DREAM Team Newsletter
March 2024 | Issue 6.2
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THE GROWING GLOBAL IMPACT OF DIABETES
By Melissa Belec, DO, MPH
For much of the world, infectious diseases (including malaria, parasites, viral fevers, HIV/AIDS, etc) have long posed the greatest threat to health. As societies have become more sedentary and food choices have shifted toward more prepared and prepackaged foods high in fat and sugar, as well as sugar sweetened beverages like sodas, this balance has shifted and most countries throughout the world are now facing greatly increased rates of type 2 diabetes and other chronic diseases-like high blood pressure, obesity, and kidney disease. Many of these places are still in the process of developing health systems to deal with these newer health problems. According to the International Diabetes Federation, there are currently 537 million adults living with diabetes worldwide and that is expected to increase to 783 million people in the next 20 years. Approximately 75% of those people with diabetes live in low and middle income countries that often have underdeveloped health infrastructure to deal with lifelong chronic diseases. There is expected to be a 50% increase in diabetes in South America over the next 20 years and a 134% increase in diabetes in Africa. We at the DREAM Team are passionate about helping to address the diabetes burden of our global partners, as well as locally in Solano County.
Current DREAM Team Global Health Initiatives - The DREAM Team has partners in both Ecuador and Tanzania with whom we have ongoing projects. We were involved in a pilot project of a Diabetes Prevention Program in Quito, Ecuador with partners at the Pontificia Universidad Católica del Ecuador (PUCE) and have been involved with ongoing education and research efforts there as well. Dr. Belec and Dr. Shubrook are currently teaching a 6-month continuing education course on Type 2 Diabetes for Ecuadorian Family Medicine Physicians. We additionally have recently embarked on a project with Shirati KMT Hospital in Tanzania. Dr. Belec traveled there in 2023 to begin learning more about diabetes there. The DREAM Team is currently involved with an interprofessional group at Touro including public health, biochemistry, and education researchers to help implement a program with community health workers to address diabetes prevention and treatment in rural Tanzania. We are hopeful that with these efforts, we can help strengthen local healthcare systems to better combat the growing threat of diabetes and help create systems and interventions that can be shared with others globally.
DIABETES WEEK 2024 RECAP
By Clipper Young, Pharm D, MPH
We did it again!!! From Feb 5 to Feb 12, 2024, over 240 Touro University California students coming from four healthcare professions (DO, PharmD, PA, Nursing) gathered to learn about diabetes, management and treatment strategies, and clinical applications; as always, we delivered this week through an interprofessional lens, training our students to be as well-rounded as possible.
This year, the DREAM Team added a new component to our teaching: Diabetes Ketoacidosis (DKA) Simulation (A Big Thank You to Kim Codella, Simulation Manager in CILT, for his support). The DKA Simulation provided an opportunity for students to work in a team to manage and treat an acute complication resulting from type 1 diabetes. It might have been a stressful 30-minute simulation experience for our students; however, this opportunity allowed students to practice solving problems under pressure. In addition to DKA Simulation, the other two components of the Applied Skills Lab included a focused physical exam on skin and foot as well as integration of diabetes technology into patients’ treatment plans.
Another highlight of Diabetes Week was the activities on the last day. We continued with our tradition of conducting a progressive mega case in small groups, focusing on diabetes diagnosis and pharmacotherapeutic approaches for glycemic management and complication reduction. After that, all the students came together, listening to a group of patients and learning about their struggles and challenges (getting exposed to what’s beneath the surface -- the blood glucose readings, medications lists – the emotions and frustrations). It is always important for students to learn about the science, but experiencing the art of diabetes management is equally important in training them to be caring clinicians.
COMMUNITY HEALTH WORKER TRAINING PROGRAM
By Sarah Dudenhoeffer, DO
Diabetes care is known for being exceptionally collaborative at its best, and it is also known for being an exceptional amount of work for patients living with diabetes. The average time per day a patient would have to devote for all recommended diabetes self-care is about four hours for adults and more than five hours for children. (1) One can easily see how having support between the short visits with clinicians is warranted. This is where community health workers come in.
Through the North Bay Community Health Worker Training Program, a collaboration between Aliados Health, Northern California Center for Well Being and Touro University California with funding from the Health Resources and Services Administration, we were able to train 15 new community health workers (CHWs) in a 20-hour diabetes upskill course over a six-week period. The training was led by current Diabetology Fellow, Dr. Sarah Dudenhoeffer.
The benefits of incorporating CHWs into the patients support team are proven and, in fact, are called out as a Level A recommendation in the American Diabetes Association Standards of Care under “Tailoring Treatment for Social Context:”
“1.6 Provide people with diabetes with additional self-management support from lay health coaches, navigators, or community health workers when available. A”
Some trainees reflected on how they could support community members with diabetes in specific scenarios such as at the gym, with cooking, between hospital discharge and clinic follow-up. Other participants were already doing healthcare-adjacent work and saw how having these skills could make them more capable in the setting of a school and a public health department. One participant shared that she was already a caregiver for a person recently diagnosed with diabetes. Another cited -representation and advocacy- as her motivation for wanting to pursue CHW training since throughout her life she witnessed members of her own family and BIPOC communities at large suffering disproportionately from diabetes. Interests and backgrounds among our participants are varied and already invaluable, and they are all part of the local Bay Area community where Touro clinicians and future clinicians work and study.
We congratulate our new community health workers on their Diabetes Upskill Certification. We celebrate guidelines that include “Tailoring Treatment for Social Context” and that we have been given this opportunity to answer that recommendation with this training course.
References:
Shubrook JH, Brannan GD, Wapner A, Klein G, Schwartz FL. Time Needed for Diabetes Self-Care: Nationwide Survey of Certified Diabetes Educators. Diabetes Spectr. 2018 Aug;31(3):267-271. doi: 10.2337/ds17-0077. PMID: 30140143; PMCID: PMC6092887.
DREAM TEAM - NEW MEMBERS
ROCHELLE SILVERMAN
DIABETES PREVENTION PROGRAM LIFESTYLE COACH
Rochelle has logged over 30 years helping people make changes in their lives as a clinical social worker. She has worked in a variety of settings, including roles with addiction treatment facilities, criminal justice organizations, mental health programs, and Veteran services. In 2020, she completed a Certified Health and Wellness Coaching program, which reimagined her journey and expertise into a career that she loves - helping people obtain better physical health and wellness. Rochelle believes most people know what their health goals are, but they are not provided with the tools to achieve them. She sees her role as providing guidance and support to help break down big goals into smaller, more manageable, and achievable ones. Rochelle looks forward to being on this wellness journey with you and celebrating any and all of your successes.
ANDREW GANIO-MARZAN
RESEARCH ASSISTANT
Andrew joined the DREAM Team in Feb 2024 as a research assistant. He will be working with Dr. Clipper Young on research examining the psychosocial needs of individuals recently diagnosed with Type 2 Diabetes. Andrew has received his BS in Public Health from San Francisco State University and has also worked as an intern health educator. Currently, Andrew is working towards gaining licensure as a registered nurse studying at City College of San Francisco.
Outside of work, Andrew’s hobbies include cooking/recipe testing, landscape photography, and running through San Francisco.
TO GOOD HEALTH
Anne Lee, RD, CDCES
Chickpea Salad (Vegan Tuna Salad)
Chickpea Salad (Vegan Tuna Salad)
If you think hummus lacks variety, try this recipe to jazz it up! The chopped-up veggies not only add color to this vegetarian entrée, they add a variety of textures and tastes. In just a few steps, you will be making a simple vegetarian meal that’s healthy and tasty.
15 ounces Chickpeas, canned
1 stalk Celery, finely chopped
1/2 Jalapeño Pepper, minced
2 tablespoons Cilantro, chopped
1/4 cup Red Onion, finely diced
1 teaspoon Fresh Lemon Juice or 1 tablespoon Fresh Lime Juice
3 tablespoons Chickpeas liquid from can
2 cloves Garlic, minced
2 tablespoons Olive Oil
1 teaspoon Honey
Salt & Pepper to taste
Drain 1 can of chickpeas, and reserve 3 Tbsp of chickpea can liquid. Place chickpeas into a wide bowl, and begin to mash them. Add up to 2 Tbsp chickpea can liquid to help the consistency resemble a chunky tuna salad. Add prep vegetables to the mashed chickpeas. For the vinaigrette: add 1 tsp salt, ½ tsp black pepper, 1 Tbsp chickpea can liquid, olive oil, honey, and minced garlic and whisk all ingredients together. Add half the vinaigrette to chickpeas and veggies, mix well and taste. Adjust flavor to your liking with more vinaigrette or salt, pepper, and lime. Eat as you would tuna salad! Over sliced toast or a tostada.
Makes 2 servings.
This recipe does not adhere to Kosher guidelines
Source: https://eatfresh.org/recipe/salads/chickpea-salad-vegan-tuna-salad/
TEA TIME CHAT
NATIONAL DIABETES PREVENTION PROGRAM LIFESTYLE CHANGE PROGRAM INFO SESSION
Don’t let another year fly by without reaching your health goals! An in-person lifestyle change program led by a health coach is starting in your area, and we invite you, your family and anyone who is interested to come find out how this program helps people achieve their health goals and have lasting results. We cannot wait to try new things, laugh, share stories and learn with you and your peers while building new habits to stay healthy!
RSVP today to reserve your spot!
Newsletter Credits
Editor: Sumera Ahmed, MD
Designer: Maryelli Ray
Sponsored by: Sutter Health
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