Randomized controlled community-based nutrition and exercise intervention improves glycemia and cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica

Goldhaber-Fiebert, Jeremy D; Goldhaber-Fiebert, Sara H; Tristan, Mario L; Nathan, David M. Diabetes Care 26. 1 (Jan 2003): 24-9.

– This is a pilot study that provides a model for other areas to improve the health or diabetics.
– community-based, group-centered nutrition and exercise program worked for the rural Costa Ricans.
– The study involved nutrition classes that were customized to the CRicans. Eg. Portion control as opposed to calorie counting; if they could not write to take notes, they would ask a family member to do so; they were given a cup for portion control; they received demonstrations about fat–showing a chunk of lard that comprised a chicharron; family members were invited on the exercise walks, etc.

A Community-Based Diabetes Prevention and Management Education Program in a Rural Village in India Balagopal, Padmini; Kamalamma, N; Patel, Thakor G, MD, MACP; Misra, Ranjita. Diabetes Care 31. 6 (Jun 2008): 1097-104.

– This is a nice study on one small rural population that measures prevalence and the effectiveness of nonpharmacological lifestyle interventions that were customized to the village.
– They planned the study with village leaders, peer educators, and residents.
– Face to face interviews were done and most appropriate since 41% of respondents had less than a 5th grade education.

Culturally competent diabetes self-management education for Mexican Americans: The Starr County Border Health Initiative
Author : Brown, Sharon A; Garcia, Alexandra A; Kouzekanani, Kamiar; Hanis, Craig L

– This is a good study even though it’s about Mexican-Americans (in the US). The group under investigation “is more likely to rely on family and curaderos for health advice, to lack transportation to health care facilities, to be isolated from mainstream culture, to consider family needs as more important than their own personal needs, and to experience language differences with health care workers”
– Page 261 has a nice list of the interventions used here.
– Education emphasized cooking the traditional cuisine, utilizing family for support and were culturally competent in terms of language and social emphasis.

Randomized Trial of a Literacy-Sensitive, Culturally Tailored Diabetes Self-Management Intervention for Low-Income Latinos: Latinos en Control
Author : Rosal, Milagros C, PHD; Ockene, Ira S, MD; Restrepo, Angela; White, Mary Jo, MS, MPH; Borg, Amy; Olendzki, Barbara; Scavron, Jeffrey; Candib, Lucy; Welch, Garry; Reed, George

– Again this is US Latinos.
– Some of the culturally tailor management tactics were: picture-based food guide for illiterate people; minimizing didactic instruction; modeling and experiential instruction (cooking lessons); educational soap operas; and attendance by family members.
– Many short term improvements, but need long term solutions.

“It Is Hard to Be Sick Now”: Diabetes and the Reconstruction of Indigenous Sociality
Dussart, Françoise. Anthropologica 52. 1 (2010): 77-87.

– This is an article from an anthropological journal and is about Aboriginal Australians who misinterpret the meaning of “chronic disease” and mix modern medicine with tradition and religion.
– page 82 uses your example of wanting the pills to “cure” them and they take them to “control” the pain as opposed to taking them forever, whether they feel sick or not.

Prevalence and awareness regarding diabetes mellitus in rural Tamaka, Kolar Muninarayana, C; Balachandra, G; Hiremath, S; Iyengar, Krishna; Anil, N. International Journal of Diabetes in Developing Countries 30. 1 (Jan 2010): 18-21.

– findings were that most people in rural areas were unaware of diabetes and lack knowledge of treatment and complications. Rural communities need mass campaigns. e.g. only 50% had heard of diabetes, 74% of the diabetics were aware of the complications, 50% of the diabetics were aware of self-care, other poor results.

Multifaceted Determinants for Achieving Glycemic Control: The International Diabetes Management Practice Study (IDMPS)
Chan, Juliana C N, MD; Gagliardino, Juan Jose, PHD; Baik, Sei Hyun, PHD; Chantelot, Jean-Marc; Ferreira, Sandra R G, PHD; et al. Diabetes Care 32. 2 (Feb 2009): 227-33.

– This study includes Ecuador as one of the regions.
– Physicians’ perception of patients meeting their hemoglobin A1C goals were not correct.
– Diabetes education improved health outcomes for diabetics in Lat AM.

Narayan, K. M. V., et al. “How should developing countries manage diabetes?” Canadian Medical Association.Journal 175.7 (2006): 733-. ProQuest Research Library. Web. 13 June 2012.

– compares cost-effectiveness of interventions for preventing and treating diabetes between Latin Am. and other regions.
– “Level 1” interventions are cost effective for all regions (glycemic control, blood pressure control, foot care), Most “Level 2” and all “Level 3” interventions aren’t cost effective, especially for Lat Am, which for some reason has the highest costs listed compared to all other developing regions.


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