sugar, heart and life: a guide to living with diabetes stephen spann, md department of family and...

Sugar, Heart and Life: A Guide to Living with Diabetes

Stephen Spann, MD

Department of Family and Community Medicine

This project was generously underwritten by Mrs. Trinidad Mendenhall Sosa

Acknowledgement

Burden of Disease

Prevalence of Diagnosed Diabetes Among US Adults Aged 18 and Older

Race/Ethnicity Prevalence*

Non-Hispanic Whites 6.6%

Non-Hispanic Blacks 8.4%

Hispanics 7.9%

Source of Data: Analysis of the National Health and Nutrition Examination Survey 1999-2004

Texas Diabetes Prevalence Compared to the US

Area Prevalence*

Texas 9.7%

US 7.2%

*Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2008, for persons who are eighteen years of age and older, and include both Type 1 and Type 2 Diabetes. Persons with diabetes include those who report that they have been told by a doctor that they have diabetes. Women who report diabetes only during pregnancy are not included in prevalence. Note: All reported rates (%) are weighted for Texas demographics and the probability of selection and thus are not derived from the simple division of numerator and denominator cases.

Prevalence of Diabetes, US and Texas, 1995 - 2008*

0

2

4

6

8

10

12

14

16

18

20

YEAR

%

Texas

US

*Source: CDC Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2008, for persons who are eighteen years of age and older, and include both Type 1 and Type 2 Diabetes. Persons with diabetes include those who report that they have been told by a doctor that they have diabetes.

Texas Projected Population Increases by Race/Ethnicity, 2000-2040*

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

35,000,000

40,000,000

2000 2010 2020 2030 2040

YEAR*Uses 0.5 migration scenario. Texas State Data Center - Office of the State Demographer, Institute for Demographic and Socioeconomic Research, College of Business, University of Texas at San Antonio.

Popu

latio

n

Hispanic

Black, non-Hispanic

White, non-Hispanic

TOTAL

Texas Projected Diabetes Cases 2000 - 2040*

Levels of A1C Among US Adults 18 and Older with Previously Diagnosed Diabetes

(Percent Distribution, SE)

Race/Ethnicity A1C<7%

% (SE)

A1C7-8%

% (SE)

A1C>8%

% (SE)

Non-Hispanic White 62.1 (4.19) 21.5 (4.26) 16.4 (4.02)

Non-Hispanic Black 39.2 (6.78) 21.2 (5.76) 39.6 (8.14)

Mexican American 30.9 (5.58) 22.9 (4.48) 46.2 (5.68)

Source of Data: Analysis of the National Health and Nutrition Examination Survey 1999-2004

Levels of A1C Among Hispanic Adults ≥ 19 years of age with Previously Diagnosed Type 2 Diabetes

Harris County Hospital District Community Clinics(Percent Distribution, SE)

Overall/Gender 7-8%

% (SE)

>8%

% (SE)

Overall (n = 191) 26.2 (3.19) 73.8 (3.84)

Men (n = 53)

Women (n = 138)

20.8 (5.62)

28.3 (3.85)

79.2 (5.62)

71.7 (3.85)

Production and DesignSugar, Heart and Life

Purpose and Development

The Diabetes Interactive Telenovela (DIT) was designed in response to the high prevalence of uncontrolled type 2 diabetes among Hispanic primary care patients in Houston’s Harris County Hospital District.

Content for development of the DIT storyline was informed by data obtained from six focus groups conducted with 72 primary care patients from three local community health clinics.

Diabetes Interactive Telenovela(Intervention)

Conceptual Model of DIT Intervention

Personal Factors• Literacy / Understanding• Attitudes / Beliefs• Outcome Expectancies• Motivation

Behavioral Factors• Social Norms• Cultural traditions• Foods consumed• Physical activity• Habits

Environmental Factors• Social support• Neighborhood• Access to health care• Transportation

Diabetes Self Efficacy

Improved AdherenceDiet, Exercise, Medication

Improved Glycemic Control

(Reduction in HbA1c)

Objectives and Messaging

Short-Term Objectives Attitudes, Beliefs, Knowledge changes

Long Term ObjectiveImprove diabetes regimen adherence in adult Hispanic men and women

Overall Messages in Storyline (sprinkled throughout):With good diabetes control one can postpone or prevent the development of complicationsImportance of family support for diabetes management and prevention

Primary Topics

Diet Physical Activity Medication Adherence Self-Care Family

Primary Storyline

To follow a family who is dealing with diabetes management over the course of 1 year

Clip: Victoria Receives Diabetes Diagnosis

Telenovela: Main Components

5 Dilemma SetsDiet (2)

Physical Activity (2)Medication Adherence (1)

INTERACTIVE

TELENOVELA

EPISODES 7 Interactive Learning Resources“What is Diabetes?”

“Check Out Your Choices”“Claudia’s Recipe Box”

“Create-a-Plate”“Diabetes Care Toolbox”

“What’s in it?”“Go for the Goal”

INFO - MARKET

Interactive Learning Modules

Diabetes Interactive Telenovela

Episode Selection Character Selection

Clip: Luis Chooses to Go to the Bar with His Friends

Diabetes Interactive Telenovela

Decision Point Consequences

Neutral Outcome: The Gonzalez family change a few things in the way they eat and get exerciseUndesirable Outcome: The Gonzalez family continue with their usual eating and exercise patternsDesirable Outcome: The Gonzales family carefully watch what they eat and get daily exercise

DIT: Five Years LaterDIT: Five Years Later

Clip: Five Years Later Reflecting on the Family’s Bad Choices

Visit us at:www.bcm.edu/shl

Questions and

Discussion