Promotoras Key to Diabetes Care

For more than 15 years, Scripps Whittier Diabetes Institute has sponsored Project Dulce to fight diabetes in San Diego. New research is showing that this big investment in community health is paying off. Project Dulce combats diabetes by recruiting peer counselors from the Latino community, called promotoras, to work directly with patients.

The program helps diabetes patients adjust their diets, exercise routines and other activities that may reverse diabetes. Research published in 2012 in Clinical Diabetes, the journal of the American Diabetes Association, showed that the program significantly lowers patients’ blood sugar, cholesterol and blood pressure.

According to Athena Philis-Tsimikas, MD, corporate vice president of Scripps Whittier Institute for Diabetes and lead author on the paper, the promotoras are the secret to the program’s success. These specially trained health workers teach classes in Spanish to patients who have been diagnosed with type 2 diabetes, or are at risk of developing the disease. Dr. Tsimikas’ paper synthesizes numerous papers that have examined Project Dulce’s efforts over the last 15 years.

The study showed that patients who worked with a promotora were healthier than those who received traditional diabetes management. For example,Project Dulce participants averaged a 7.2 percent drop in total cholesterol compared with a 2.4 percent reduction for nonparticipants. Most Scripps promotoras learned to control their own diabetes through the program, which was created in 1997 by Scripps, the County of San Diego,community health centers and researchers at San Diego State University.

As peers, promotoras relate to at-risk people in the Latino community, overcoming cultural barriers to help patients change their lifestyles. “Getting buy-in from patients is about showing,rather than lecturing,” says Alma Ayala, a promotora who started as a program client. “Promotoras exercise with our patients, and we check our own blood sugar levels.”

Promotoras also can help combat deeply held traditions. For example, Latino cooks often use lard in their recipes. While it adds a distinctive flavor, lard is quite fattening. Promotoras can persuade their patients to choose healthier alternatives.The program has been so successful that Scripps has trained other caregivers in Los Angeles, Tijuana, New Jersey and even India.

For more information

To learn more, view the 2014 Community Benefit Report. (PDF, 6.41 MB)