U.S., Mexico bordering on a diabetic health crisis
Officials hope to improve disease management
Health officials in the United States and Mexico are cooperating in an ambitious program to pinpoint the incidence of diabetes in the border states and to assist a largely Hispanic population toward better diabetes management.
The first step of the Collaborative U.S.-Mexican Diabetes Prevention and Control Project involves making contact with 7,000 residents of both countries in a door-to-door survey designed to quantify the rising incidence of diabetes along the border, says David Espey, MD. Espey is an epidemiologist for the Centers for Disease Control and Prevention (CDC) who works with the New Mexico Department of Health in Albuquerque.
"We don’t know why the rate of diabetes is 50% higher than in the general population on the U.S. side of the border, and 70% higher on the Mexican side of the border," says Espey. "That’s why we’re starting with this survey." After the survey, Espey says he expects, "Good solid epidemiological data will help us find ways to begin to decrease the burden of diabetes."
In Phase 1 of the survey, which is not yet fully funded, trained bilingual researchers will conduct door-to-door interviews to assess the prevalence of diabetes, related behavioral risk, and access to health services for the entire population. Phase 1 is scheduled to begin in October.
Information will include height, weight, blood pressure, and access to health care. "We won’t just be asking them if they have been told they have diabetes," Espey says. "We will be actually doing fasting blood glucose tests, so we’ll get a much more accurate picture."
Those surveyed will be given a financial incentive to have fasting glucose levels tested at a local lab. The results of that survey, expected about a year after the project begins, will be used to help develop diabetes education and training activities in Phase 2. Those programs will be designed to appeal to the primarily Hispanic population and will include the participation of primary health care providers and community health workers.
The house-to-house survey will be repeated in the final year of the five-year program to assess results.
Diabetes is among the top 10 causes of death along the border and causes about one-third of the deaths due to non-communicable diseases on the Mexican side of the border, says Gerardo De Cosio, MD, director of technology and skill building for the U.S.-Mexican Border Health Association in El Paso, TX. Recent data suggest the death rate from diabetes has increased by 5% to 13% in recent years. The high death rate is due in part to the poor quality of health care available to the Hispanic population, he says, since at least one-third of the Hispanic border population has no health insurance.
He says the high mortality rate is due to a destructive combination of genetic predisposition to diabetes and the lack of access to health care among Hispanics. "Diabetes isn’t just a disease. It’s a life-devastating problem that just doesn’t go away. That’s why this study is so important."
De Cosio offers these sobering figures:
• The incidence of diabetes runs as high as 30% in some border communities.
• Large numbers of U.S. residents travel to Mexico to get care, which can be 40% to 60% cheaper, and prescription medications which reflect similar savings because of lower labor costs in Mexico.
• About 60% of the Mexican border communities are now closed to U.S. residents seeking medical care because the influx placed a burden on the health care system, so those people are now even further distanced from access to health care.
De Cosio says he sees the project as a way of increasing collaboration between U.S. and Mexican health officials. Funds for the survey project are being contributed by the 10 border states and public and private agencies. The U.S. government has not yet made its contribution, but the CDC has been asked for $735,000. A grant is expected in the next few weeks.
He notes he has been puzzled about the slow funding process: "The CDC says we spend $25 billion a year on treating diabetes. It seems like such a small amount to spend this $2 million to help prevent it and to help patients act before complications set in." U.S. states participating in the project are Arizona, California, New Mexico, and Texas. Mexican border states are Baja California, Sonora, Chihuahua, Tamaulipas, Coahuila, and Nuevo Leon.
[Contact David Espey at (505) 841-5862 and Gerardo De Cosio at (915) 581-6645.]
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