Sugar, Heart and Life: A Guide to Living with Diabetes
Stephen Spann, MD
Department of Family and Community Medicine
This project was generously underwritten by Mrs. Trinidad Mendenhall Sosa
Acknowledgement
Burden of Disease
Prevalence of Diagnosed Diabetes Among US Adults Aged 18 and Older
Race/Ethnicity Prevalence*
Non-Hispanic Whites 6.6%
Non-Hispanic Blacks 8.4%
Hispanics 7.9%
Source of Data: Analysis of the National Health and Nutrition Examination Survey 1999-2004
Texas Diabetes Prevalence Compared to the US
Area Prevalence*
Texas 9.7%
US 7.2%
*Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2008, for persons who are eighteen years of age and older, and include both Type 1 and Type 2 Diabetes. Persons with diabetes include those who report that they have been told by a doctor that they have diabetes. Women who report diabetes only during pregnancy are not included in prevalence. Note: All reported rates (%) are weighted for Texas demographics and the probability of selection and thus are not derived from the simple division of numerator and denominator cases.
Prevalence of Diabetes, US and Texas, 1995 - 2008*
0
2
4
6
8
10
12
14
16
18
20
YEAR
%
Texas
US
*Source: CDC Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2008, for persons who are eighteen years of age and older, and include both Type 1 and Type 2 Diabetes. Persons with diabetes include those who report that they have been told by a doctor that they have diabetes.
Texas Projected Population Increases by Race/Ethnicity, 2000-2040*
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
35,000,000
40,000,000
2000 2010 2020 2030 2040
YEAR*Uses 0.5 migration scenario. Texas State Data Center - Office of the State Demographer, Institute for Demographic and Socioeconomic Research, College of Business, University of Texas at San Antonio.
Popu
latio
n
Hispanic
Black, non-Hispanic
White, non-Hispanic
TOTAL
Texas Projected Diabetes Cases 2000 - 2040*
Levels of A1C Among US Adults 18 and Older with Previously Diagnosed Diabetes
(Percent Distribution, SE)
Race/Ethnicity A1C<7%
% (SE)
A1C7-8%
% (SE)
A1C>8%
% (SE)
Non-Hispanic White 62.1 (4.19) 21.5 (4.26) 16.4 (4.02)
Non-Hispanic Black 39.2 (6.78) 21.2 (5.76) 39.6 (8.14)
Mexican American 30.9 (5.58) 22.9 (4.48) 46.2 (5.68)
Source of Data: Analysis of the National Health and Nutrition Examination Survey 1999-2004
Levels of A1C Among Hispanic Adults ≥ 19 years of age with Previously Diagnosed Type 2 Diabetes
Harris County Hospital District Community Clinics(Percent Distribution, SE)
Overall/Gender 7-8%
% (SE)
>8%
% (SE)
Overall (n = 191) 26.2 (3.19) 73.8 (3.84)
Men (n = 53)
Women (n = 138)
20.8 (5.62)
28.3 (3.85)
79.2 (5.62)
71.7 (3.85)
Production and DesignSugar, Heart and Life
Purpose and Development
The Diabetes Interactive Telenovela (DIT) was designed in response to the high prevalence of uncontrolled type 2 diabetes among Hispanic primary care patients in Houston’s Harris County Hospital District.
Content for development of the DIT storyline was informed by data obtained from six focus groups conducted with 72 primary care patients from three local community health clinics.
Diabetes Interactive Telenovela(Intervention)
Conceptual Model of DIT Intervention
Personal Factors• Literacy / Understanding• Attitudes / Beliefs• Outcome Expectancies• Motivation
Behavioral Factors• Social Norms• Cultural traditions• Foods consumed• Physical activity• Habits
Environmental Factors• Social support• Neighborhood• Access to health care• Transportation
Diabetes Self Efficacy
Improved AdherenceDiet, Exercise, Medication
Improved Glycemic Control
(Reduction in HbA1c)
Objectives and Messaging
Short-Term Objectives Attitudes, Beliefs, Knowledge changes
Long Term ObjectiveImprove diabetes regimen adherence in adult Hispanic men and women
Overall Messages in Storyline (sprinkled throughout):With good diabetes control one can postpone or prevent the development of complicationsImportance of family support for diabetes management and prevention
Primary Topics
Diet Physical Activity Medication Adherence Self-Care Family
Primary Storyline
To follow a family who is dealing with diabetes management over the course of 1 year
Clip: Victoria Receives Diabetes Diagnosis
Telenovela: Main Components
5 Dilemma SetsDiet (2)
Physical Activity (2)Medication Adherence (1)
INTERACTIVE
TELENOVELA
EPISODES 7 Interactive Learning Resources“What is Diabetes?”
“Check Out Your Choices”“Claudia’s Recipe Box”
“Create-a-Plate”“Diabetes Care Toolbox”
“What’s in it?”“Go for the Goal”
INFO - MARKET
Interactive Learning Modules
Diabetes Interactive Telenovela
Episode Selection Character Selection
Clip: Luis Chooses to Go to the Bar with His Friends
Diabetes Interactive Telenovela
Decision Point Consequences
Neutral Outcome: The Gonzalez family change a few things in the way they eat and get exerciseUndesirable Outcome: The Gonzalez family continue with their usual eating and exercise patternsDesirable Outcome: The Gonzales family carefully watch what they eat and get daily exercise
DIT: Five Years LaterDIT: Five Years Later
Clip: Five Years Later Reflecting on the Family’s Bad Choices
Visit us at:www.bcm.edu/shl
Questions and
Discussion
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