>> Pam: Hi, everybody. This is Pam Allweiss with the
Division of Diabetes Translation at the CDC.
We have Gretchen Piatt, who's with the University
of Michigan; Morgan Smith, with Feeding America; and
Barbara Gordon, with the Kentuckiana Regional Planning and
Development Agency, KIPDA for short, in Louisville, Kentucky.
>> Gretchen: So one of the questions that I
have to ask myself is that, are peer-support
models the answer? And there's four key functions
of a peer leader: assisting in self-management,
providing emotional and social support, linking to clinical care,
and providing ongoing support. And we know from
the literature that peer support helps to lower
problematic health behaviors, improve depression, and improve diabetes self-management
behaviors. Peers may effectively and economically fill the
need for the patient support in maintaining
lifestyle changes that all patients seem to really be wanting.
So who are the peer leaders? Peer leaders
are people who live and work in the
study communities. They often have diabetes.
They're respected members of the organization that they
work in or they volunteer in.
They're usually very empathetic and I think, very
importantly, they are not necessarily the diabetes superstar. 25 00:01:53,320 --> 00:01:57,080 They are the people who struggled, and that
usually is what makes them a really good
peer leader. They understand the struggle that it
takes to manage their diabetes.
So the Praise Study, like I said, is a
diabetes self-management support study that takes
place in churches.
The goal of Praise was to determine the
relative effectiveness of parish nurse plus peer leader
diabetes self-management support versus peer leader only diabetes
self-management support, compared to a usual care group.
And then to implement diabetes self-management support
in a feasible, scalable, and sustainable manner.
So we have all of our qualitative data analyzed,
and we saw three key processes for diabetes self-
management support come out of that qualitative data.
Patients identified goal-setting, problem-solving, and sharing
experiences and information in the context of mutual support,
camaraderie, and a sense of safety as being the
most important. The group processes were also linked
to improvements in motivation and self-management goals.
Additionally, participants found that discussion of non-evidence-based
treatments was beneficial. And this may be a cultural aspect
that we see in the African American churches,
but there does seem to be a desire for non-traditional
diabetes treatments to be discussed. So if the patients
bring it up and ask about it,
we will certainly discuss it with them.
The challenges that the peer leaders and the parish
nurses found was in using open-ended questions.
And they also found it very difficult to motivate attendance.
However, you know, to summarize, peer-led, self-management
support efforts in these churches can motivate self-management
behaviors in part via positive group dynamics that
are facilitated by the safe community setting.
>> Morgan: We see that diabetes prevalence rates are also
impacted by food-security status. So this chart
shows data from NHANES and looks at
rates of diabetes among low-income adults by
food security status. And rates are significantly
higher in adults who've faced food insecurity.
So at 10.2%, again looking at the
low-income population, people who are food insecure
have higher diabetes prevalence rates than the
food secure population, looking at this NHANES data.
We also know that food-insecure adults with
diabetes have additional challenges for diabetes self-management.
And to echo some of what Gretchen was
talking about in terms of capacity for
self-management, we know that food insecurity
also impacts people living with diabetes in
their self-efficacy. Food insecurity results
in higher rates of diabetes-related distress.
And all these can again impair self-management
capacity and really increase their risk for
adverse-health outcomes and diabetes-related complications.
We see this play out in long-term blood glucose
control as indicated by hemoglobin A1C levels.
To compare to food-secure counterparts,
food-insecure diabetes patients are less likely
to have A1C levels at target, and
they're more likely to have elevated A1C levels
well above goal, putting them at increased
risk for acute and long-term diabetes complications.
So the success of the food bank diabetes
management and prevention programs, again, really hinges
on strong partnerships with community organizations, many
of which are listed here on this slide.
Perhaps the biggest lesson learned from this process
is to make collaborations and partnerships effective,
is finding a champion in that organization
that you're wanting to partner with who can
really spearhead efforts internally to support that work.
So, for food banks, it's finding one clinician,
a nurse, a provider at a clinic to really
focus on food insecurity within that clinic.
If you're working in a clinic or diabetes education
program, it might be reaching out to a food bank
or food pantry to find someone who's interested in
diabetes and can support diabetes programming
in the food bank, whether it be additional self-
management support or the provision of diabetes-appropriate
food through that food pantry that your
clinic patients can access.
>> Barbara: Older adults with type 2 diabetes, again,
were our primary target, living in rurul
communities. And we wanted to come towards this
initiative from a coalition perspective, from the ground up,
from the community up, utilizing coalition work to
facilitate and impact the change that is necessary
in communities, and particularly rural communities.
The focus of our work, utilizing coalition work, took on
several aspects, including convening and mobilizing a coalition.
And if you've done any coalition work you know
that that is very, very challenging. In
order to be able to do that in these communities,
we knew that we had to understand the communities.
And basically, the work that we do as an area
agency on aging—we have a lot of knowledge,
a lot of involvement, a lot of participation
in the community—but there were several things
that we needed to understand about our communities,
including its geography, but also the resources—what's
available in those communities? And what are
the critical issues that our citizens experience
that interfere with them being able to have access
to health care, access to the things that they
need to manage their diabetes, the things that they
need to be successful in taking care of themselves?
And their mantra is, “Diabetes is personal,
diabetes is about family, diabetes is about community,
and so is health.” It is personal, it's
about family, and it’s about community. And
impacting community change with coalition work, making
sure that the people that live and exist in those
communities are able to access the things that
they need to manage their health and to
improve their condition, is very, very important.