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Local initiatives educate Latinos about diabetes

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Local initiatives educate Latinos about diabetes
(Photo: Margarita Persico)

Author: Joslin Latino Diabetes InitiativeDr. Enrique Caballero (right) assists a patient at the Joslin Latino Diabetes Initiative. As director of the clinic, Caballero stresses that his patients with diabetes must incorporate a healthy lifestyle as part of their daily routine, in addition to doing more than just taking medication.

Juan Humberto Perez, a chef for the Boston Red Sox, has struggled with type 2 diabetes for seven years. Perez has learned how to treat his disease with the help of  the Joslin Latino Diabetes Initiative. (Margarita Persico photo)

Juan Humberto Perez has been a chef for nearly 20 years. He learned the culinary arts from Danny Wisel, a famed Boston executive chef and graduate of France’s prestigious Le Cordon Bleu. Since 1999, Perez has plied his trade as a chef for the Boston Red Sox.

But until recently, oddly enough, he had no idea how to cook for himself.

It was no mystery. A diabetic since 2002, he had little idea of how to treat his disease on a daily basis.

“What can I eat?” was his common inquiry, said Perez, 59, a slim, 5-foot-9-inch, cinnamon-skinned Latino.

If cooking and eating properly is difficult for a professional chef like Perez, imagine what the nearly 400,000 people in Massachusetts with type 2 diabetes must go through.

Type 2 diabetes is a condition in which the body either does not produce enough of the hormone insulin, which is needed to convert sugar into energy, or cannot properly use the insulin that it does produce.

To try to help the many Massachusetts residents living with this disease, several health institutions are launching new programs aimed at boosting diabetic patients’ health by teaching them how to take care of themselves. Part of that includes incorporating better health habits, such as cooking, exercising and managing their weight, into their daily lives.

“Preventing diabetes from getting worse is beyond taking the proper medication,” said Dr. Enrique Caballero, director of the Latino Diabetes Initiative at the Joslin Diabetes Center, who is Perez’s physician. “People with diabetes must incorporate a healthy lifestyle as part of their daily routine.”

“[Treating diabetes] really takes a lot of time and effort and motivation,” added Dr. Alexander Green, associate director of the Disparities Solutions Center at Massachusetts General Hospital (MGH) in Boston. “A coaching program along with nurse education can be an effective approach.”

In nearby Chelsea, MGH’s Chelsea HealthCare Center has incorporated a culturally appropriate and “multidiscipline team approach” to dealing with diabetes.

The center’s staff reaches out to the local Latino at-risk population, according to Barbara B. Chase, nurse practitioner and coordinator of the center’s Diabetes Management Program. They provide health care coaching, mental health services and diabetes self-management education (DSME) programs, as well as ongoing support groups offered in both English and Spanish.

Perez, also an artist who paints about the Red Sox, said he had never been offered formal diabetes education classes. When he found out the Joslin Diabetes Center’s Latino Diabetic Initiative had such an education program, he switched doctors to take advantage.

He recalls how out of control his blood sugar had been. The ideal blood sugar level is under 100 milligrams of glucose per deciliter of blood. One day, his was nearly 300 milligrams per deciliter. He decided to take 10 additional units of insulin, even though he knew he was taking a risk.

“My sugar never goes up that high,” said Perez.

Later, at the diabetes management classes, Perez learned that injectable insulin expires 30 days after opening.

Both MGH and Joslin’s Latino Diabetes Initiative are trying to get this kind of information to local Latino communities. Joslin has developed a series of culturally tailored programs with educational tools such as the DSME classes, exercise groups, grocery shopping tours and even an audio soap opera.

It is important to take into consideration health literacy levels, or the ability people have to comprehend health care messages, according to Caballero. He says health messages and materials need to be appropriate for each patient’s literacy level.

The Joslin Latino Diabetes Initiative has several culturally oriented strategies to educate their population. One of them is “La Historia de Rosa (Rosa’s Story),” an audio novella CD, recorded in Spanish and designed for patients with low health literacy. This tool educates not only the patients, but also their families about diabetes’ basic care and prevention, said Caballero.

“[‘Rosa’s Story’] conveys the message on what they need to do in terms of their diabetes, their nutrition, their exercise, their medications, glucose testing [and] diabetes prevention in a very practical, interesting, funny way,” said Caballero.

But the Joslin initiative, which started in 2002, recognizes patients’ need for more educational resources.

“One example of our culturally oriented activities is that we just created a pilot [program] of salsa dancing,” said Caballero. “Many of our patients said they … didn’t like to run or jog, but that they would dance.”

That led Caballero and his team to hire a salsa instructor for a monthly meeting with his patients at Boylston Congregational Church in Jamaica Plain.

“We all get together with the patients, and we dance for a little bit,” said Caballero. “And we take that opportunity to also convey some educational messages of what to do with their diabetes, how to improve their care.”

The approach has earned praise within the field. Caballero and his team were the recipients of the National Minority Quality Forum’s 2009 Bernardo Alberto Houssay award for their work with minority and underserved populations.

Another strategy that Joslin educators have used is conducting supermarket tours to educate their low-income patients on how to purchase healthy food within their budget.

“Sometimes healthier foods are more expensive, but not all the time,” said Caballero. “So even within a limited budget, people can make better choices. And so now we go exactly to where people buy the food and teach people how to do that in a better way.”

After patients learn how to purchase healthy food on a budget, they need to know how much to consume. The Joslin initiative has that class, too — “Balanceando su plato; como planificar sus comidas,” or “Balancing your plate; How to plan your meals.” In that class, patients learn about carbohydrates and meal planning.

Depending on the patient’s health literacy level, Andreina Millan-Ferro — the patient education and clinical outcomes coordinator at the Joslin Latino Diabetes Initiative — may recommend trying carbohydrate counting or what is called “the plate method.”

“They divide the plate into three different sections,” said Millan-Ferro, a trained nutritionist. “… Half of the plate [is] for vegetables, and then the other half they divide by half. They will put the carbohydrates in one quarter of the plate, and the meat in one quarter of the plate.”

Patients are allowed two other portions, she said — a portion of fruit and a glass of milk, for instance.

All of these programs need funding, said Caballero. But they often go without, he added, because insurance companies do not always consider the educational and health values of culturally oriented programs.

Perez said he thinks that should change because, since he started attending classes at the Joslin clinic, he has felt better. He said he thinks insurance companies would save a lot of money by promoting measures to control more serious complications from a disease.

“I now keep track of my blood sugar levels before and after meals, and I make sure that I eat the proper nutrition and the right portions of food,” said Perez, who now exercises regularly.

And it seems to be working — Perez said he hasn’t needed insulin since May 7.

“Now I’m in control of everything I eat,” said Perez. “So it’s easy for me to maintain my blood sugar at a good and healthy level.”