U'S'MEXICO BORDER DIABETES PREVENTION AND CONTROL PROJECT

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U.S.-MEXICO BORDER DIABETES PREVENTION AND
CONTROL PROJECT

• Pan American Health Organization
• U.S.-Mexico Border

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U.S.-MEXICO BORDER a site for merging cultures
and behaviors
Ten States 70 million people
25 US counties 34 Mexican municipalities 24
Native American Nations 11.4 million people
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Why diabetes?
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US. -MEXICO BORDER DIABETESPREVENTION AND
CONTROL PROJECT

• Description
• This is a five year U.S. and Mexico
  collaborative project that attempts to determine
  the prevalence of diabetes and identification of
  risk factors along the U.S.-Mexico border and to
  develop binational diabetes prevention and
  control programs that respond to the needs of the
  border population

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Project Purpose

• The purpose of the project is 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 program for diabetes prevention

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Project Rationale

• WHO estimated that by 2025 diabetes will increase
  between 150-200
• It is estimated that 5-14 of the total health
  expenditure will be used for diabetes
• Along the U.S.-Mexico border, diabetes mortality
  rates are higher than national figures.

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Project Rationale (cont.)

• In 1996 there were 161,000 diabetes hospital
  discharges with an average length of stay of 5.1
  days in the U.S.
• Diabetes is 2-3 times higher in Mexican Americans
  than in non-Hispanics
• Uncontrolled diabetes makes difficult treatment
  of infectious diseases (i.e., TB)

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Additional considerations

• Large minority population in the U.S. border
  (average Hispanic population 70)
• Population growth rate (4.3 for Mexico and 1.8
  for U.S) higher than national rates
• ( 1.9) Mexico, (0.9) U.S.

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Additional considerations

• High poverty levels on both side of the border
• Five of the seven poorest counties of the U.S.
  are located in the border
• More than 30 of the Hispanic population
  uninsured
• Several border communities are designated
  Medically Under-Served Areas

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Facts about diabetes among Hispanics

• In 1998, about 1.2 million Hispanic were known to
  have diabetes in the U.S.
• One in every four Mexican Americans age 45 and
  older has diabetes
• Being overweight or physically inactive is a
  major risk for developing diabetes.
• Hispanics have higher incidence of developing
  diabetes complications

Source www.niddk.nih.gov/health/diabetes/pubs/hip
an/hipan.htm
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Distribution of the Hispanic Diabetic population
in U.S. (1982-1984)
Source www.niddk.nih.gov/health/diabetes/pubs/hip
an/hipan.htm
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Diabetes Mortality Rates for Selected U.S.-Mexico
Border Communities, 1995-1997
Source PAHO. Mortality Profiles of the Sister
Communities on the United States-Mexico Border.
Washington, D.C. 1995-1997
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Risk and associated factors of Diabetes type II

• Older age
• Obesity
• Malnutrition
• Physical inactivity
• Gestational diabetes
• Race/ethnicity
• Low health care access

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Diabetes Mortality Rates El Paso, Texas,
1990-1998
Source soupfin.tdh.state.tx.us/cgi-bin/deathcgi R
ate per 100,000
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Diabetes Mortality Rates USA, Texas, El Paso,
Juarez, Chihuahua, and Mexico, 1998
Source PAHO. Mortality Profiles of the Sister
Communities on the United States-Mexico Border.
Wahsington, D.C. 1995-1997
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Diabetes Mortality Rates by RaceTexas and El
Paso, 1990-1994-1998
Diabetes Mortality Rates by RaceEl Paso, Texas
1990-1994-1998
Diabetes Mortality Rates by RaceTexas
1990-1994-1998
Source soupfin.tdh.state.tx.us/cgi-bin/deathcgi R
ate per 100,000
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Hispanic Diabetes Mortality Rates by ageEl Paso,
Texas, 1990-1994-1998
Source soupfin.tdh.state.tx.us/cgi-bin/deathcgi R
ate per 100,000
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Healthy People / Gente 2010 Goals

• People
• Reduce death rate by 7.8/100,000

• Gente
• Reduce death rate by 10
• Reduce diabetes morbidity by 25

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U.S.-Mexico Border Diabetes Prevention and
Control ProjectPrevalence Study 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 (FPG)
• Determine glucose control (hemoglobin A1C (HbA1c
  or glycohemoglobin).

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Prevalence Study Objectives (cont.)

• Determine the prevalence of behavioral risk
  factors and access and barriers to health care
  for diabetes using a standard questionnaire.
• Assess associated risk factor for diabetes using
  anthropometric and blood pressure measurements.

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U.S Mexico Border Diabetes Prevention and Control
Project.-

• Intervention Program Objectives
• Develop the implementation of three to four
  binational diabetes intervention models.
• Involvement of social participation on diabetes
  prevention and healthy life styles

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Collaborative Partners
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Collaborative Partners

• Pan American Health Organization
• U.S.-Mexico Border Health Association
• Centers for Disease Control and Prevention
• Secretaria de Salud de México
• State Health Authorities and Diabetes Control
  Programs of
• Arizona Baja California
• California Chihuahua
• New Mexico Coahuila
• Texas Nuevo Leon
• Sonora
• Tamaulipas
• Paso del Norte Health Foundation
• El Paso Diabetes Association
• Border Health Foundation
• California Endowment/Project Concern
  International

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Funding

• CDC awarded the Pan American Health Organization
  with 462,000.00 to undertake project activities
• El Paso del Norte Health Foundation has assigned
  more than 400,000.00 for the prevalence study in
  the El Paso/Southern New Mexico/Northern
  Chihuahua area
• Texas Department of Health has made a 60,000.00
  financial contribution.
• New Mexico Department of Health contributed
  80,000.00 to fund the position of US Coordinator
• California Endowment awarded the Border Health
  Initiative of Project Concern International
  272,000.00 to fund project activities in
  California

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Project Management

• PAHO coordinates activities with support of
• Executive Committee
• Scientific Committee
• Workgroups as needed
• Intervention Advisory Committee
• Workgroups as needed
• CDC and SSA advisor as needed

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Diabetes Today
AMERICAN DIABETES ASSOCIATION RECOGNITION FOR
EXCELLENCE Facility Columbia Medical Center
Program Name Columbia Diabetes Treatment Center
Comprehensive Education Outpatient Program
Original recognition date 9/25/98 Current
recognition date 9/25/98
El Paso Diabetes Association
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Challenges

• The project is binational in scope therefore, it
  requires to maintain bilingual communication
• Teleconferences with participation of both
  countries are cumbersome
• This is a multiagency and mutifunded project
  within a binational context in which different
  policies and many points of view need to be taken
  into consideration.
• Availability of resources is uneven, therefore,
  activities will begin at different time.
• Coordination of activities is complex

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U.S.-Mexico Border Diabetes Prevention and
Control Project
- AS A MODEL -

• Protocol
• Prevalence study includes both measurements FPG
  and Glycosylated hemoglobin (HbG)
• New participatory intervention models for
  diabetes prevention
• Determination of risk and associated factors.
• New data collection and analysis methodologies
• Training methodology for capacity building
  addressed to selected risk groups