Community diabetes education: The CoDE program

Elizabeth A. Prezio, MD, Office for Community Health, HealthTexas Provider Network, 8080 N. Central Expressway, Suite 1700, Dallas, TX 75206, 214-526-3807, eaprezio@sbcglobal.net, Virginia Lamb, RMA, Community Diabetes Education Program, Central Dallas Ministries Community Health Services, 801 N. Peak Street, Dallas, TX 75246, Dan Culica, MD, PhD, School of Public Health, University of Texas Health Science Center at Houston, 5323 Harry Hines Blvd., V8.300, Dallas, TX 75390, and James W. Walton, DO, Medical Director, Office for Community Health, HealthTexas Provider Network, 8080 N. Central Expressway, Suite 1700, Dallas, TX 75206.

The culturally appropriate inner city Community Diabetes Education (CoDE) Program employs a Community Health Worker (CHW) as the sole patient educator. The Program is a collaborative educational experience delivered in a clinical faith-based setting to uninsured English and non-English speaking patients. Successful and appropriate therapies for diabetic patients are translated to these patients in a cost-effective, and time-efficient manner. An endocrinologist regularly trains CHWs. An eight-hour modular program is conducted over a one-year period and consists of three highly structured initial visits, and three quarterly follow-up visits. In this one-to-one setting, patients are trained in the use of a home glucose monitor, and given a personalized culturally appropriate meal plan. Short-term health indicators including quantitative Hemoglobin (HbA1C), urinary microalbumin, lipid levels, and blood pressure are recorded. The presence of long-term diabetes complications is noted, and appropriate clinical referrals are made. Medication adjustments are made in conjunction with the primary care provider. Referrals are made to community resources, which provide patient support for lifestyle changes, and specialty medical care. Costs are measured in contrast with a standard clinical setting. Fifty-two patients were enrolled in the CoDE Program so far. Changes in HbA1C levels were notable: 1.3% overall decrease in the first three months, and 2% decrease for patients with an initial HbA1C > 8%. The efficacy of the CHW model is tested with rigorous outcomes measurements. The CoDE Program can improve short-term outcomes, reduce long-term complications, improve quality of life, and demonstrate cost-benefits to the uninsured diabetic patients in our community.

Learning Objectives: Learning Objectives

be familiar with the community model for diabetes education, the CoDE Program, that can be used to deliver American Diabetes Association standards of care to uninsured, non-English speaking type 1 and type 2 diabetics;
understand the process of training a community health worker to act as a sole diabetes educator to an indigent population;
know the actual costs associated with the delivery of the CoDE Program;
know the outcomes currently being measured and how to manage collection of outcomes data in this clinical setting.
understand the methods used for duplicating this program at other inner-city sites.
recognize the integral nature of the faith-based setting for the success of this program.

Keywords: Diabetes, Faith Community

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation

Disparities and Diabetes

The 132nd Annual Meeting (November 6-10, 2004) of APHA