Perhaps the biggest barrier in diabetes care is the divide between the doctor's office and everyday life. Patients with type 2 diabetes might interact with their physician for half a dozen hours each year. For diabetics who live in urban areas, the rest of the time is spent locked in a struggle against the smell of the neighborhood pizzeria, the high cost of a gym membership, and the general stressors of the city.
It's that gap between the couch and the clinic that inspired a recent "small-town approach" to diabetes care called Cities for Life. The year-old program, piloted in Birmingham, Alabama, recruits local partners to help diabetes patients make the difficult changes to their diet, exercise, and stress levels necessary to manage the problem. Patients can discover the nearest health assistance through a website called My Diabetes Connect — effectively extending their care well beyond the waiting room.
"As a clinician, I'm seeing somebody and maybe looking at their glucose levels or giving them a prescription, and then they meet with a nutritionist who tells them basics about what they can do, but it's up to them to go back to where they live or work and implement that," says Dr. Andrea Cherrington, a physician and diabetes researcher at the University of Alabama-Birmingham connected with Cities for Life. "This is a way to touch base with all the resources there that can help you do that."
Cities for Life launched last spring as a partnership between UAB, the American Academy of Family Physicians Foundation, and Sanofi US. Birmingham made for a logical testing ground in part because the city wasn't too big to cultivate a community element. It's also smack in the so-called "diabetes belt" that runs through the southeast United States — showing up clearly on this recent incidence map from the Center for Disease Control and Prevention (via Harvard Health Blog):
The My Diabetes Connect site is populated by a wide range of diabetes services and health activities promoted by local organizations. Patients can find anything from a Zumba class at the nearest YMCA to health lectures at their church to the next farmer's market coming through town, complete with contact information and (when applicable) cost. Cherrington says the site is a helpful resource for clinicians, too, since it enables them to personalize care far more than a simple prescription would.
It's also an aid for family members concerned with the health of a loved one. Surveys conducted at the start of the Cities for Life program (presented at a recent medical conference [PDF]) revealed that while patients had adequate social support systems to manage their disease, they lacked the right motivation. In that context, better community outreach can assist the family and friends of diabetics as much as the patients themselves.
What's great about the current program, says Cherrington, is that it represents much more than the equivalent of an online phone book. On the contrary, volunteers from Cities for Life scoured the Birmingham area for partners, calling or visiting as many community groups as they could. So far that grassroots effort has drummed up at least 80 official Cities for Life partners — together known as the Community Action Team for area patients.
"We're basically looking under every rock and stone to find the resources," says Cherrington. "So in that way it has a small-town feel."
Ultimately, Cherrington believes this small-town approach could extend to other cities in the diabetes belt and beyond. (She also thinks it would do well in rural areas, where both services and access to physicians is limited.) In the long run, she says, the goal should be a louder general conversation about diabetes. For the moment, though, program leaders are focused on sustaining Cities for Life in metropolitan Birmingham the aftermath of its initial funding period.
"We feel like we've garnered a lot of momentum," says Cherrington. "We want to figure out a way to continue to build on that."