U.S.-Mexico Border Diabetes Prevention and Control Project

Purpose

The goal of the U.S.-México Border Diabetes Prevention and Control Project is to prevent diabetes complications by controlling diabetes among people who have type 2 diabetes in the U.S.-México border region. The project develops and implements strategies in collaboration with the 10 U.S.-México Border States; the Pan American Health Organization (PAHO); and various federal, state, academic, and nonprofit organizations with an interest in diabetes prevention and control in the border region.

This project is a borderwide collaborative research effort between two neighboring nations, and it consists of two phases. Phase 1 focuses on activities to determine the prevalence of diabetes and its risk factors for the largely Hispanic population living on both sides of the border. Phase 2 focuses on activities with community health workers (CHWs), health care professionals, border legislators, health authorities, academics, researchers, policy makers, and decision makers. Activities in phase 2, include training for health care providers; diabetes forums, publications, and policy briefs; and developing a network of researcher in the border region.

Although Phases 1 and 2 were implemented consecutively, the two-phase approach was conceptualized from the project’s beginning— the Border Region partners and stakeholders, listed in the Partner section below, clearly expressed their intention to only support a prevalence study (Phase 1) that would inform community interventions intended to improve the health status of the border region population (Phase 2).

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Background

The border area extends 60 miles (100 km) on each side of the 2,040 mile (3,400 km) international boundary between the United States and México. It includes the southern portions of four states of the United States (Arizona, California, New Mexico, and Texas) and the northern portions of six Mexican states (Baja California, Chihuahua, Coahuila, Nuevo León, Sonora, and Tamaulipas). According to the 2000 censuses of both countries, the total population of the border region is about 12 million people. The U.S.-México Border Diabetes Prevention and Control Project documented the problem of diabetes in this program. Phase 1 showed that more than 1.11 million inhabitants of the bi-national border region had diabetes. Of adults with diabetes, 40% of adults in the México Border States and 11.6% of adults in the U.S. Border States were unaware of their status. Overweight and obesity rates were high with prevalence values among people with diabetes in Mexico at 27% and in the United States at 54.5%.

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Implementing Phase 1

1999–2003
The U.S.-México Border Diabetes Project was originally funded in 1999 as a joint initiative of the Centers for Disease Control and Prevention’s (CDC) Division of Diabetes Translation, the United States and México Border State Diabetes Control Programs, the Secretariat of Health of México (SSA), the U.S.-México Border Health Association (USMBHA), the PAHO, Paso del Norte Health Foundation, the California Endowment Foundation through Project Concern International/Border Health Initiative, the Border Health Foundation, and the El Paso Diabetes Association.

The project is a cross-sectional study of the prevalence of diabetes, prediabetes, overweight adults, and preventive health practices. A survey was administered between February 2001 and October 2002 to a large random, stratified sample (n=4027) of the population aged 18 years or older living in the U.S.-México border region.

The objectives of Phase 1 were to 1) determine the prevalence of diabetes among residents of for the U.S. México border aged 18 years and older, based on current American Diabetes Association recommendations and National Health and Nutrition Examination Survey IV using fasting plasma glucose (FPG), and to assess glucose control by also testing for hemoglobin A1c (HbA1c or glycohemoglobin); 2) determine the prevalence of behavioral risk factors and access or barriers to diabetes care; 3) assess associated risks factor for diabetes; 4) conduct quantitative analysis of the study data as well as a qualitative analysis; and 5) develop reports for reference and recommendations based on study findings.

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Summary of Results and Accomplishments - Phase 1

Prevalence of diabetes
Among residents of the Border region, the total (whether self-reported or diagnosed through the study) prevalence of diabetes was 15.7%. More than 11% reported having been told by a health professional that they have diabetes and an additional 4.3% did not know that they had diabetes at the time of the study.

Prevalence of prediabetes
In the total border population sample, the prevalence of prediabetes was 14%. Prediabetes was defined as having no diabetes and FPG in the range 100–125 mg/dl.

Prevalence of overweight and obesity
Body Mass Index (BMI) was used to classify the participants as underweight (BMI <18.5 kg/m2), normal (BMI 18.5–24.9 kg/m2), overweight (BMI 25.0–29.9 kg/m2) or obese (BMI ≥30.0 kg/m2). By this criterion, less than 1% of the Border population was underweight, 23.6% was normal weight, 36.9 % was overweight and 38.3 % was obese. In the border area, 40.9% of men and 35.6% of women were overweight, whereas 34.4% of women and 33.0% men were obese.

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Implementing Phase 2

2004–Present

In collaboration with partners and stakeholder from Phase 1 who provided technical support to the project, a proposal was developed for the implementation of Phase 2. In this phase, the goal is to strengthen the capacity of health care providers and CHWs through skill building trainings. An additional focus of this phase will be to publish the findings of the prevalence study. Phase 2 includes the following activities: trainings for health care providers, diabetes fora, publications, policy briefs, and developing a network of researcher in the border region.

Training
Training is being delivered in seven strategically selected sites along the border, in English or Spanish, as preferred by the health care providers and CHWs. CHWs are being trained using Road to Health Toolkit (RTH), a toolkit on primary prevention of type 2 diabetes based on the Diabetes Prevention Program Study (DPP). This toolkit was developed by National Diabetes Education Program (NDEP), a collaboration between the U.S. Department of Health and Human Services’ National Institutes of Health (NIH) and the CDC. Health professionals will be trained using the International Curriculum for Diabetes Health Professional Education of the International Diabetes Federation (IDF).

US-México Border Diabetes Fora
Border Diabetes Fora target policy makers, health care professionals, media, diabetes educators, persons with diabetes and their family members, and faith-based organizations across the border area. These fora are intended to educate the participants about the needs of the border population with diabetes with the expectation of informing policy makers to act and possibly influence border related policies.

Publications
The purpose of the publications will be to share the findings of the project with the community and partners at large. Scientific articles will cover the following health themes: burden of type 2 diabetes, risk factors and Border social determinants of health. The U.S.-Mexico Border Diabetes Prevention and Control Project First Report of Results publication is available from the PAHO/WHO United States-Mexico Border Offices or can be accessed from their Web site at http://www.fep.paho.org/.

Network of researchers in the Border Region
A network of researchers currently working on chronic diseases in the border region will be assembled. Training and technical support for up-and-coming local researchers will be provided, to increase their awareness and access to prevalence data collected during phase 1 of the project.

Policy briefs
Policy briefs and white papers will be developed in collaboration with partner border institutions, such as the University of Texas El Paso, University of Texas Pan American, University of Ciudad Juarez, National Institute of Public Health of México, Colegio de la Frontera (COLEF), Colegio de Sonora (COLSON), and Universidad de Tamaulipas. These policy briefs and white papers will also be shared with policy makers, decision makers, and community leaders.

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Key Messages for policy and decision makers, and community leaders

• Prevalence data from the phase 1 study are available for researchers on border health issues through the PAHO US- México Border Field Office at El Paso, Texas (www.fep.paho.org)
• The U.S.-México Border Diabetes Prevention and Control Project is a unique study that considered the border area of the United States and México as an epidemiological unit.
• By the end of August 2010, a well trained cadre of health care professionals and CHWs on Border health issues will have been created.
• Publications using data obtained from the phase 1 study are available for states in both the United States and México that are working to reduce the burden of diabetes in Hispanic/Latino populations and other organizations or partners with interest in border health issues.
• A network of researchers currently working on chronic diseases in the border region will have access to phase 1 data.
• Policy briefs and white papers will be produced to help increase awareness about type 2 diabetes in the border region and for organizations and partners interested in border health issues.

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Summary

U.S.-México Border Diabetes Prevention and Control Project is a two-phase collaborative project that includes Phase 1, a survey of diabetes prevalence and identifying risk factors, and Phase 2, which includes training for CHWs and health care providers, diabetes forums, publications, policy briefs, and developing a network of researchers in the border region.

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Partners

México
Ministry of Health of México
Centro Nacional de Vigilancia Epidemiológica y Control de Enfermedades
Mexican Diabetes Association of Nogales, Sonora
Ciudad Juárez Diabetes Association
Ciudad Juárez Autonomous University
Mexican Diabetes Association
Mexican Diabetes Association of the State of Chihuahua
State Diabetes Prevention and Control Program of Baja California,
State Diabetes Prevention and Control Program of Chihuahua,
State Diabetes Prevention and Control Program of Coahuila,
State Diabetes Prevention and Control Program of Nuevo León,
State Diabetes Prevention and Control Program of Sonora
State Diabetes Prevention and Control Program in Tamaulipas
Local Health Departments in all Border Cities
Laboratorio Estatal de Monterrey
United States
United States Department of Health and Human Services
Health Resources and Services Administration
Centers for Disease Control and Prevention
Arizona Department of Health Services
California Department of Health Services
New Mexico Department of Health
Texas Department of State Health Services
Pan American Health Organization
U.S.-México Border Health Association
Paso del Norte Health Foundation
Border Health Research
Border Health Foundation
The California Endowment
Project Concern International
California Diabetes Control Program
Arizona Diabetes Control Program
New Mexico Diabetes Control Program
Texas Diabetes Control Program
El Paso Diabetes Association
University of Missouri, School of Medicine
Center for Border Health Research
Primus Corporation
R.E. Thomason Hospital, El Paso, TX
Río Grande Council of Governments
New Mexico State University at Las Cruces
Doña Ana County Community College
Arizona Border Health Office
Local Border Health Departments
County of San Diego Public Health Laboratory
Gateway Community Health Center
Southwest Arizona Health Education
University of Texas at Houston School of Public Health at El Paso
College of Public Health of the University of Arizona
Western Arizona Area Health Education Center
American Institute of Research
National Diabetes Today Training Center Office of International Health and Human Services
Home Choice Nurses
National Diabetes Education Program
National Institutes of Health

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More Information

PAHO

Maria Teresa Cerqueira, MS, Ph.D.
Chief of the U.S.-México Border Office
PAHO/WHO
5400 Suncrest Drive Suite C-4
El Paso, Texas, 79912-5615
Tel. (915) 845-5950 ext.12
cerqueim@fep.paho.org 

Rosalba Ruiz -Holguin MD MPH
US- México Border Diabetes Prevention and Control Project
Pan American Health Organization
US- México Border Field Office
5400 Suncret Drive Suite C-4
El Paso, Texas 79912
Phone 1 (915) 845 5950 ext. 37
Fax 1 (915) 845 4361
ruizrosa@fep.paho.org 

México Secretariat of Health

Agustín Lara, M.D. – México Coordinator
Director, México Secretariat of Health
132 Benjamin Franklin, 2do piso
Colonia Escondón-Miguel Hidalgo
México DF, México C.P. 11800
(011) 52-55-2-614-6339 or 6340
adulto_anciano@mail.ssa.gob.mx 

For more information, call toll-free 1-800-CDC-INFO
1-888-232-6348 TTY, or E-mail cdcinfo@cdc.gov

 

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