ABSTRACT Diabetes is a public health issue of growing magnitude. It currently ranks among the top ten leading causes of death in the United States. To address this problem in Philadelphia, the Health Promotion Council of Southeastern Pennsylvania, Inc. (HPC) developed Taking Control: Diabetes Education, a health education intervention program. This program aims to change health behaviors among African-American and Latino diabetics through education. Short-term modifications have been demonstrated in glycosylated hemoglobin (HbA1C), blood pressure, and knowledge following completion of Taking Control. To assess the long-term impact of this program on its participants, an outcomes evaluation was conducted. A total of 150 patients with Non-Insulin Dependent Diabetes Mellitus (NIDDM) were randomly selected. Medical charts were reviewed to abstract data including weight, blood pressure, cholesterol, glycosylated hemoglobin (HbA1C), religion, home environment, and documentation of ophthalmologist and podiatrist visits. Data collection covered a period of three years following the completion of Taking Control program. For subjects who had cholesterol and HbA1C tests before the program and during Year 3, mean levels decreased (p<0.01). There was no statistically significant change in systolic blood pressure, diastolic blood pressure, and weight (p= 0.25, 0.32, and 0.88 respectively). Due to the lack of sufficient information on religion and home environment, a qualitative analysis of these data was not possible. The percentage of participants that had an eye exam increased from Year 1 to 2 after follow-up, while those who had a foot exam decreased. This evaluation demonstrated that Taking Control is successful at decreasing cholesterol and HbA1C levels in the long-term. Recommendations have been made to assist in the improvement of other health outcomes for participants. Additional areas of study have also been suggested to gain a greater understanding of this chronic public health problem.

Risk Factors for Type 2 Diabetes Mellitus: Background Diabetes Mellitus (DM): an endocrine disorder that results in increased blood glucose levels Risk Factors for Type 2 Diabetes Mellitus: Obesity Thrifty Gene Low Socioeconomic Status Family History History of Gestational a Diabetes

Statement of the Problem Diabetes afflicts 800,000 new people each year in the United States (CDC, 2000) Disproportionately affects the minority community 7th leading cause of mortality in the United States Lack of sufficient information regarding the effectiveness of smaller programs

Diabetes in Philadelphia 5th leading cause of death among 45-64 year old age group More than 6,000 diabetics receive treatment from the Philadelphia Department of Public Health (Philadelphia Department of Public Health, 2001) Total number of diabetics: from 5.7%  9.4% of the population since 1991(Philadelphia Health Management Corporation, 2000)

Taking Control:Diabetes Education Sponsored by the Health Promotion Council of Southeastern Pennsylvania, Inc. (Part of Pennsylvania’s Diabetes Control Program) Target audience: Low-income African-American and Latino diabetics Health Centers 4, 5, 6, 9 & 10 of the Philadelphia Department of Public Health Classes- diet, exercise, reading food labels, use of blood glucose monitors, and meal preparation

Aims Assess the effectiveness of Taking Control beyond the 1-year follow-up period: Identify the effect of Taking Control on specific mediators (Blood Pressure, Cholesterol, LDL, and HbA1C ) Determine the impact of social support on the ability of participants to maintain successful changes upon completion of the program- (home environment and religion) The variables cited here are in accordance w/those recommended in diabetes literature and are also those that HPC measures in their 1-yr eval.

Research Design & Methods Theoretical Framework: MATCH (Multilevel Approach to Community Health) A. Measure Impact Mediators Behavior outcomes: Retinal and foot exams, and weight loss/maintenance B. Monitor Outcomes Health Outcomes: Complications of diabetes

Evaluation Process Time period involved: 3 years Health Centers- 4, 5, and 6 150 charts reviewed Random selection using a stratified sampling technique Proportional sampling of participants from each of the health centers Data analyzed using SPSS v.10

Results- Study Population Health Centers 4 (68%) 5 (21%) 6 (11%) Ethnicity 95% African-American 3% White 1% Latino Age 35- 44 (7%) 45- 60 (27%) 65- 90 (66%) Gender 66% female 34% male 16% of participants developed diabetic retinopathy 7% developed foot complications

Results T-tests analyses (pre-admission vs. Year 3) Cholesterol- 25.43mg/dl (p<0.001) Systolic BP- 2.50mmHg (p= 0.254) Diastolic BP- 1.36 mmHg (p= 0.320) HbA1C- 22% (p<0.001) Weight- 21 lbs (p= 0.877)

Recommendations “Diabetes Foot Care” Poster – more comprehensive to include retinal and laboratory exams (currently being implemented) Include screening exams on Health Center’s Master Problem List Diabetes Care Card – for self-tracking of visits and diabetes-related results Provide participants with a diabetes education refresher course

Conclusions Long-term changes achieved with HbA1C and cholesterol in HbA1C is consistent with the literature on the effects of diabetes education programs Future studies should explore methods of increasing the utilization of screening exams by diabetics