Diabetes self-management: Let’s keep helping diverse populations

Dr. Ileana Ponce-Gonzalez challenges researchers to build upon KPWHRI’s recent success in Eastern Washington

As our team at Kaiser Permanente Washington Health Research Institute (KPWHRI) finishes our implementation of a diabetes self-care program in Eastern Washington, I thought of an interesting analogy. What if this had been a clinical trial of an effective drug that patients needed but could not afford to buy? How sad we would feel if they could no longer get that drug.

But we were not testing a drug with our program. Instead, we were studying ways that communities can help underserved people with Type 2 diabetes take control of their disease in their everyday lives. Our study leader Katherine Newton, PhD, explained why this is important: Medications and clinical attention are necessary, but 90 percent of a person’s success at managing diabetes comes from being able to make healthy changes around food and exercise.

That’s why I’m so happy that the diabetes self-management programs we started building three years ago in communities near Kennewick, Wenatchee, and Spokane are going to continue — even though KPWHRI’s grant to study them is now nearly complete.

We chose to conduct our study among underserved populations in these communities because of their high prevalence of diabetes and their limited resources to deal with the disease. And now — thanks to the hard work and dedication of local coordinators and volunteer trainers — the programs have all found sustainable funding to continue offering the six-week series of classes. The programs are offered by:

• Benton-Franklin Health District, based in Kennewick;
• Community Choice Health and Education Institute in Wenatchee; and
• Inland Northwest Health Services in Spokane.

Classes were offered in Spanish for the first time in the state

Our program began in 2013 with a grant from the Washington State Attorney General’s Office. We used a well-known curriculum called the Diabetes Self-Management Program (DSMP), which was developed by Stanford University’s Dr. Kate Lorig. Others have proven that DSMP is effective in helping people with diabetes improve their health. But our team was the first in Washington state to offer DSMP in Spanish to underserved, rural populations such as migrant farm workers. As a physician-researcher and native Spanish speaker who has worked extensively with migrant and refugee populations, I served as an advisor to the program. We also offered the program in English to other underserved populations, including Russian immigrants and older adults in senior centers in Spokane.

Our program, which was staffed by local coordinators and volunteer lay leaders, faced many challenges in meeting these populations’ special needs. Problems included language barriers, lack of transportation and childcare, and finding energy in the evenings after working long hours. Some participants and leaders had to drive long distances in rural areas to reach their classes. Because of these challenges, our enrollment was lower than we had anticipated. But we learned so much along the way!

Surveys showed participants benefited and valued the program

Despite the challenges we faced, we found that the classes helped many people make healthy changes! Surveys showed improvements in many areas, including participants’ confidence in:

• Choosing appropriate foods to eat when hungry
• Exercising 15 to 30 minutes, four to five times a week
• Taking steps to control blood sugar
• Controlling diabetes so that it does not interfere with things they want to do

One key lesson was the importance of involving the community in planning. Katherine set up an advisory board and local steering committees that included patients and other key people who really understood the challenges. This helped build trust, respect, and commitment. It also helped our team to tailor the DSMP outreach strategies to meet each of the three communities’ needs. In the end, it wasn’t our work that made the program sustainable. It was their work!

Looking back, I realize that Katherine took a risk when she decided to lead this program. There are so many gaps in American health care that need to be filled. There are so many health disparities that need to be addressed. Katherine was a senior researcher with a lot of experience in women’s health, but she had never worked with immigrant and rural populations before. Still, she saw the need and she was willing to find ways to really listen. She helped to build a foundation that others can now build from.

I hope that other researchers and providers will not let this experience go to waste. I hope they will see that they, too, can make a difference to address health disparities in underserved populations.

Ileana Ponce-Gonzalez, MD, MPH, is executive director of the Community Health Worker Coalition for Migrants and Refugees. She is also clinical assistant professor at the University of Washington School of Public Health. Dr. Ponce-Gonzalez served as an advisor to KPWHRI’s diabetes self-management study. KPWHRI’s Michael Parchman, MD, MPH, is principal investigator of the study, replacing Katherine Newton, PhD, who recently retired. Anne Renz, MPH, serves as project manager.

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