# Presentation: 064615

## U.S. – Mexico Border Diabetes Prevention and Control Project

- PAN AMERICAN HEALTH ORGANIZATION
- Pan American Sanitary Bureau, Regional Office of the
- WORLD HEALTH ORGANIZATION

**U.S. – Mexico Border Diabetes Prevention and Control Project**

## Description

**This is a U.S. and Mexico collaborative project that attempts to determine the prevalence of diabetes, identify risk factors along the U.S.-Mexico border, and develop a bi-national diabetes prevention and control program that respond to the needs of the border population**.

## Purpose

- 	To diminish the impact of diabetes of the border population by conducting activities in two related and chronological phases:
-  Development of a Prevalence Study and identification of risk factors.
-  Implementation of a program for diabetes prevention and control.

## Challenges

- 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.

**Challenges**

## 
PHASE ONE

Prevalence Study and identification of risk factors

**PHASE ONE**
**Prevalence Study and identification of risk factors**

## Objectives

- Determine the prevalence of diabetes among residents aged 18 years and older for the U.S.‐Mexico border using current ADA recommendations (fasting plasma glucose).
- Determine glucose control (hemoglobin A1C.

## 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.

## Communities where survey was conducted

-     State			County/Municipio
- California		Imperial, San Diego.
- Baja California		Tecate, Tijuana, Mexicali, Algodones.
- Arizona		Yuma, Pima, Cochise, Santa Cruz.
- Sonora		Agua Prieta, Altar, Caborca, Cananea, Luis B. 				Sánchez, Naco, Nogales, Puerto Peñasco, 					SLRC, Sonoita.
- Chihuahua		Juárez, Guadalupe, Praxedis, Ascensión, 					Ojinaga.
- New Mexico		Doña Ana, Luna, Hidalgo.
- Nuevo León		Anahuac.
- Coahuila		Piedras Negras, Nava, Acuña.
- Tamaulipas		Matamoros, Camargo, Miguel Aleman, Nuevo 				Laredo, Reynosa.
- Texas		El Paso, Presidio, Hidalgo, Cameron, Webb, 					Maverick, Valverde.

## Survey components:

**Survey**** ****components:**
**Questionnaire**
**Anthropometric measurements**
**Blood Pressure measurements**
**Blood Draw for FGP &  HbA1C**

**      **

**Number of completed surveys by state**

| State | Surveys required | Surveys |  | Blood draw |  |
| --- | --- | --- | --- | --- | --- |
|  |  | Completed | Percentage
% | Completed | Percentage
% |
| United States | 1980 | 1893 | 96 | 1722 | 87 |
| California | 660 | 654 | 99 | 630 | 95 |
| Arizona | 330 | 324 | 98 | 311 | 94 |
| New Mexico | 330 | 330 | 100 | 270 | 81 |
| Texas | 660 | 585 | 88 | 511 | 77 |
| Mexico | 1980 | 1969 | 99 | 1770 | 89 |
| Baja California | 330 | 319 | 96 | 280 | 85 |
| Sonora | 330 | 330 | 100 | 315 | 96 |
| Chihuahua | 330 | 330 | 100 | 320 | 96 |
| Coahuila | 330 | 330 | 100 | 272 | 82 |
| Nuevo Leon | 330 | 330 | 100 | 318 | 96 |
| Tamaulipas | 330 | 330 | 100 | 265 | 80 |
| Total | 3,960 | 3,862 | 97.52% | 3,492 | 88% |

## Data Analysis

- Data Publication and Presentation Policies
- Executive Summary
- Data Base completed and reviewed
- Weight procedure in progress

## PHASE TWOCommunity Intervention Pilot Study

## To improve the quality of care that is being delivered at the selected sites,  
integrate the family, through their 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.

**integrate the family, through their 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.**

**Purpose**

## Goal

- “ To develop bi-national community intervention strategies that best address the needs of the U.S.-Mexico border population”

## Objectives

- 	Family based interventions delivered by the CHW/PdS will:
- Reduce several risk health indicators in the intervention group;
- Increase the adoption of healthy behaviors in the intervention group;
- Decrease the proportion of several risk factors among relatives at risk for diabetes.

##  Pilot study centered in:

- Health care delivery system;
-  Improvement of self-management among individuals with diabetes to delay the onset of complications;
-  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***

## INTERVENTION SELECTED SITES

**	****State****	****	****City**
**California****	****       ****	****Brawley**
**Baja California****	****	****Mexicali**
**Arizona****	****	****	****Elfrida**
**Sonora****	****	****	****Agua Prieta**
**Chihuahua****	****	****Ojinaga**
**New -Mexico****	****	****Columbus**
**Nuevo Leon****	****	****Anahuac**
**Coahuila****	****	****Piedras Negras**
**Tamaulipas****	****	****Matamoros**
**Texas****	****	****	****Pharr**
**	****	****	****	****Laredo**

## Training for personnel

- CDC’s Diabetes Today/ La Comunidad en Acción
- Diabetes Education and Empowerment for Promotoras (DEEP). University of Chicago, Midwest Latino Research Center
- Su corazón, Su vida. NHLBI
- Cardiopulmonary Resuscitation (CPR)
- Technical Guidelines for Patient Diabetes Education (SSA, Mexico)
- Operational Manual
- Patient Electronic Care System (PECS)

## 
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

**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

## 
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

**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

## 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 U.S.- 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.

## Evaluation 

**Reduction of body mass index**
**Reduction of waist circumference**
**Reduction of A1c levels**
**Smoking cessation**
**Physical activity**
**Consumption of healthy diet**

## 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**

**Accomplishments**

## Slide 24