As diabetes rates ratchet steadily up, researchers find that the use of community health workers and peer support groups for chronic disease prevention and management can work in all settings, particularly low-resource areas.
A grim new report out this week estimates that half of Asian Americans and Hispanic Americans with diabetes don't know they have the disease.
The estimates from the National Institutes of Health and the Centers for Disease Control and Prevention are detailed in the Sept. 8 issue of the Journal of the American Medical Association and the findings should alarm anyone who cares about population health.
The estimates for the first time quantify the prevalence of diabetes in Asian Americans and the news is not good. Researchers estimate that Asian Americans have the highest proportion (51%) of undiagnosed diabetes among all ethnic and racial groups. Hispanic Americans have the highest prevalence (23%) of diabetes, 49% of which is undiagnosed.
But wait. It gets worse.
The NIH/CDC researchers estimate that the prevalence of diabetes for all US adults went up by as much as 12% from 1988 to 2012. Those levels rose regardless of sex, age, level of education, income, or racial group or ethnic subgroup.
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Thomas Gaziano, MD |
About 14% of the overall population has diabetes, of which just over 5% is undiagnosed. About 20% of non-Hispanic black adults have diabetes, with about 37% undiagnosed. Prevalence of diabetes for non-Hispanic whites is 11%, and 32% are undiagnosed. Diabetes cost the nation about $245 billion in 2012 in the form of medical care and lost productivity.
The only ray of sunshine to come out of the estimates is that the proportion of people with undiagnosed diabetes dropped 23% over that same nearly three decades.
Coincidentally, these estimates arrived in my email this morning as I was listening to a three-hour briefing sponsored by Health Affairs entitled: Noncommunicable Diseases: The Growing Burden.
I'll focus on a briefing in Health Affairs detailing the success of community-based interventions that was given by Thomas Gaziano, MD. He determined that marginally trained community health workers in resource-poor countries such as South Africa, Mexico, and Guatemala could provide effective screenings for cardiovascular diseases in adults, by asking a few simple questions using either a paper-based or cell phone-based screening tool.
"We found that screening by community health workers was very cost-effective or even cost-saving in all three countries, compared to the usual clinic-based screening," Gaziano wrote. "The mobile application emerged as the most cost-effective strategy because it could save more lives than the paper tool at minimal extra cost."
A briefing by Edwin B. Fisher, PhD, focused on the use of community health workers and peer support groups for chronic disease prevention and management. The good news here is that these programs can work in all settings, particularly low-resource areas.
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"Success factors for peer support programs include proactive implementation, attention to participants' emotions, and ongoing supervision," Fisher wrote. "Reaching those whom conventional clinical and preventive services too often fail to reach; reaching whole populations, such as people with diabetes, rather than selected samples; and addressing behavioral health are strengths of peer support that can help achieve healthcare that is efficient and of high quality."
Fisher cited seven community health workers in Chicago who were able to reach 3,787 "hardly reached" low-income Latino adults to help them monitor blood sugar levels.
"A big issue in healthcare around the world, especially with non-communicable diseases, is the hardly reached, those who we too often fail to engage," Fisher said at the briefing. "We found that peer support is remarkable effective."
Given that a frighteningly large percentage of Americans in general and minorities in particular don't know they have diabetes, rallying communities around improving population health seems an obvious tactic. Yet, Fisher says other countries with far fewer resources, such as Thailand and Pakistan, have done a much better job.
"The U.S. is sort of culturally handicapped in approaching these kinds of interventions," Fisher says. "In this area we very much have more to learn from places like Pakistan and Thailand as opposed to their needing to learn from us."
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.