By: Kristine Conner
The best treatment for Type 2 diabetes is actually prevention: identifying people with prediabetes, indicated by risk factors such as blood glucose levels and weight, and helping them reverse it through healthy eating, weight loss, and exercise. This is why, in 2013, Chester County Hospital sought to become one of the first hospitals in Pennsylvania to offer the Centers for Disease Control and Prevention's (CDC) National Diabetes Prevention Program. Certified lifestyle coaches work with patients for 22 sessions over a full year to help them make lasting lifestyle changes. The hospital also has a Diabetes Self-Management Program that serves about 1,000 patients annually.
More recently, the hospital realized that these services were neglecting a key population in Chester County: Spanish-speaking residents. People of Hispanic origin are the second largest ethnic group in the county after non-Hispanic Caucasians. The 2010 Census found that nearly 60 percent of the population in Avondale and 50 percent in Kennett Square were Hispanic. In Pennsylvania as well as nationwide, this is a group especially hard hit by diabetes and its complications: According to the CDC, more than half of Hispanic men and women are expected to develop Type 2 diabetes.
In light of this knowledge, Julie Funk, MS, RD, CDE, LDN, director of Chester County Hospital's Community Health and Wellness Services, and her team developed a plan to offer a Spanish Language Diabetes Prevention Program in 2017. They soon earned a $50,000 grant from a local family foundation to launch the program.
Funk and her team first offered six diabetes screenings at local mushroom farms in early 2018, including South Mill and Kaolin, which employ large numbers of Spanish-speaking residents. The screenings reached over one hundred employees, with bilingual educators helping them understand their risk of diabetes and action steps to prevent it. This was accomplished through partnerships with the Chester County Department of Health and La Comunidad Hispana (LCH). Following these screenings, LCH, a bilingual health center in southern Chester County, offered a weight loss program for these workers as a result of the grant's support. The hospital also partnered with Community Volunteers in Medicine (CVIM), which provides free healthcare to Chester County residents, to offer four Reversing Prediabetes classes in Spanish. In addition, the partnership between CVIM and the hospital supported four bilingual cooking classes that focused on ways to increase fruit and vegetable consumption and build confidence cooking healthy meals at home.
But the program's main focus was training bilingual lifestyle coaches who could provide the CDC's National Diabetes Prevention Program (NDPP) — the same one available in English at the hospital - in communities where Spanish-speakers live and work. To do this, the hospital again partnered with CVIM and La Comunidad Hispana as well as the Maternal and Child Health Consortium of Chester County, which focuses on the health of young families in need. Victor Alos, DMD, MPH, a dentist, public health consultant, and CVIM volunteer who is also certified as a master trainer with the NDPP, trained 22 lifestyle coaches across the three organizations.
One of those coaches is Carla Graves, RD, the diabetes care coordinator at CVIM. Graves estimates that 25 percent of the population served by CVIM has prediabetes and another 25 percent have diabetes. She is offering the diabetes prevention program at the Jenners Village Professional Building in West Grove, working closely with a second certified lifestyle coach who also lives in the community and is herself a CVIM client with diabetes - a major advantage for connecting with participants. The program started in April 2018 and will continue through spring 2019.
"We weigh participants in, we track their activity, we track their A1C [a measure of average blood sugar levels]," Graves says. "The goal of the lifestyle changes is five-percent weight loss and 150 minutes of exercise a week. Such changes aren't easy and they take time." Over the course of the year, the coaches aim to "give those enrolled more and more freedom so they can sustain the goals on their own," she adds.
Given the level of challenge and the time commitment, retention can be an issue, but the West Grove site has attracted a core group. At the 12-week mark, the program had nine active participants who had committed to staying together until spring 2019. They had lost 57.4 pounds, an average of 6.4 pounds per person and just shy of the five-percent average weight loss goal.
"A big part of the success of the program is sharing information and knowledge," Graves says. "The community is so family-oriented. We have a mother and daughter coming together, as well as husbands and wives. Young mothers bring their kids. They have bonded as a group. They are getting this information and they can spread it even further."
Similarly, the program offered by the Maternal and Child Health Consortium had 11 active participants at week 11, with an average weight loss of 5.68 pounds per person. As at CVIM, the strong retention was attributed to having a Spanish-speaking instructor and encouraging participants to bring along family and friends.
"We always wanted to do more for the Spanish community," Funk says. "The family [foundation] that awarded us the grant felt that it met a need that was worthwhile. And truthfully out of that some incredible things have happened."