Comprehensive, culturally appropriate approach to diabetes care: Dulce New Jersey diabetes disease management program

This study reports on the outcomes of a two-year demonstration project aimed at improving the health outcomes of New Jersey minorities with diabetes, particularly Hispanics/Latinos and African Americans, who have traditionally exhibited poor diabetes management and outcomes and are at high risk for disease complications. The project modified and implemented a “Project Dulce” model originally developed in California. The model employs two complementary strategies: (a) nurse-managed clinical care, including routine screening and healthcare services using Staged Diabetes Management, provided by a team of clinicians, and a mechanism for referrals to specialists, lab tests and tracking outcomes using an electronic management system; and (b) community-based health education/promotion using trained peer educators who lead culturally and linguistically appropriate eight-week education courses for individuals with diabetes from the same community, using a curriculum that promotes healthy lifestyles and addresses cultural beliefs in ineffective remedies. The project, planned to help hospitals close the gap in diabetes care for minorities, has been piloted in three hospitals with primary care clinics and ADA-recognized diabetes education programs. The preliminary findings document improved diabetes clinical outcomes; increased patient knowledge about the disease and how to manage it; improved health and self-care behaviors; decreased incidence of diabetes-related complications; and decreased diabetes-related hospitalizations and emergency department visits for diabetes-related conditions/complications, reflecting lower diabetes care costs. Long-term plans are underway to expand to additional sites, promote further replication of the model throughout New Jersey and establish a regular training program relying on previously trained nurses and educators to serve as faculty.