November is National Diabetes Month, a time when communities across the United States bring attention to this chronic and long-lasting health condition. Diabetes affects the way one’s body turns food into energy and, until this day, although it can be treated and controlled, there is no fundamental cure for it.
One of the communities most affected by diabetes is Latinos. U.S. adults overall have a 40% chance of developing Type 2 diabetes over their lifetime. Latino adults have more than a 50% chance of being diabetic and are more likely to develop it at a younger age, according to the Centers for Disease Control and Prevention.
Preventing diabetes, especially for Latino kids and teens, is the main focus of a study by Gabriel Shaibi, a professor at Arizona State University’s (ASU) Edson College of Nursing and Health Innovation. The study published in September in the Journal of the American Medical Association assessed the efficacy of a diabetes prevention program for Latino youths aged 12 to 18 years old. The program began in 2016 and included a total of 117 youths who were predisposed to diabetes and their families.
The hypothesis of the study was to see whether culturally relevant diabetes education and community-driven care would be more effective than traditional medical clinic visits when it came to successfully have kids and families change their eating, exercise habits and steer away from a diabetes diagnosis.
The program was a collaborative effort between ASU, Valley of the Sun YMCA, St. Vincent de Paul, and Phoenix Children’s Hospital. Shaibi told CALÓ NEWS that the origin of the project came from a relationship with Ivy Center for Family Wellness at St. Vincent de Paul, a community agency that was providing diabetes services to Latino patients who did not have health insurance.
“The organization knew that they had to worry not just of the parents but also the kids so they began to create a prevention program for the kids of the patients that they were seeing,” Shaibi said.
According to an ASU article, Shaibi saw an opportunity to join forces with St. Vincent de Paul, where ASU would bring the research prowess and St. Vincent De Paul would bring the connection to the community that would ensure the program lasted.
The dual focus of the preventative program was exercise and education. The youth and their families took on nutrition, physical education and diabetes prevention. St. Vincent De Paul provided health educators and registered dietitians and the exercise programs were designed by YMCA trainers.
One of the highlights for Shaibi is the way this program was community-run. He said it proves that effective community care is efficient and necessary for Latinos. “We created a program that is based on the evidence grounded in the culture and thinking of the community. It was developed in the community by the community for the community,” Shaibi said.
For Elvia Lish, director of the Ivy Center for Family Wellness at St. Vincent de Paul, the youth’s community and family was a key ingredient to the success the kids would have and, therefore, the success of the program.
All of the nutrition, diabetes and exercise classes were offered in both English and Spanish, so not only would the youth learn new practices but so did their immediate family members, guardians, and/or parents. “We knew having a community aspect would have a bigger impact on the family. We wanted to make sure that people involved in the kids’ life were getting the same education,” Lish told CALÓ NEWS. “Parents are the leaders in the households and we know how much they can positively influence the kids’ lives.”
There were three major findings and results from the study, which was boosted in 2021 with a $3.3 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases.
One of the results of the program resulted in a 10% improvement in glucose tolerance (a measure of how kids process sugar) after 12 months.
“Anytime someone drinks something with sugar in it, their blood sugar level goes up and then comes down, so how quickly it comes down and then returns back to its normal state is how well the bodies of the youth are able to tolerate glucose,” Sahibi explained. He said the kids and youth were brought into a clinical research unit and given 75 grams of sugar water. They then took blood samples over the course of two hours and examined how their blood samples came after drinking that sugar water. “That ten percent improvement means that after they finished the program their body was able to bring the sugar down much more rapidly and to a lower degree when drinking that same amount of sugar water,” Shaibi said. “That’s an indication of how well their body can metabolize sugar now.”
A second key finding from the study was that there was a 37% increase in insulin sensitivity (a measure of how well the body uses insulin) after six months. Shaibi explains that insulin is a hormone that the body makes, and that it’s what brings sugar down in the bloodstream. “It takes the sugar from the blood and essentially lets it go to the muscle, that means the body is able to use that sugar much better,” Shaibi said. “That improvement is the ability of the body to produce insulin even when you are not exercising, and that insulin works to bring the blood sugar down.”
For Shaibi, the most interesting and fascinating key finding is the third one, which says the kids in the study reported a 10% increase in their weight-related quality of life after 12 months. What this entails is the way the youth thought and felt of themselves, their health and their bodies relative to their friends, surroundings, environment, and social relationships after the program. Shaibi said this is relatively interesting because, in reality, the youth were not losing a lot of weight throughout the program. “They were improving their health but not by weight loss, but instead by engaging in healthier behaviors that made them feel better. The weight loss was not driving the way they felt, but it was the confidence they were gaining through these newly learned behaviors,” Shaibi said.
Shaibi believes the success of the program is clearly tied to community agents like those of the Valley of the Sun YMCA, St. Vincent de Paul, and Phoenix Children’s Hospital. “They are the key to the success of prevention in our communities. It’s one thing for a doctor to tell you everything about diabetes but that’s not what this program is about, this program is about community services and community agents,” Shaibi said. “These are health educators that are bilingual, and bicultural and that deliver a prevention message in a way that resonates with these families.”
The overall conclusion in the study is that increasing access to programs like these, which focus on diabetes prevention services among high-risk youths, may lead to reductions in Type 2 diabetes rates in underserved populations like those of Latinos.
“Diabetes prevention programs have been available for adults for a long time, but rarely have there ever been prevention programs for kids and teens,” Lish said. She hopes programs like this serve as an example for other communities around the U.S. and in the world. “We often get asked by other organizations how they can duplicate this type of program elsewhere and I think it comes down to the partnerships that we get to foster in the communities that help the population that needs it, in this case the Latino community. To duplicate these programs one must work with the community,” Lish added.
Shaibi said this kind of program also challenges the CDC statistics that say that 50% of Latino youths will develop Type 2 diabetes in their lifetime. “I know we are studying a disease that is chronic and disproportionately impacts low-income and minority populations and a disease that there’s still some mystery about,” Shaibi said. “But our goal is no matter who you are, you get the care needed so you are not part of these statistics.”
He advises those with diabetes not to give up and to not be scared of this disease. “Set goals and write those goals down. Look for support, don’t try to do this alone,” Shaibi said. “Look for people who are willing to support you and engage them in the changes you’d like to see. Those support structures can be your spouse, family member, friend, or neighbors, but making these changes with the support of another is vital.”
Shaibi and his team will continue to work on preventative care. They have secured additional funding for a new study that is currently recruiting Latino families and households interested in learning strategies to prevent Type 2 diabetes. “Now, we will not just be looking at individuals, youth, or families but everyone that lives under one roof,” Shaibi said. “Yes, it will be more challenging, but it’s worth doing.”