Diabetes Doesn't Need to Disable African Americans, Yale School of Nursing Researcher Finds

Gail D’Eramo Melkus is fighting a vicious and subtle epidemic.

Melkus, an associate professor at the Yale School of Nursing, studies diabetes in African-American women along with co-investigator Geralyn Spollett, assistant professor. Their work is funded by the Donaghue Foundation.

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 than whites do: blindness, renal failure and amputations are much more common as a result of diabetes in African-Americans than in whites.

Although 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.

“They are very motivated to improve their health,” Melkus says of the women in her current study. “They know they are needed by others, because they are caregivers and gatekeepers.”

Despite that motivation, Melkus realizes that many people of color are reluctant to participate in health studies. They are scared off by a history of exploitation, most notoriously epitomized by the Tuskegee syphilis study, and are put off by a primarily white healthcare system that is rife with barriers both cultural and economic.

“This program would never have worked without the support of the New Haven black community,” said Melkus. She and Delorise Simmons, recruitment coordinator for the study, established an advisory board of African-American community and church leaders who do everything from helping her recruit study participants after Sunday services to previewing educational videos for cultural appropriateness.

Women in Melkus’s 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 is helpful in getting the 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. Topics include reading labels of prepared foods, culturally appropriate recipes and strategies for working an exercise routine into an already full day. Melkus notes that the women in her study all work and many care for children and grandchildren as well, all with limited resources. 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.

“It’s a partnership,” says Melkus. It’s a partnership that pays off, she notes. With an approximate 15 pound weight loss, blood pressure, blood sugar and cholesterol all improve significantly.

Access to health care has historically been a big issue for many of the women in the study. Even some with private insurance do not see their providers as often as they need to because they cannot afford the co-payment or deductible, says Melkus. She has tried to remove as many barriers as possible for the women in the study, 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 said.

Even when African-American women do have good access to care, their diabetes may go unaddressed. In a previous study, Melkus 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. Gender, race and weight discrimination all play into the lack of attention to diabetes risk, according to Melkus.

Melkus’s pilot study is drawing to an end. 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. Women who were caregivers and heads of households require hours and days of care every week from their families. We know we can prevent that.”

African-American women interested in participating in Melkus’s diabetes program may call her at (203) 785-4418.