Community Health Workers and their Role in Diabetes Disease Management

Chronics conditions, like diabetes, continue to affect the public, yet optimal preventative care and treatment is not secured for the many communities. Many individuals face lack of access to quality, culturally appropriate preventative healthcare. Diabetes self-management education is considered a very important component of diabetes care. However many individuals do not receive self-management training or they receive interventions that are not effective.

As seen in previous blogs, healthcare is moving towards implementation of new media to breakdown some of the barriers faced in despaired communities. Access to technology can begin to bridge a gap between the digital divide, but who or what will connect the patient to the provider once they have access to the services?

Community Health Workers (CHWs) are defined as community members who work in community settings and serve as connectors between consumers and providers to promote health among groups that have traditionally lacked access to adequate healthcare. They are often referred to as the ‘vital links’ or the ‘in-between people.’ In my opinion, these individuals are a necessity for successful management programs. They can provide the support needed to gain skills for self-management. As a community member, the CHW is often seen as a peer rather than a provider.

A successful, integrated CHW-based diabetes program at Gateway Community Health Center in Laredo, TX recognized the need for additional assistance to address escalating health disparities and implemented Amigos en Salud, a program developed in partnership with Pfizer Health Solutions, which trains CHWs to educate Hispanics with diabetes to develop and maintain self-management skills and behavior change. CHWs support patients by providing a culturally relevant education curriculum, connecting patients and their families to the healthcare system and available community resources. The skills and responsibilities of CHWs from this program have been successfully woven into clinic operations, complementing the efforts of clinical and non-clinical staff. CHWs work in conjunction with the healthcare team, reinforcing and simplifying provider’s treatment plan in areas such as nutritional counseling, ensuring appointment keeping and participation in clinic programs. This CHW model enhances patient, family members and provider continuity and coordination of care, while increasing the delivery of quality care in the clinic. CHW insights into achieving clinic support, strategies for successful implementation and suggestions for overcoming obstacles will be discussed.

Integrating Internet with disease management and the support given by a CHW can only enhance the healthcare delivery in communities facing disparities. In order to incorporate new media into healthcare delivery, public health must continue its expansion as well. Individuals in the field must become part of the Internet community in order to continue building new neighborhoods.

Internet Communities

After the presentation on "Community Building Online and Implications for Health," I began to think back to previous courses and discussions on social capital/networks and the affect of social resources and health.

Studies have shown that individuals with strong social networks have better chances of recovery and those rich in social capital can cope with daily inconveniences, such as those faced by diabetics.

Support helps people with diabetes feel less isolated and more confident about self management. Traditionally, support occurred through face-to-face medical care, education programs, and support groups. Internet technology has made it possible to continue this tradition of supportive interaction combined with information and education in a way that transcends the clinic environment. The Joslin Diabetes Center's Internet discussion boards were designed to be a technological extension of traditional support groups for chronic illness.
The Internet continues to develop as a place where people gather to share experiences, exchange information, and find emotional support. The increasing number of people who communicate over the Internet via mailing lists, news and discussion groups, or live chat rooms emphasizes that people find the Internet an effective way to communicate, especially about health-related issues.

Dr. John F. Zrebiec from Harvard Medical School and the Behavioral and Mental Health Unit condicted a study that established and evaluated a Web-based educational and emotional resource for patients with diabetes and their family members.

This study demonstrated that Internet communities are beneficial for individuals with diabetes and their family members. There seems to be a need or desire to discuss with peers similar problems, learn coping strategies, and maintain hope. In summary, a professionally moderated health-related discussion group offering a combination of information and support is an effective strategy for engaging people about management of their diabetes.

Many questions still need to be explored. Are these results clinically significant?Can they be maintained over time through online support? Are individuals seeking help online different from those seeking help in person? Are virtual relationships more or less valuable than face-to-face meetings? Can virtual communities replace or complement face-to-face support groups? Does participation in these Internet communities change the dynamics of the provider patient relationship? Are these online health care services compatible with existing healthcare delivery?

As many public health findings, further research is often needed to answer the remaining questions. Without a doubt I believe the Internet can only benefit a management/support program. I only wonder, if the Internet becomes accessible to all, will there still be face-to-face social support systems and if so will they be as rich as before the Internet?

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Take Control...Live Uninterrupted

One of the daily battles diabetics face is the monitoring of their sugar levels. Imagine having to continuously stop your daily activity to check your sugar level. Now available is a DexCom STS wireless continuous monitor.

Continuous blood glucose monitoring will become a very important change in diabetes management. In the next few years, continuous blood glucose monitoring will likely replace many patients' use of test strips. I believe the monitoring process will dramatically change management of diabetes, especially when the patient is sleeping or is in between meals and is unlikely to test his or her blood sugar.

Studies have demonstrated statistically significant improvements in glycemic profiles with the use of the short-term system with no guidance or therapeutic adjustments from physicians. One particular study of a short-term continuous glucose sensor in subjects with type 1 diabetes summarized accuracy and effectiveness of the STS Sensor.

Diabetics are very excited with the new technology and convenience DexCom offers. Matt Vogel of Insulin Factor, created an online DexCom user chronicle, where he discussed his triumphs and challenges with the monitoring system and Amy Tenderich, another individual new to DexCom, discusses her fascination with the device on her blog, Diabetes Mine.

"It's so easy to use that I'm baffled. Just two buttons, plus the calibrating with the OneTouch meter. But that's a simple matter of 2 fingersticks and then using a cable to connect the two meters for a few moments. The DexCom screen displays your BG "line" over the last hour, three hours, or nine hours -- in a way that even my grandma could understand." Tenderich

Another way technology keeps improving quality of life. It has become evident to me that glucose monitoring is a crucial part of diabetes disease management. Through diet and exercise levels can be controlled to some extent, but without testing individuals will not know there current status. There are many barriers diabetics have for monitoring their blood glucose (BG), such as cost of strips, lack of knowledge on the value of monitoring and perceived lack of time. Hopefully this device will make it easier to monitor BG and facilitate the path to an uninterrupted life.

There are problems faced by individuals seeking to gain access to these new devices, one of course is reimbursement. With all advances there will be obstacles faced!

Recommendations for Diabetics and Those at Risk

Self-care for diabetes can be approached in a number of ways—but it can be hard to know just where to start. Some doctors recommend trying these simple steps, step I personally feel can be beneficial for the entire public:

Slim down
If you are overweight, lose weight with a long-term program of exercise and healthier eating to improve your insulin sensitivity.
Eat high-fiber foods
Stabilize your blood sugar by eating fiber from whole grains, beans (legumes), vegetables, and fruit, and consider using a fiber supplement such as glucomannan or psyllium. A high-fiber diet has been shown to work better in controlling diabetes than the diet recommended by the ADA, and may control blood sugar levels as well as oral diabetes drugs. Eating a high-fiber diet can show significant reductions in total cholesterol.
Focus should be placed on fruits, vegetables, seeds, oats, and whole-grain products.
Eating fish also may afford some protection from diabetes.
Vegetarians have been reported to have a low risk of type 2 diabetes. When people with diabetic nerve damage switch to a vegan diet, improvements have been reported after several days. Fats from meat and dairy may also contribute to heart disease, the leading killer of people with diabetes.
Vegetarians also eat less protein than do meat eaters. Reducing protein in the diet has lowered kidney damage caused by diabetes and may also improve glucose tolerance.
Multivitamins
Help ensure your body is getting the vitamins and minerals it needs to help prevent common infections.
Chromium supplement
Taking 200 to 1,000 mcg a day of this supplement may improve glucose tolerance. Medical reports dating back to 1853, as well as modern research, indicate that chromium-rich brewer’s yeast can be useful in treating type 2 diabetes. In recent years, chromium has been shown to improve glucose levels and related variables in people with glucose intolerance and type 2, gestational, and steroid-induced diabetes.
Improve and protect with ALA

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full diabetes article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.
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Causes & Cures for Diabetes

Pancreas Transplant: An Insulin-Free Treatment for Type 1 Diabetes

Your pancreas is a narrow organ about the length of your hand that lies behind your stomach. It releases enzymes into your small intestine to break down nutrients. It also releases hormones into your bloodstream to help your body use sugar (glucose). As mention in previous entries, insulin, which is released by the pancreas, acts as a gatekeeper, letting glucose into your cells. The cells use the glucose as fuel for energy production.
When your body is unable to regulate the amount of glucose in your blood, you may have diabetes. Type 1 diabetes occurs because your pancreas produces little or no insulin and individuals with type 2 diabetes the insulin produced is not efficiently used by the body.
A pancreas transplant can be a successful treatment option for people who have advanced type 1 diabetes or who don't respond well to standard insulin treatments.
As also discussed previously, many people with type 1 diabetes can manage their disease by following a diet and exercise plan, monitoring their blood glucose, and receiving insulin injections. But for some people this is a difficult task, resulting in a number of serious complications.
A pancreas transplant is the closest thing to restoring normal pancreas function. A pancreas transplant isn't the best option for all people with type 1 diabetes, however, and is primarily recommended for people with kidney failure.

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Coming soon will be a discussion on additional diabetes treatments.

Time for Barbecues and Picnics!

Summer has arrived and a barbecue can be a great alternative to dull old dinners. But before you turn on the grill here are a few things to keep in mind.

Be hesitant when eating chicken, though it maybe crispy and charred on the outside it could be a different story on the inside. Raw and undercooked food is one of the biggest causes of food poisoning, and can contain nasty bugs such as salmonella and E.Coli 0157, which can make you feel really ill. Cooking food properly on the barbecue is more difficult than you might think!
Frozen food needs to be completely defrosted before it’s cooked and when cooking it should be turned around regularly to make sure it’s evenly cooked throughout.
Sausages, chicken and burgers need to be fully cooked and piping hot with no pink juices spilling out of them. Poking the food with to see if any juices flow out is a good way of testing how cooked it is. Raw meat should be kept in a sealed container away from ready-to-eat foods like salads and bread buns. Make sure all salads and fruit that you eat outdoors are properly washed beforehand.

Summer is also a perfect time for picnics, but they can often be really fattening and filled with calories! Here are our top tips and recipes to avoid piling on the weight:
Forget snacking on crisps and dips and try something more healthy and tasty. We like celery, carrots sticks and some juicy red cherry tomatoes.
Sandwiches are great for a picnic, but they don’t have to be as dull as the ones in your school lunch box. Instead of choosing white bread why not buy a freshly baked loaf from your bakery? There are loads of different ones to choose from including bread stuffed with olives, walnuts, onions and sun-dried tomatoes. When it comes to the fillings forget boring cheddar and ham and go for something more adventurous like hummus, mozzarella, turkey and tuna; although we wouldn’t recommend eating these all at once!
If you’re not a fan of bread or if you have a wheat allergy then why not pack a couple of cold dishes instead? Quiche is really versatile and if you have time is tasty and wholesome if you make it yourself. If you want to be extra healthy fishy snacks like crabsticks, prawns and slices of salmon are perfect on a summer’s day, particularly with a dash of lemon and pepper.
A picnic wouldn’t be complete without a salad. If you’re bored of green salad then how about mixing it up a bit with sweet corn, yellow peppers, mushrooms and red radishes? For something more filling we suggest a potato or pasta salad. These don’t take long to make and taste just as good when eaten cold as they do eaten hot. Vegitarians can enjoy couscous, spinach and feta cheese pasta salad, packed with vitamins and iron also tastes delicious.
Strawberries and picnics go hand in hand. But instead of smothering them with fattening cream, how about a spoon full of low fat yoghurt? Alternatively compliment them with other fruits this season. Mango, grapes, kiwi fruits and bananas are all lovely and ripe this time of year.

*Remember not to sit in the sun for too long, either find a nice shady tree or bring a big umbrella. There’s nothing worse than getting sunburn!

Childhood Obesity Prevention


The rise in childhood obesity has increase rates of Type 2 diabetes in young children. It is important to bring awarenesss to our youth so the can lead healthier lives.
Here are two additional clips bringing awareness to children:
Healthy Children
Even Healthier Children

Additional Videos
Fit & Healthy with Flax
Family Guy on Diabetes
Disability Awareness