Nurses provide diet of support

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Nurses provide diet of support
Study targets black, Hispanic diabetics
Tuesday, December 30, 2008
BY DAVID WENNER
Of The Patriot-News

People with diabetes face a lot of painful and scary possibilities.

Infections that won't heal. Toe, foot and leg amputations. Blindness. Kidney failure. Heart attack.

Much of it can be avoided with diet, exercise and adherence to medical advice.

Yet diabetes continues to disable and kill, and account for much of the country's health care bill.

With so much at stake, why don't more diabetics take better care of themselves?

"Diet and exercise are both very hard to follow. We all want easy solutions to our problems," says Dr. Renu Joshi, who specializes in treating diabetic patients for PinnacleHealth System.

It's an issue for people of all races, but studies show health problems stemming from diabetes are more common among blacks and Hispanics.

Using a $252,000 grant from health insurer Highmark Inc., Joshi and Pinnacle decided to find out if black and Hispanic diabetics would stay healthier if they received intense support from a nurse of the same race.

The study was based on the theory that cultural issues can prevent members of those groups from obtaining and accepting the best medical care and advice. It involved 232 patients, lasted 18 months and showed positive results.

Overall, there was major improvement in the patients' control of their blood sugar, Joshi says. Their diabetes-related emergency room visits were cut in half.

The patients also showed improvement in areas including blood pressure and cholesterol levels and in obtaining preventive measures such as eye exams and flu shots.

As part of the studies, two nurses educated the patients about their disease and what it takes to stay healthy, and contacted them regularly to keep them on track and encourage them.

"She used to call me every day for a while. She would be fussing," says Willie Donald, 67, of Harrisburg.

Donald, a retired chef, has had diabetes for 40 years. Until recently, he still feasted on the rich foods he used to prepare for hotel and wedding guests. A stroke five years ago limited his ability to walk.

"With him, my main focus was on limiting how much he was eating, and increasing his physical activity to match his level of ability," says Shannon Pearson, the registered nurse who worked with Donald.

Donald says he longer eats such large portions. He eliminated foods such as unskinned chicken and eats more fresh vegetables. He became more active.

Donald, who lives alone in a Harrisburg apartment complex, says he didn't find Pearson intrusive. "I really feel good that someone has taken an interest in me," he says.

Marvin Vazquez, 61, was hospitalized for heart trouble about two years ago. That's when he learned he's diabetic.

He says nurse Hilda Rivera made him aware that his diet was severely endangering his health.

Vazquez says he used to eat large, unhealthy meals and snack constantly, mostly on sweets.

When he and Rivera sat down to revise his diet, his wife, who does the cooking, also attended.

They both adopted the new diet, and began taking daily walks together. Each has dropped 40 pounds, Vazquez says.

"They helped me do it. I feel much better," says Vazquez, who lives in Steelton and works as a patient care assistant at Harrisburg Hospital. "Without the program, I don't know how to eat."

Joshi hasn't yet compiled numbers to show the amount of medical costs saved as a result of the program.

She said she's already convinced the nation's health care bill could be reduced substantially if more diabetics received the level of support given to the study participants.

The study was funded by the Highmark Foundation, a branch of Highmark that funds efforts to improve health care.

Yvonne Cook, the president of the foundation, says one of the goals is to support models that can be used to address health care problems. But the results of this study will have no direct result on Highmark health insurance coverage, she said.

DAVID WENNER: 255-8172 or dwenner@patriot-news.com

ABOUT DIABETES

Diabetes occurs when the level of blood sugar becomes too high because the body isn't producing enough insulin. There's no cure. About 23 million people in the United States have diabetes. At least 57 million people have pre-diabetes, according to the American Diabetes Association. Diabetes can lead to major medical problems and death. But people can do a lot to control the disease and minimize the harm. Source: American Diabetes Association

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