Robert Albee is a retired school teacher and Minneapolis resident who was diagnosed with Type 2 diabetes in 1995. I met Albee on a cold and rainy morning for a monthly Diabetes Breakfast in the culturally diverse Phillips neighborhood at the Phillips Community Center.
On that Thursday morning traffic all around the Twin Cities screeched to a very slow halt as the unexpected heavy rain came during rush hour. The rain was no deterrent to 35 participants who showed up to eat a hearty breakfast burrito bowl layered with beans, eggs, sausage, lettuce, fresh cilantro, tomato and a side of fresh apple slices.
Participants crowded around tables with hot coffee in hand to hear a psychologist and nurse practitioner from the Native American Community Clinic talk about diabetes and how it can affect their mental health. Topics at past breakfasts have included foot care, dental hygiene, and nutrition. The approach that Albee and his wife Sharon took in forming their two-year-old group, A Partnership of Diabetics (A-POD), is one of sharing in community with other diabetics. In addition to a monthly diabetes breakfast with speakers, A-POD holds weekly meet-up style groups. Each meeting starts with members recording their blood pressure and weight. During the meetings, members share their successes, struggles, and tips for better management of a sometimes very complex disease. Albee says about 100 people per month attend the breakfast and/or meet-up groups.
Albee has no medical background outside his personal experience with diabetes. He believes that a medical background is not necessary to help those with diabetes succeed. “We come mostly from mostly inspiration, not from an academic background. Innovation comes from people willing to take risks… It’s not a medical model at all, it’s a community model, and some would call it a promotoras (Latino lay health educators) model in some ways. In other words, villages have always kept people healthy. We learn by indigenous wisdom and experience.”
Diabetes in Minnesota
Two Twin Cities residents are taking an innovative approach to bringing awareness to the disease. Looking past the statistics Robert Albee and Robert Karimi are using their personal experiences with diabetes to meld community togetherness and culture as tools in the fight against diabetes.
In Minnesota, diabetes is the sixth leading cause of death. The number affected by the disease is on the rise in Minnesota and nationally. Diabetes costs $174 billion dollars per year in the United States.
Type 2 diabetes is a type of diabetes that typically develops later in life. “80 % of individuals with Type 2 diabetes whether child or adult could prevent or reduce risk by modifying lifestyle, which primarily comes down to healthy eating and being active,” says Carol Manchester, Advanced Practice Clinical Nurse Specialist and Certified Diabetes Educator at University of Medical Center and Amplatz Children’s Hospital. Usually diagnosed in adulthood as a result of the body’s inability to use insulin effectively or produce enough insulin. Insulin is a hormone secreted by the pancreas and is responsible for controlling the amount of sugar in the blood.
Ironically once referred to as “adult onset diabetes” Type 2 diabetes is now being diagnosed in young children, a startling effect of rising obesity rates and inactivity in young children. However, half of all dollars spent on diabetes related medical care are directed at treating the high cost complications of the disease in the hospital. When diabetes is left untreated it can result in heart disease, blindness, nerve damage, limb amputations, infections and wounds that are slow to heal, and kidney failure.
APOD Diabetes Breakfast
Richard Jacobi is a southeast Minneapolis resident, Type 2 diabetic and A-POD member since its inception. When he was diagnosed in 2009, Jacobi was thankful for the initial support from a diabetes educator and dietician. What was missing was very practical advice. “How do I journal food intake?” Jacobi asked. “I had to figure it out myself.” Through A-POD and self determination, Jacobi started to incorporate cooking, exercise (including yoga 2-3 days/week), and a food journal to eventually lose 100 pounds. His diabetes is now completely controlled with a healthy diet and exercise.
Carol Manchester, Advanced Practice Clinical Nurse Specialist and Certified Diabetes Educator at University of Medical Center and Amplatz Children’s Hospital, says diabetes can’t be cured presently. She said, “I tell my patients you have no current clinical signs of diabetes if you continue on this path of healthy eating and exercise you will likely be okay, but if you lapse ( diet and exercise) you will see the diabetes return.”
Jacobi feels that the traditional medical system needs to seriously look at the benefits of the peer to peer exchange that is inherent in the A-POD model. “There is information that comes up in that kind of exchange that doesn’t come up in the lecture format where the medical professional sits the diabetics down and lectures them,” he said. “Even with Q&A after (a medical appointment) it just isn’t the same. You receive and share information (at A-POD) that doesn’t come to mind in other contexts.”
Manchester agrees that patients could benefit from more support, “With coaching and emotional support — it can come from family, a church group or community group, to really support an individual for the long haul so they aren’t feeling isolated, alone, or discouraged. Our system needs to be looking at how do we reach out to individuals in their home? People live at home and that’s where we need to help them succeed.”
Kickoff event of Somali Elder women’s diabetes program
Albee volunteers all of his time and operates on a very small budget with support from the Allina Backyard Initiative, Novo Nordisk, and the Phillips Neighborhood Association. Albee feels that his model of partnership and exchange between diabetics could be expanded to help more communities. A-Pod started a Somali elder diabetes group in late 2011 and has plans to create a Spanish speaking A-POD group. New immigrants are at especially high risk of developing Type 2 diabetes as they acculturate to the American diet.
For Albee, one roadblock to reaching more people in need are the finances of a group like A-POD in the medical system. “There is no insurance reimbursement for programs like this,” he noted. “When you look at the cost of medical care and what the outcomes are, you find they are totally unrelated. We have been spending trillions of dollars and people are getting sicker, but there is no huge profit in what we’re doing here.”
Currently most insurance policies cover up to 10 hours of diabetes education at the time of diagnosis and two hours annually thereafter. Manchester doesn’t think for most individuals this is enough support. “People who are highly motivated may be fine,” she said, “but others might need a monthly/weekly phone call and a monthly visit. Our system is currently not set up to support that.”