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Self-empowerment is sweet for diabetes patients in this innovative program

Empowering diabetes patients to feel like they can change their health is the goal of Project Dulce, an innovative program in San Diego that has been held up as a national model. It combines peer counseling, guidance from physicians and monitoring technology to help people avoid serious complications, improve their health and reduce care costs. Special correspondent Cat Wise reports.

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    More than eight million Americans suffer from diabetes, and more than $320 billion are spent every year treating the disease.

    But an innovative program in San Diego is trying to improve health and reduce those costs by encouraging better self-management of the disease.

    Special correspondent Cat Wise has our report.


    Fifty-one year old Alma Ayala is not a doctor or a nurse, but she is on the front lines of the diabetes epidemic in her community. She's a peer educator for a program called Project Dulce, which works with people who have diabetes or are at risk of developing the chronic illness.

    Her classes are part informational, part support group. Ayala says the goal of the program, which has been held up as a national model, is for people to feel empowered about changing their health. That's something she didn't feel 30 years ago when she was first diagnosed with the disease.

  • ALMA AYALA, Peer Educator:

    I was devastated. I didn't want to hear the word diabetes. I felt that my life was done, that I was signing a certificate of death.


    Here in San Diego County, nearly half the adult population has pre-diabetes and about 8 percent have diabetes. It's a disease that affects all socioeconomic groups and races, but the Latino community has been disproportionately impacted. And that's the population Project Dulce has been targeting for the past 20 years.


    There are lots of barriers for the Latino community, language, insurance. Sometimes, doctors don't have the time to spend with them. So the classes that we provide is that extra support, working together with a clinical team to help our participants stay healthy.


    The program is scattered throughout 12 clinics in Latino neighborhoods throughout San Diego County and was designed by several local health care organizations, including the Scripps Whittier Diabetes Institute.

    Dr. Athena Philis-Tsimikas is an endocrinologist who oversees the program.

  • DR. ATHENA PHILIS-TSIMIKAS, Scripps Whittier Diabetes Institute:

    This is a disease in which you have to do a number of management components, not only every day, but many times a day. And it's not that easy to expect someone to remember to test their blood sugar, take their pill, to go out and take that walk, to have exactly the right meal on the table all the time to take care of this.

    I don't see any lows there, so I don't think we have to worry that you might dip down too low.


    To help patients, a team is set up at each clinic with a physician, nurse practitioner, a dietitian and multiple peer counselors like Ayala who come from the communities they serve and also have the disease.


    If you can train these other people and professionals to help you do the other components that take longer, but are still absolutely necessary, then you're using your team to work very synergistically to deliver everything that patient needs in order to improve their care.


    The program is now adding another layer, technology. Last year, Tsimikas conducted a study to see if patients receiving daily text messages could manage their disease even better.

    Artist Gloria Favela-Rocha was one of the participants. She's a muralist who does large scale works for hospitals, schools and private clients. She says, before the study, she often forgot to regularly check her glucose levels. Project Dulce changed that.

  • GLORIA FAVELA-ROCHA, Diabetes Patient:

    The text message would come every day at the same time, so if I would lose track of where I was during my day, I would hear it ring, and so I would start checking my blood sugars, send in my result right away. It would send me back a message according to whatever my result was, like good job, or maybe you need to eat something that has a little more protein today.

    So, it was just very — it was very convenient.


    Dr. Tsimikas' team has also been studying the effects of continuous glucose monitoring, which uses Bluetooth technology to send results to the patient and physician in real time.

  • MAGDALENA HERNANDEZ, Diabetes Patient:

    This device is reading my sugar levels.


    Magdalena Hernandez wears a small monitor on her stomach.


    I love it. I love it because I don't have to prick my finger many times during the day, and it alerts me when my blood sugar goes high or goes low.


    And what happens if your levels go above 200? What do you do?


    I grab a bottle of water, and I get up and walk for five minutes.


    Thirty miles away, Dr. Tsimikas is also able to keep tabs on Hernandez's levels.


    This is just over the last three hours, that she probably ate breakfast here, it went up, and is now declining.


    This technology has been on the market for several years, but has not been widely used because of cost and a somewhat complicated user interface. But Tsimikas says those barriers are being reduced and she predicts it will have a big impact on health.


    It is reinforcement to both the patient and to the provider that's helping to make recommendations on whether this is working or not. I think it's really going to revolutionize the way we can take care of patients.


    Dr. Tsimikas says the objective is to prevent the serious complications that can accompany diabetes, including blindness, kidney failure, amputations or heart failure.


    I really love the black beans and all the vegetables in here.


    According to studies conducted by the University of California, San Diego, and elsewhere, Project Dulce has helped lower patients' blood sugar and cholesterol levels, while at the same time reduced the number of costly hospitalizations and emergency room visits.

    While some elements of the program are being used in other communities, Project Dulce stands out for its comprehensive approach. So, why aren't similar initiatives being rolled out in every neighborhood in America?


    It's probably the way we reimburse for each of these components. That's probably the biggest hurdle. We traditionally have reimbursed only for physician visits. If we could find a way to actually reimburse for each of these components, it may be more sustainable for the future.

    Or maybe we simply reimburse based on our success. If you are successful in achieving better outcomes, maybe then you pay for what led to those better outcomes.


    In the coming weeks, Project Dulce will begin a new study of patients that combines text messaging with continuous glucose monitoring and a wireless pill box that will alert a nurse if a patient isn't taking his or her medication.

    From San Diego, I'm Cat Wise for the PBS NewsHour.

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