ABSTRACTDiabetes 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 (p<0.01). 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.

Background Diabetes Mellitus (DM): an

endocrine disorder that results in increased blood glucose levels

Risk Factors for Type 2 Diabetes Mellitus:

Family History

History of Gestational a Diabetes

Obesity Thrifty Gene Low

Socioeconomic Status

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

Diagnosed cases of diabetes in the United States (in millions)

5.4

15.7

Total casesUndiagnosed

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)

Taking Control:Diabetes Education

Sponsored by the Health Promotion Council of Southeastern Pennsylvania, Inc. (Part of Pennsylvania’s 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

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)

Theoretical Framework: MATCH (Multilevel Approach to Community Health)

A. Measure Impact Mediators Behavior outcomes: Retinal and foot

exams, and weight loss/maintenanceB. Monitor Outcomes

Health Outcomes: Complications of diabetes

Research Design & Methods

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

Results- Study Population

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

Health Centers

4 (68%) 5 (21%) 6 (11%)

Ethnicity 95% African-

American

3% White 1% Latino

Age 35- 44 (7%) 45- 60 (27%)

65- 90 (66%)

Gender 66% female 34% male

Results

T-tests analyses (pre-admission vs. Year 3)

Cholesterol- 25.43mg/dl (p<0.001)

Systolic BP- 2.50mmHg (p= 0.254)

Diastolic BP- 1.36 mmHg (p= 0.320)

HbA1C- 22% (p<0.001)

Weight- 21 lbs (p= 0.877)

Recommendations “Diabetes Foot Care” Poster – more

comprehensive to include retinal and laboratory exams (currently being implemented)

Include screening exams on Health Center’s Master Problem List

Diabetes Care Card – for self-tracking of visits and diabetes-related results

Provide participants with a diabetes education refresher course

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