Operated as a part of CDM's overall Community Health Services program, the Community Diabetes Education (CoDE) program was developed as a cost-effective way of treating one of the primary problems faced by CHS' patients: diabetes.

CoDE employs a Community Health Worker (CHW) as the sole patient educator. The program is a collaborative educational experience delivered in a clinical faith-based setting to uninsured English and non-English speaking patients.

Successful and appropriate therapies for diabetic patients are translated to these patients in a cost-effective, and time-efficient manner. An endocrinologist regularly trains CHWs. An eight-hour modular program is conducted over a one-year period and consists of three highly structured initial visits, and three quarterly follow-up visits.

In this one-to-one setting, patients are trained in the use of a home glucose monitor, and given a personalized culturally appropriate meal plan. Short-term health indicators including quantitative Hemoglobin (HbA1C), urinary microalbumin, lipid levels, and blood pressure are recorded. The presence of long-term diabetes complications is noted, and appropriate clinical referrals are made.

Medication adjustments are made in conjunction with the primary care provider. Referrals are made to community resources, which provide patient support for lifestyle changes, and specialty medical care. Costs are measured in contrast with a standard clinical setting.

RESULTS

Fifty-two patients were enrolled in the CoDE Program in 2005. Changes in HbA1C levels were notable: 1.3% overall decrease in the first three months, and 2% decrease for patients with an initial HbA1C > 8%. The efficacy of the CHW model is tested with rigorous outcomes measurements. The CoDE Program can improve short-term outcomes, reduce long-term complications, improve quality of life, and demonstrate cost-benefits to the uninsured diabetic patients in our community.