Choosing a worthy messenger key to getting diabetes message across

A healthy lifestyle would help turn the type 2 diabetes epidemic around

The public is not aware of the steps it can take to prevent the onset of type 2 diabetes, says Lois Exelbert, RN, MS, CD, BC-ADM, administrative director of the Diabetes Care Center at Baptist Hospital of Miami.

General health guidelines for preventing other chronic problems, such as heart disease, apply to diabetes as well. These include maintaining an ideal body weight, remaining physically active, choosing healthy foods, eating regularly, getting enough sleep, and managing stress, Exelbert says.

While the message may be the same for everyone, people are more likely to listen if they identify with the messenger. That is why in New Mexico, community health representatives work within Native American communities. These community members are essentially an extension for health services and act as agents.

"If you take these community members and send them back into their communities where they are recognized, respected, and part of the culture, the message has more meaning and they are listened to," explains Carol Maller, MS, RN, CHES, diabetes/AIDS coordinator for the Southwestern Indian Polytechnic Institute in Albuquerque, NM. In this case, then, the messenger is just as important as the message.

The American Heart Association based in Dallas offers programs designed to be taught by members of certain ethnic groups. For example, Search Your Heart is a faith-based program that targets African-American communities. It is a modular program with each module providing information on certain health issues such as hypertension, nutrition, physical activity, or diabetes.

"With the Search Your Heart program we have to identify someone in the health ministry or maybe a nurse in the congregation to take the program and recruit the volunteers needed to implement it," says Erin McDonald Bicknell, senior director for State Health Alliances in New Mexico, Montana, and Wyoming, for the American Heart Association and American Stroke Association Pacific/Mountain affiliate.

Recently Maller and McDonald Bicknell worked together to give lay educators in New Mexico health information that they could customize for their community. For example, the preparation of food is important to the prevention and management of diabetes or heart disease and includes lowering fat and sugar as well as portion control.

"We talk about these kind of concepts and then we give them opportunities to reflect on how they would bring that information back to their community in a way that has meaning," Maller says. "It might be putting together a family night and bringing people together for an evening meal where they would prepare some native traditional foods in a healthier way. It might just mean using a healthier oil for cooking or it may be portion control, looking at serving size and quantity."

Provide teaching tools

It's important for the people learning the message to be actively involved and to be taught by analogies so, in turn, they can provide hands-on learning opportunities when they teach others what they have learned, says Maller.

For example, during one training session the educators passed around different food products and beverages and showed everyone how to figure out the grams of fat and sugar per serving. They also showed how to figure the equivalence according to a measuring cup and had the volunteers put the sugar or shortening for fat in containers.

Each person would show the food product and how much sugar or fat was in a serving size. Some would measure the amount for the entire content of the bag because they knew people would most likely eat the whole thing.

"Some may be three serving sizes per container, but unless you look at that carefully you may open the bag and eat it while watching TV," says Maller.

One eye-opener, Maller reflects, was that the amount of sugar in an energy drink was comparable to a can of soda.

The basic message is that people can make healthy choices in their selection of food and their activity level. "We don't want a complicated message. We want a simple message of prevention," says Maller.

McDonald Bicknell says the organization she works for wants to get the message out that people need to know their numbers, including blood pressure, cholesterol, body mass index, and blood glucose.

"It's not just getting the tests done but understanding what those numbers mean. When we do community screening we typically partner with groups that are familiar and well trained to deal with the interpretation of those numbers," she says.

Exelbert says the Diabetes Care Center at Baptist Hospital gives free screenings on a regular basis; people simply need to call and make an appointment. Following the screening, the person is counseled on the results, and if there is a need to see a physician, he or she is called within two days. Anyone with a fasting blood glucose level of more than 100 is advised to talk to their doctor about pre-diabetes, a condition that leads to diabetes. They also can begin to experience the damaging effects of diabetes.

"I think most people think if they had something wrong with them like diabetes they would feel it, and the truth is they don't detect early diabetes. They blame symptoms such as fatigue on 100 other things," Exelbert says.

One of the most accessible ways for people to reduce their risk for diabetes is through exercise, says McDonald Bicknell. All that is required is 30 minutes of sustained exercise daily at an elevated heart rate for adults and 60 minutes for children.

That is why her organization has a physical activity initiative focused on walking and starting walking clubs at work sites.

"It is frightening. We are looking at the first generation that will not outlive their parents. I have seen statistics that one out of three people will have diabetes in the upcoming generation," says McDonald Bicknell.

To make the biggest impact for prevention focus on people who are borderline at risk and children, she advises.

Are the education strategies working?

Maller says she does not have any statistics; however, out in the field she has witnessed lifestyle change. At a potluck at a Native American school, she found trays of fresh vegetables, and items such as fry bread were cut in small pieces.

"It is all about balance. It is not about depriving yourself, and of course the serving size, not having huge serving sizes. I have seen some of those kinds of changes," says Maller.


For more information on strategies to prevent or delay the onset of type 2 diabetes contact:

  • Lois Exelbert, RN, MS, CDE, BC-ADM, administrative director, Diabetes Care Center, Baptist Hospital of Miami. Phone: (786) 596-4930. E-mail:
  • Carol Maller, RN, MS, CHES, diabetes/AIDS coordinator, Southwestern Indian Polytechnic Institute, 9169 Coors Rd NW, Albuquerque, NM 87120. Phone: (505) 259-4729. E-mail:
  • Erin McDonald Bicknell, senior director, State Health Alliances, New Mexico, Montana, Wyoming, American Heart Association, Pacific/Mountain affiliate, 2201 San Pedro NE, Building 2, Suite 102, Albuquerque, NM 87110. Phone: (505) 353-5802. E-mail: