University of Texas at Austin Nursing Researcher Receives Additional Funding To Help South Texans Manage Diabetes

AUSTIN, Texas—Dr. Sharon Brown, a professor of nursing at The University of Texas at Austin, has received $470,000 from the National Institute of Diabetes and Digestive and Kidney Diseases to continue her research in the area of health promotion and disease prevention in Mexican Americans with type 2 diabetes.

The study, a diabetes self-management education border initiative in the impoverished South Texas community of Starr County, has shown significant positive results, but much more needs to be done, said Brown.

Her grants since 1992 now total nearly $6 million. The new project continues the successful 17-year collaboration between Brown and Dr. Craig Hanis, a geneticist at the University of Texas Health Science Center at Houston.

With the new funding, Brown plans to add nurse case managers to the diabetes self-management education program that she has been testing in Starr County to improve health care access.

"These are nurses specifically trained to assist people in navigating the health care system," said Brown. "There are many health care services and resources residents could be taking advantage of—but don't know about them or how to access them. We can teach them everything they need to know about managing diabetes, but it's irrelevant if they can't get the health care resources they need, such as medications for treating their diabetes."

Starr County, the site of the current ongoing study, is a community that holds the record for the highest number of diabetes-related deaths of any county in Texas. The area, which is 98 percent Mexican American, also is the poorest county in Texas and one of the poorest in the United States. Fifty percent of residents over the age of 35 have diabetes or have a first-degree relative with diabetes, which means they are at high risk of getting it themselves.

"The problem of type 2 diabetes among Mexican Americans who live along the Texas-Mexico border is at epidemic levels and recent research shows that rates have doubled over the past 20 years," Brown said.

Researchers believe its occurrence can be accounted for by genetics and individual lifestyles.

"Since becoming aware of the tremendous burden of diabetes in Mexican Americans," Brown said, "we have worked to develop and test culturally sensitive approaches to address this enormous problem, particularly in South Texas."

Brown and her group designed and are using an educational intervention, which includes instruction on nutrition, self-monitoring of blood glucose, exercise and group support to promote behavioral changes. The program is culturally specific for language, diet, family participation and health beliefs. More than 1,000 people have gone through the education program.

Results of the self-management program have shown reductions in blood sugar levels, but effects diminished over time. Outcomes also have shown a reduction in glycosylated hemoglobin levels, a measure of what blood sugar levels have been over the past two to three months and a more stable indicator of progress.

"Yet, there are still socio-cultural and personal barriers that remain, preventing individuals from achieving optimal health outcomes," said Brown.

Health initiatives like Brown's are considered a challenge in Starr County particularly because the community has been designated by the state of Texas as underserved and residents may lack transportation and tend to live chaotic lives with frequent financial, health and personal crises.

"These are the poorest of the poor," said Brown. "Per capita income is $8,500 a year."

Often there is no access to medical care, and advice about the disease comes from family members and other people with diabetes so Brown's approach has been to include family members in the project. Her program has been an attempt to teach participants how to take proper care of their diabetes themselves.

Interventions in Brown's program are held in churches, schools and day care centers throughout the community. The ultimate goal is to integrate the program into clinics and hospitals so that a greater number of people with diabetes can benefit from learning diabetes self-management.

For more information contact: Nancy Neff, The University of Texas at Austin Office of Public Affairs, 512-471-6504; Dr. Sharon Brown, James R. Dougherty, Jr. Centennial Professor in Nursing, 512-232-4704.