  of the health centers
• Data analyzed using SPSS v.10

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Results- Study Population

• 16 of participants developed diabetic
  retinopathy
• 7 developed foot complications

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Results

• T-tests analyses (pre-admission vs. Year 3)
• Cholesterol- 25.43mg/dl (plt0.001)
• Systolic BP- 2.50mmHg (p 0.254)
• Diastolic BP- 1.36 mmHg (p 0.320)
• HbA1C- 22 (plt0.001)
• Weight- 21 lbs (p 0.877)

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Recommendations

• Diabetes Foot Care Poster more comprehensive
  to include retinal and laboratory exams
  (currently being implemented)
• Include screening exams on Health Centers Master
  Problem List
• Diabetes Care Card for self-tracking of visits
  and diabetes-related results
• Provide participants with a diabetes education
  refresher course

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Conclusions

• Long-term changes achieved with HbA1C and
  cholesterol
• in HbA1C is consistent with the literature on
  the effects of diabetes education programs
• Future studies should explore methods of
  increasing the utilization of screening exams by
  diabetics