Managing Diabetes Doesn’t Stop at Diagnosis

From Zumba classes to farmer's markets, one health center in Detroit is taking a holistic approach to managing diabetes.



The Community Health and Social Services Center, or CHASS Center, located in Detroit, Michigan, helps patients manage diabetes in a number of ways. Each Thursday, during the summer, the health center hosts a farmers market so patients have access to fresh food. (Photo by Stephanie Parshall for Direct Relief)
The Community Health and Social Services Center, or CHASS Center, located in Detroit, Michigan, helps patients manage diabetes in a number of ways. Each Thursday, during the summer, the health center hosts a farmers market so patients have access to fresh food. (Photo by Stephanie Parshall for Direct Relief)

Diabetes is quickly becoming the biggest epidemic of the twenty-first century. According to the American Diabetes Association, more than 30 million Americans — nearly 10 percent of the U.S. population — had diabetes in 2015, and 1.5 million Americans are diagnosed with new cases of diabetes each year. A full 25 percent of people don’t even know they have the disease or are at risk.

Working toward controlled diabetes has multiple benefits: healthier people, fewer complications, and lower costs. Complications of uncontrolled diabetes, such as peripheral neuropathy, cardiovascular disease, and kidney issues, are incredibly damaging and resource intensive. The Centers for Disease Control and Prevention estimates that the total medical costs and lost work and wages for those diagnosed with diabetes totals a staggering $245 billion every year.

But despite the severe and life threatening complications, Type 2 diabetes can often be prevented — and managed — through diet and exercise. That’s why self-management and education is so important to treating the disease and improving the quality of life for patients. Health centers across the country and in Michigan are approaching the epidemic in unique ways. CHASS Center, in Michigan, is a great example of what’s working. That’s because at the Community Health and Social Services Center,  known as CHASS, tackling diabetes is a team sport.

Since 2001, CHASS Center has implemented and tested a number of different diabetes interventions.

When a patient is first diagnosed, the care team activates a multi-pronged approach to not only treat the disease, but also to educate the patient on how to manage it. After working with their patients, providers immediately refer them to a community health worker. Community health workers are the frontline defense in the battle against diabetes, especially because physicians may only see a patient two times a year. They help patients create a personalized care plan based on the treatment goal, which includes patient preferences, educational materials, and a schedule for monthly check-ins and home visits, if necessary.

But treatment and support doesn’t stop there. Because diabetes affects all aspects of one’s health, staying healthy means having access to behavioral health specialists who can mitigate stress and encourage healthy lifestyle choices, dentists who can prevent and treat oral health complications, and an onsite pharmacy where it’s easy to pick up medication and stay on track. In addition, these providers work together to identify previously undiagnosed patients with diabetes and connect them with care, providing warm handoffs from one specialty to another. When necessary, they also coordinate care and make referrals to the Henry Ford Health System, which works with CHASS Center to provide vouchers to patients in need.

There are challenges, though.

CHASS Center serves a predominantly Latinx population, which experiences unique cultural and language barriers to accessing care. To make it easier for those patients, 97 percent of CHASS Center’s staff is bilingual, and they provide text and voicemail reminders to their patients in their language of preference. Community health workers who are connected to patients with diabetes address health literacy challenges one-on-one, meeting patients where they are to ensure they understand their condition and their treatment.

Exercising and preparing nutritious foods are also key to managing diabetes, but may be difficult for patients based on their home and financial situation.

At CHASS, there’s an indoor track running through the building. It provides patients and providers alike the opportunity to exercise in a safe environment any time during business hours. They’ve offered yoga and Zumba classes, and they sponsor a 5K road race every year. Patients can learn about cooking nutritious foods through lecture series, workshops, and Cooking Matters demonstration classes, which are facilitated by the Henry Ford Health System Generations with Promise Program. And, to make it easier to find those healthful foods, CHASS Center hosts a Mercado, or farmers market, which provides access to fresh fruits and vegetables every Thursday during the summer. As an added benefit, the Mercado accepts WIC Project FRESH coupons.

All these services are in addition to a number of grant-funded programs that have specifically addressed challenges for the diabetic population. As an example, a grant in 2013 let CHASS launch Fresh Prescription (Rx), which allows providers to “prescribe” food to patients with an A1C greater than or equal to nine. Prescriptions are “filled” in the CHASS Mercado. Fresh Rx just completed its sixth year. CHASS Center also relies on new technologies, such as electronic health records, to automate alerts that prompt providers to screen patients and schedule checkups.

By actively working across specialties, educating patients in a culturally appropriate way, and addressing patients’ social determinants of health, CHASS Center has made tremendous strides in identifying patients with diabetes and helping them manage their condition. In fact, between 2014 and 2016, CHASS Center decreased the number of patients with poorly controlled diabetes by nearly 15 percent, even as the number of patients with diabetes increased by 6.9 percent.

Dr. Felix Valbuena Jr., chief executive officer at CHASS Center, describes it as a work in progress. “While continuing all of our efforts to work as a team to control diabetes and its consequences, our ultimate goal is to increase efficient preventive efforts to decrease the chronic illness burden and improve the overall health and wellbeing of the community we serve,” he said.

– Jen Anderson is the Associate Director of Communications for the Michigan Primary Care Association. This post was originally published on the Michigan Primary Care Association’s website on Nov. 6, 2018. 

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