[Community diabetes educational intervention at the primary care level].
OBJECTIVE
To offer an educational alternative on diabetes, with the participation of patients with type 2 diabetes, their family members, and health care providers, adapted to local conditions and to these person's felt needs.


METHODS
Focused on the primary-care level, this program was carried out in the health area of El Guarco, which is in the province of Cartago, Costa Rica. The first stage of the project included a qualitative study of the knowledge and practices of both patients and health care providers, looking at diabetes prevention and control and the local availability of foods. Based on those results, an educational methodology was developed, educational manuals were written, and courses for health care providers, patients, and patients' families were implemented. Other strategies were developed to make the effort sustainable.


RESULTS
We found that patients did not associate family history or obesity with diabetes and that those persons were also confused about the symptoms of diabetes. Patients also received inconsistent nutrition messages from health care providers. Using the diabetes education manual as a base, the providers increased their knowledge of diabetes prevention, treatment, and education by an average of 85%. The diabetic patients who received educational training (mean age, 57.0 years, with a standard deviation of 8.9 years; 92% women) improved their glycemic control. Blood glucose levels decreased from 189 +/- 79 mg/dL (average and standard deviation) to 157 +/- 48 mg/dL (P < 0.05), and glycosylated hemoglobin (HbA1c) went from 11.3% +/- 2.4% to 9.7% +/- 2.3% (P = 0.05). There were no significant changes in body weight or lipid profile, except for triglycerides, which declined (P < 0.05).


CONCLUSIONS
This educational program was successfully incorporated into the regular activities of the El Guarco-area health centers. The primary-care level is ideal for carrying out educational programs for diabetes treatment and early detection that are directed at patients, their families, and health care providers.
Aráuz
A G
AG
Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (Inciensa), Tres Ríos, Apartado 4-2250, Costa Rica. aarauz@inciensa.sa.cr
Sánchez
G
G
Padilla
G
G
Fernández
M
M
Roselló
M
M
Guzmán
S
S
D000328:Adult; D000368:Aged; D003364:Costa Rica; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000517:prevention & control*; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011320:Primary Health Care; D012307:Risk Factors