August 18, 2000
By Jose A. Alvarez
In June of 1998, six clinics in northern San Diego County launched a two-year pilot program aimed at improving access to quality care for low-income patients with diabetes.
Although the pilot program has ended and it's effectiveness is still being evaluated, demand for Project Dulce has been so great that it is being replicated in clinics throughout San Diego County.
"There is a high need for it," said Cheryl Lilley, Project Dulce nurse liaison with Vista Community Clinic. "It's keeping patients out of emergency rooms and hospitals," she added, indicating that the program teaches patients how to monitor their disease.
Project Dulce provides outreach, education, screening, diagnosis and clinical care to diabetics with high-blood pressure who are part of the County Medical Services (CMS) program. CMS serves low-income and unemployed San Diego County residents.
Through the program patients receive intensive clinical care by a registered nurse, who has extensive training in diabetes education. The nurse leads a team of registered dietician and other health specialists. Patients also participate in diabetes self-management classes, and are ensured access to medications, blood sugar monitoring supplies, and ophthalmology and podiatry care.
The 12-week curriculum covers the basic concepts and complications of diabetes as well as how diet, exercise, medication, and the importance of self-monitoring all contribute to controlling the disease. Program graduates will have access to monthly support groups.
"The project teaches patients how to manage their disease," added Lilley. "It makes them their own advocate."
The project is free to all CMS patients but will be available at an accessible price for those who are not CMC patients.
"We want people to improve their health," said Karla Torres, health educator at the San Ysidro Health Center, indicating that her clinic has already found nearly 300 patients who qualify for the program.
Project Dulce also hopes to demonstrate that adhering to standards of care for managing diabetes can significantly reduce complications and health-care costs.
"We want people to control their blood sugar levels now so that they can prevent complications. That is why it's so important," added Torres, who will begin contacting patients individually and hopes to get the project running by August.
Education and self-monitoring coupled with proper nutrition and exercise, stated Lilley and Torres, are essential to controlling the disease and living healthier lives.
But getting people to change their eating and lifestyle habits is quite a challenge.
"There needs to be a lot of education going on. It's not easy to convince someone who is used to eating four tortillas in the morning that they can only eat one," indicated Lilley. "It's a full lifestyle change and it's really hard to get people to understand that," she added, indicating that to properly control the disease, diabetics must exercise and follow specific nutritional habits.
Diabetes is an ailment that prevents the body from producing or properly using insulin, a hormone needed to convert sugar, starches and other food into energy the body needs to function.
It is estimated that over 15 million people suffer from diabetes in the United States, 5.4 million of which do not know they have the disease.
Many people first become aware that they suffer from the disease after they develop one of its life-threatening complications. Blindness; kidney, nerve and heart disease; and stroke are the most common.
In its first two years, Project Dulce provided clinical care to more than 300 high-risk patients and comprehensive diabetes education to nearly 1000 patients each year.
(Reprinted from Border Reflections, Profiles on Community Health, July/August 2000, Issue 26)