In the 50 years since he moved to Chicago from his native Puerto Rico, Jose Lopez has witnessed the devastating effects of type 2 diabetes on the Humboldt Park community he calls home. He has seen hundreds of his neighbors crippled by a disease that is avoidable and, if diagnosed, manageable.
While about 7 percent of all Americans have diabetes, the rate of prevalence in Humboldt Park is 14 percent, and it's a staggering 21 percent for the community's Puerto Rican population — one of the highest rates ever reported. When this disturbing trend was reported in the Journal of Epidemiology in 2006, preventive and family medicine physician at Rush Steven Rothschild, MD, convened a task force comprising health care providers and community activists to figure out what could be done to turn back the diabetes epidemic.
There is no simple solution. But for Lopez and his neighbors, there is new hope thanks to an innovative intervention based on the premise that just as it takes a village to raise a child, it takes a community to tackle a health crisis.
A Team Approach
The 72 Block-by-Block project grew out of the recommendations set forth by the task force. The project is being overseen by the Puerto Rican Cultural Center and the Greater Humboldt Park Community of Wellness in collaboration with researchers from Rush and Sinai Health System.
Rothschild and Lopez, who is director of the Humboldt Park Puerto Rican Cultural Center, are co-principal investigators for Block-by-Block, a multifaceted grassroots intervention to educate the community, increase early diagnosis and provide resources to improve diabetes care and self-management for 13,000 adults in a 72-block section of Humboldt Park.
"Health care professionals can go into a community and talk to people about nutrition and exercise," Rothschild says. "But we believe that for an intervention to truly succeed, the change has to come from within. Our goal is to partner with the community to reduce the impact of diabetes. We want to make this a social phenomenon, something people are buzzing about."
Mobilizing the Community
The five-year project starts this fall, when four residents trained to serve as block captains will conduct household screenings to identify everyone with diabetes and prediabetes. The block captains will follow up with those who are diagnosed, encouraging them to seek medical care and make necessary lifestyle changes.
Future efforts will include establishing a Diabetes Community Education Center to house educational programs, screenings and self-management training; implementing an intervention program for children identified as "at risk" for diabetes involving both parents and neighborhood schools; developing a case management program to help residents with diabetes organize their care; and working with community-based organizations to improve access to fresh produce and physical activity opportunities for residents of all ages; and much more.
If successful, the Block-by-Block project will provide a blueprint for others to follow.
"When community members own the solution, the solution then becomes an organic part of the culture of that community," Lopez says. "I believe this approach will ultimately be the answer for communities like ours facing major health problems."
Tips for Managing Diabetes
While diabetes is a serious health problem, the good news is that it is manageable — especially if diagnosed early. Rothschild offers the following lifestyle tips to help keep diabetes under control and avoid the often debilitating complications related to the disease.
- Eat a balanced diet. Seeing a dietitian every one to two years can be helpful if you have diabetes. They, along with your diabetes health care team, will help you plan a diet that is right for you.
- Exercise at least three to four times a week for 20 to 40 minutes each session. A regular exercise program can improve blood sugars, decrease the risk of heart disease, and help you lose weight. Talk to your health care provider before starting any exercise program. He or she may want to do a few tests first. If you have complications related to your diabetes like neuropathy or retinopathy there are certain types of exercise that you should avoid. Tell your doctor what kind of exercise you want to do so adjustments can be made to your medicine schedule or meal plan. Remember, it is important to check your sugars prior to vigorous exercise.
- Get plenty of sleep. Keeping a regular schedule and getting enough sleep will help you keep your blood sugar levels in good control.
- If you smoke, quit. While smoking is bad for your health, it is especially harmful for people with diabetes. Nicotine in cigarette smoke causes large and small blood vessels to harden and narrow, resulting in reduced blood flow to the rest of your body. Because people with diabetes already have a greater risk of developing health problems like heart disease, stroke, kidney disease, nerve damage, foot problems and more, smoking makes the risks that much greater.
- Manage stress as best you can. Stress, both physical and mental, can send your blood sugar levels out of whack. Consider a stress management workshop to help you learn better coping methods.
- Practice good foot and skin care. Check your feet daily for calluses, cracks, or skin breakdown. If you notice redness, ulcerations, pus or a foul smelling drainage from your feet, or if you notice that any of the toes have turned black and cold, notify your doctor immediately. Also, tell your doctor if you have any swelling in your ankles or feet.
- Report signs of infection to your doctor. If you have any signs of infection — redness in areas of the skin, fevers, vomiting, etc. — call your doctor or health care provider immediately.
- Discuss sexual problems with your doctor. Diabetes can cause a variety of sexual and urologic problems for both men and women.
- Stay knowledgeable about diabetes. Continue learning about diabetes to maintain and improve your health. Attend a diabetes class or schedule visits with your diabetes educator at least once a year.
More Information at Your Fingertips:
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Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.
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