prevalence of diabetes, identify risk. factors along the U.S.-Mexico border, and develop a bi-national diabetes. prevention and control program that …
US Mexico Border Diabetes Prevention and Control Project
PAN AMERICAN HEALTH ORGANIZATION
Pan American Sanitary Bureau, Regional Office of the
WORLD HEALTH ORGANIZATION
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Description
This is a US and Mexico collaborative project that attempts to determine the prevalence of diabetes, identify risk factors along the US-Mexico border, and develop a bi-national diabetes prevention and control program that respond to the needs of the border population
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Purpose
To diminish the impact of diabetes of the border population by conducting activities in two related and chronological phases: 1 Development of a Prevalence Study and identification of risk factors 2 Implementation of a program for diabetes prevention and control
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Challenges
The project is bi-national in scope; therefore, it requires to maintain bilingual communication; This is a multi-agency and multi-funded project within a bi-national context in which different policies and many points of view need to be taken into consideration; Availability of resources are not equal; Turnover rate;
Coordination of bi-national activities is complex
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PHASE ONE
Prevalence Study and identification of risk factors
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Objectives
Determine the prevalence of diabetes among residents aged 18 years and older for the US-Mexico border using current ADA recommendations fasting plasma glucose Determine glucose control hemoglobin A1C
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Objectives
Determine the prevalence of behavioral risk factors and access and barriers to health care Assess associated risk factor using anthropometric and blood pressure measurements
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Communities where survey was conducted
State
California Baja California Arizona Sonora
County/Municipio
Imperial, San Diego Tecate, Tijuana, Mexicali, Algodones Yuma, Pima, Cochise, Santa Cruz Agua Prieta, Altar, Caborca, Cananea, Luis B Sánchez, Naco, Nogales, Puerto Peñasco, SLRC, Sonoita Juárez, Guadalupe, Praxedis, Ascensión, Ojinaga Doña Ana, Luna, Hidalgo Anahuac Piedras Negras, Nava, Acuña Matamoros, Camargo, Miguel Aleman, Nuevo Laredo, Reynosa El Paso, Presidio, Hidalgo, Cameron, Webb,
Maverick, Valverde
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Chihuahua New Mexico Nuevo León Coahuila Tamaulipas Texas
Survey components:
Questionnaire Anthropometric measurements Blood Pressure measurements Blood Draw for FGP HbA1C
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Number of completed surveys by state
State Surveys required 1980 660 330 330 660 1980 330 330 330 330 330 330 3,960 Surveys Completed 1893 654 324 330 585 1969 319 330 330 330 330 330 3,862 Percentage 96 99 98 100 88 99 96 100 100 100 100 100 9752 Blood draw Completed 1722 630 311 270 511 1770 280 315 320 272 318 265 3,492 Percentage 87 95 94 81 77 89 85 96 96 82 96 80 88
United States California Arizona New Mexico Texas Mexico Baja California Sonora Chihuahua Coahuila Nuevo Leon Tamaulipas Total
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Data Analysis
Data Publication and Presentation Policies Executive Summary Data Base completed and reviewed Weight procedure in progress
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PHASE TWO Community Intervention Pilot Study
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Purpose
To improve the quality of care that is being delivered at the selected
sites, integrate the family, through th 
eir participation in educational sessions, in the diabetes self -management of individuals with diabetes and implement culturally relevant and sensitive health promotion activities in the selected communities
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Goal To develop bi-national community intervention strategies that best address the needs of the US-Mexico border population
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Objectives
Family based interventions delivered by the CHW/PdS will: 1Reduce several risk health indicators in the intervention group; 2Increase the adoption of healthy behaviors in the intervention group; 3Decrease the proportion of several risk factors among relatives at risk for diabetes
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Pilot study centered in:
1 Health care delivery system; 2 Improvement of self-management among individuals with diabetes to delay the onset of complications; 3 Community awareness to promote healthy lifestyles
The pilot intervention will utilize community health workers/ promotores de salud, trained in health promotion and diabetes self-management education
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INTERVENTION SELECTED SITES
State California Baja California Arizona Sonora Chihuahua New -Mexico Nuevo Leon Coahuila Tamaulipas Texas City Brawley Mexicali Elfrida Agua Prieta Ojinaga Columbus Anahuac Piedras Negras Matamoros Pharr Laredo
California
Arizona
New Mexico
Baja California Norte Sonora Chihuahua
Texas
Coahuila
Selected Sites for Phase II Intervention
Nuevo Leon Tamaulipas
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Training for personnel
1 CDCs Diabetes Today/ La Comunidad en Acción 2 Diabetes Education and Empowerment for Promotoras DEEP University of Chicago, Midwest Latino Research Center 3 Su corazón, Su vida NHLBI 4 Cardiopulmonary Resuscitation CPR 5 Technical Guidelines for Patient Diabetes Education SSA, Mexico 6 Operational Manual 7 Patient Electronic Care System PECS
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Participants
Estimated number of participants: 60 per eleven sites: 30 assigned to the intervention group per site 30 assigned to the delay intervention group per site At least 2 Family members per participant will be part of the study
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Timeline
Two years project: 18
months 74 educational sessions with the intervention group 4 months 16 weeks of educational sessions with the delayed intervention group
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Participant selection criteria
Type 2 diabetes; Ambulatory participant identified by the primary care center as a user of the clinic; Hispanic origin; 18 years and older; Have local residency in the US- Mexico border; Willing to participate in a two year study; Male or female 50 each; Has a blood relative, at high risk for diabetes, living with them in their home or in the same neighborhood
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Evaluation
Reduction of body mass index Reduction of waist circumference Reduction of A1c levels Smoking cessation Physical activity Consumption of healthy diet
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Accomplishments
Border region as one epidemiological unit Project implemented through a consensus process Operation Manual for phase I Mexican laboratory capacity strengthened Symposium Diabetes a Challenge for All Prevalence and intervention models in same project
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Source:nhlbi.nih.gov
