A DIABETES CONTROL PROGRAM IN A PUBLIC-HEALTH CARE SETTING

The Houston Diabetes Control Program is part of an effort by the State of Texas and approximately 30 other programs throughout the United St ates to ensure that persons with diabetes-related complications receiv e ongoing state-of-the-art preventive care and treatment. For the past 5 years, this program has served an urban, high-risk patient populati on with special cultural, ethnic, and economic challenges. The interve ntion has included the development and implementation of protocols for the prevention and care of diabetes-related complications of the eyes , lower extremities, and cardiovascular system, as well as general man agement of diabetes and patient and professional education. The progra m is ongoing in nine community health centers located in low-income ne ighborhoods of a large metropolitan area. The results thus far indicat e an increase in sensitive eye examinations from 8 percent to 26 perce nt of the patient population, a reduction in incidence of legal blindn ess from 9.5 to 2.7 per 1,000 during a 4-year period, an increase in f oot examinations from 18 percent to 44 percent of the patient populati on, and 77 percent of hypertensive patients in good control of blood p ressure at less than 160 over 95 mmHg (millimeters of mercury). On the average, there have not been significant long-term improvements in we ight reduction or blood glucose control. The major challenges for this program are (a) improvement in control of glycemia, hypertension, and cholesterol (b) more effective diet and physical activity interventio ns, and (c) more effective education approaches that help patients to understand metabolic and cardiovascular functions. These challenges wi ll require collaboration of health care professionals in constructive and imaginative ways through their unselfish commitment toward common goals.