Sugar, Heart and Life:
A Guide to Living with
Diabetes
Stephen Spann, MD
Department of Family and
Community Medicine
Acknowledgement

This project was generously underwritten by
Mrs. Trinidad Mendenhall Sosa
Burden of Disease
Prevalence of Diagnosed Diabetes Among US
Adults Aged 18 and Older
Race/Ethnicity
Prevalence*
Non-Hispanic Whites
6.6%
Non-Hispanic Blacks
8.4%
Hispanics
7.9%
Source of Data: Analysis of the National Health and Nutrition Examination
Survey 1999-2004
Texas Diabetes Prevalence Compared to the US
Area
Prevalence*
Texas
9.7%
US
7.2%
*Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2008, for persons who are
eighteen years of age and older, and include both Type 1 and Type 2 Diabetes. Persons with diabetes include those
who report that they have been told by a doctor that they have diabetes. Women who report diabetes only during
pregnancy are not included in prevalence. Note: All reported rates (%) are weighted for Texas demographics and
the probability of selection and thus are not derived from the simple division of numerator and denominator cases.
Prevalence of Diabetes, US and Texas,
1995 - 2008*
20
18
%
16
14
12
10
Texas
US
8
6
4
2
08
20
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
20
99
19
98
19
97
19
96
19
19
95
0
YEAR
*Source: CDC Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2008, for persons who are
eighteen years of age and older, and include both Type 1 and Type 2 Diabetes. Persons with diabetes include
those who report that they have been told by a doctor that they have diabetes.
Texas Projected Population Increases by
Race/Ethnicity, 2000-2040*
40,000,000
35,000,000
Population
30,000,000
25,000,000
Hispanic
20,000,000
Black, non-Hispanic
15,000,000
White, non-Hispanic
10,000,000
TOTAL
5,000,000
0
2000
2010
2020
2030
2040
YEAR
*Uses 0.5 migration scenario. Texas State Data Center - Office of the State
Demographer, Institute for Demographic and Socioeconomic Research, College of
Business, University of Texas at San Antonio.
Texas Projected Diabetes Cases
2000 - 2040*
Hispanic (Prevalence = 12.3%)
Black, non-Hispanic (Prevalence = 12.9%)
White, non-Hispanic (Prevalence = 8.5%)
TOTAL (Prevalence = 10.3%)
Number of Diabetes Cases
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
0
2000
2010
2020
2030
2040
YEAR
*Uses 2007 diabetes prevalence by race/ethnicity from BRFSS and population data from the Texas State Data
Center - Office of the State Demographer, Institute for Demographic and Socioeconomic Research. Uses 0.5
migration scenario.
Levels of A1C Among US Adults 18 and Older with
Previously Diagnosed Diabetes
(Percent Distribution, SE)
Race/Ethnicity
A1C<7%
A1C7-8%
A1C>8%
% (SE)
% (SE)
% (SE)
Non-Hispanic White
62.1 (4.19) 21.5 (4.26) 16.4 (4.02)
Non-Hispanic Black
39.2 (6.78) 21.2 (5.76) 39.6 (8.14)
Mexican American
30.9 (5.58) 22.9 (4.48) 46.2 (5.68)
Source of Data: Analysis of the National Health and Nutrition Examination
Survey 1999-2004
Levels of A1C Among Hispanic Adults ≥ 19 years of age with
Previously Diagnosed Type 2 Diabetes
Harris County Hospital District Community Clinics
(Percent Distribution, SE)
Overall/Gender
7-8%
>8%
% (SE)
% (SE)
Overall (n = 191)
26.2 (3.19)
73.8 (3.84)
Men (n = 53)
20.8 (5.62)
79.2 (5.62)
Women (n = 138)
28.3 (3.85)
71.7 (3.85)
Production and Design
Sugar, Heart and Life
Purpose and Development

The Diabetes Interactive Telenovela (DIT) was
designed in response to the high prevalence of
uncontrolled type 2 diabetes among Hispanic
primary care patients in Houston’s Harris County
Hospital District.

Content for development of the DIT storyline was
informed by data obtained from six focus groups
conducted with 72 primary care patients from
three local community health clinics.
Conceptual Model of DIT Intervention
Personal Factors
• Literacy / Understanding
• Attitudes / Beliefs
• Outcome Expectancies
• Motivation
Diabetes
Interactive
Telenovela
(Intervention)
Improved Adherence
Diet, Exercise, Medication
Behavioral Factors
• Social Norms
• Cultural traditions
• Foods consumed
• Physical activity
• Habits
Diabetes
Self Efficacy
Improved
Glycemic Control
(Reduction in HbA1c)
Environmental Factors
• Social support
• Neighborhood
• Access to health care
• Transportation
Objectives and Messaging

Short-Term Objectives
Attitudes, Beliefs, Knowledge changes

Long Term Objective
Improve diabetes regimen adherence in adult Hispanic men and
women

Overall Messages in Storyline (sprinkled throughout):
With good diabetes control one can postpone or prevent the
development of complications
Importance of family support for diabetes management and
prevention
Primary Topics

Diet

Physical Activity

Medication Adherence

Self-Care

Family
Primary Storyline
To follow a family who is dealing with diabetes management
over the course of 1 year
Clip: Victoria Receives Diabetes Diagnosis
Telenovela: Main Components
INTERACTIVE
TELENOVELA
EPISODES
5 Dilemma Sets
Diet (2)
Physical Activity (2)
Medication Adherence (1)
INFO - MARKET
7 Interactive Learning Resources
“What is Diabetes?”
“Check Out Your Choices”
“Claudia’s Recipe Box”
“Create-a-Plate”
“Diabetes Care Toolbox”
“What’s in it?”
“Go for the Goal”
Interactive Learning Modules
Diabetes Interactive Telenovela
Episode Selection
Character Selection
Clip: Luis Chooses to Go to the Bar
with His Friends
Diabetes Interactive Telenovela
Decision Point
Consequences
DIT: Five Years Later
Neutral Outcome: The Gonzalez
family change a few things in the
way they eat and get exercise
Undesirable Outcome: The
Gonzalez family continue with their
usual eating and exercise patterns
Desirable Outcome: The
Gonzales family carefully watch
what they eat and get daily exercise
Clip: Five Years Later Reflecting on the
Family’s Bad Choices
Visit us at:
www.bcm.edu/shl
Questions
and
Discussion