Study helping African-American women learn to manage diabetes

Gail D'Eramo Melkus is fighting a subtle -- yet tremendously costly -- epidemic.

Melkus, an associate professor at the School of Nursing, along with assistant nursing professor Geralyn Spollet, studies diabetes in African-American women. Both black men and women are more prone than whites to Type 2 diabetes, also called "adult onset diabetes." An estimated 9,000-12,000 African-Americans in New Haven alone have the disease. The problem is truly epidemic among African-American women, with one in four over the age of 55 affected. Blacks also suffer more serious consequences from the disease than whites do; blindness, renal failure and amputations are much more common as a result of diabetes in African-
Americans than in whites.

Though diabetes can be managed through lifestyle changes, sometimes coupled with medication, the disease does not have striking symptoms in its earliest phases when it is most easily controlled. By offering diabetic black women strategies for healthier eating and information about their disease, Melkus is working to attack diabetes before its more serious effects take hold.

The women in Melkus' study meet in small groups facilitated by a nurse practitioner and student assistants to talk about diabetes, healthy eating and exercise habits, and the warning signs of its more serious consequences. Once a month, they are examined by a diabetes nurse practitioner, with the understanding that they will also continue to see their own primary care providers on a regular basis. The School of Nursing study also provides them with a glucose monitoring meter and testing strips donated by Boerrhinger Mannheim so that they can get an immediate reading of their blood sugar levels, something Melkus has found helpful in getting women to make healthy food choices.

Obesity and diabetes are closely related in adults, so diet is a major concern. "Every provider tells them to lose weight," says Melkus. "Nobody was telling them how to do it."

Education sessions tend to focus on eating a healthy diet rather than on losing weight. Discussion subjects include the importance of reading the labels of prepared foods, culturally appropriate recipes and strategies for working an exercise routine into an already full day. Through these small group sessions, the researchers and the women with diabetes work together to arrive at a sensible balance between health needs and the demands of job and family.

Access to health care is a big issue for many women in the study who have limited resources. And diabetes may go unaddressed even in those women with good access to care, according to Melkus. In a previous study, she found that middle-class black women who saw their providers regularly had appropriate cancer screenings 95 percent of the time, but only half were properly screened for diabetes complications.

Melkus has tried to remove as many barriers as possible for the women by scheduling evening and weekend sessions, providing bus fare or parking fees, and babysitting. Melkus has also made herself available by telephone around the clock. "I never wore a beeper until this study," she says.

To recruit women to participate in her study, which is funded by the Donaghue Foundation, Melkus relied on the support of an advisory board made up of community and church leaders in the African-American community. In addition to helping her recruit study participants, board members also previewed educational videos for cultural appropriateness.

Melkus' pilot study is drawing to an end, but she hopes to recruit more area black women for a much larger project, in which some of the participants in the current program will act as facilitators. The cost of this intervention is steep up front, says Melkus, but she hopes to convince policy makers that it is worth the investment.

"If you can educate people in self-management skills, you can minimize the incidence of complications," she says. "When people end up on dialysis, become blind or require amputations, that's tremendously costly to the community. ... We know we can prevent that."

African-American women interested in participating in Melkus's diabetes program may call her at 785-4418.