Diabetes sufferers take charge of their health with Project Dulce's help

When Trinidad Marasigan checked in at Operation Samahan community clinic last April she was worried to the point of panic — her blood sugar was high, she suffered dizzy spells, and her weight was ballooning.

In other words, the 63-year-old uninsured Filipino woman was the perfect candidate for Project Dulce.

A partnership between Scripps Health and a network of 13 community-based clinics, Project Dulce is a comprehensive diabetes management program for the underserved and uninsured in San Diego County.

The program, which served more than 14,000 people through 440 classes last year, is tailored to fit the unique cultural needs of the population that each clinic serves, such as Operation Samahan’s largely Filipino community in San Diego’s Mira Mesa neighborhood. In 2009, Scripps’ investment in the program was $449,000.

For Marasigan, that meant learning about which ethnic foods – from the everyday staple of rice to turon, the Philippine dessert of deep-fried, wonton-wrapped bananas rolled in brown sugar – caused her blood glucose to spike. It also meant learning to cut back on portion sizes, to dispel misconceptions about diabetes medications, and to begin an exercise regimen.

Now, after completing an eight-week course of intensive classes and regular monitoring by the Project Dulce team, Marasigan’s hemoglobin A1c — which measures what a diabetic’s blood sugar levels have been running for the past three months — has dropped from 11.4 % to 8.7%, and she’s shed 20 lbs.

“If I did not come to the Project Dulce classes, things would be very different because I didn’t know how to do food portions, I didn’t know about exercise, and I was very scared of taking insulin,” said Marasigan. “But they taught me that these things are not bad,” said Marasigan, with a laugh. “It was ‘do you want to sit in a wheelchair, or take care of yourself and be healthy?’ ”

It’s a choice that an increasing number of Filipino Americans, the second largest Asian group in the United States, must face. Recent studies indicate that Filipino Americans have an elevated risk for developing diabetes compared to both other Asian groups and non-Asians, with some studies putting it as high as 16 percent.

There has also been an alarming rise in obesity — which is linked closely with the onset of Type 2 diabetes — in California’s Filipino community. An estimated 46 percent of Filipinos are considered overweight or obese, compared with the state average of 34 percent, according to UCLA researchers.

The elevated risk for diabetes within the Filipino community is compounded by the present economic recession and rise in the uninsured — now at roughly 20 percent — among Filipinos, according the San Francisco-based Asian and Pacific Islander American Health Forum.

This makes programs like Project Dulce more vital than ever, says endocrinologist Dr. Athena Philis-Tsimikas, corporate vice president of the Scripps Whittier Diabetes Institute, which helped launch Project Dulce in 1997.

At every level, Project Dulce — through its classroom approach and the nurse-led team that monitors and manages patient care with clinic physicians — has a proven track record.

Project Dulce participants have significant reductions in HbA, blood pressure, and cholesterol, compared to diabetes patients who don’t participate in the program, according to Philis-Tsimikas.

And while studies indicate that Project Dulce participants experience higher up-front costs in the first year of intervention — because they are getting the medications and diabetes testing supplies that they might otherwise not have gotten – they also have reduced emergency room and hospitalization costs.

“It’s a unique program,” says Philis-Tsimikas, whose nonprofit institute actively tracks about 5,000 Project Dulce diabetes patients at any given time. “We’ve not been able to find one like it in the country where community health centers and a nonprofit center of excellence in diabetes work this collaboratively, and produce these kinds of results.”

And, by helping the patient to take charge and make a change in his or her own health, Project Dulce has a positive ripple effect on the lifestyle choices and eating habits of the patient’s family, according to patients and Project Dulce administrators.

“Once you get a patient to come into the program — that initial visit — then you have them, they are hooked,” said Aurellia Stephens, a registered nurse and certified diabetes educator who leads the Project Dulce team at Operation Samahan and several other San Diego community clinics. “Then it’s ‘oh, why didn’t I come before.’ ”

For Stephens, whose mother died of diabetes-related complications, Project Dulce is “a passion.”

“What I tell my patients to do, I have to do, because I have those genes in my body,” said Stephens, who has been involved in Project Dulce for eight years. “I have to do exactly what I’m telling them to do, so I know what they are going through.”

It is that intensive, hands-on and culturally sensitive approach to diabetes management that wins over almost every patient who enrolls in Project Dulce, says Syeeda Akhter-Rahmann, project coordinator of Operation Samahan.

“Many of our patients really love coming to class because they see that there are other people dealing with this just like them,” said Akhter-Rahmann, who teaches three, 8-week Project Dulce courses each year at Operation Samahan.

“They come here confused and often in a panic,” said Akhter- Rahmann. “Then they learn how to manage their diabetes and delay or avoid complications, and they leave with hope.”

For information about diabetes programs at Scripps Whittier Diabetes Institute, call 1-877-WHITTIER.