Improving Diabetes Management in Mexico and the United States

Five years ago, Diane Berry, PhD, ANP-BC, FAANP, FAAN, first connected with Lidia G. Compeán Ortiz, PhD, of the Autonomous University of Tamaulipas School of Nursing in Tampico, Mexico through email. Dr. Compeán was introduced to Dr. Berry by Associate Dean for Strategic and Global Initiatives Gwen Sherwood, PhD, RN, FAAN, in the hopes the two of them might strike up a research collaboration through their shared interests in health care related to type 2 diabetes management and prevention. Now, along with co-investigator Paulina Aguilera Pérez, MSN, they are working together on a series of projects that could, among other goals, lead to an evidence-based intervention to help individuals of Hispanic heritage manage their diabetes in Mexico and the United States.

According to Dr. Compeán, diabetes is a growing problem in Mexico. “Every six years, the government does a special health survey,” she explained. “To determine the prevalence of diabetes, one of the indicators they investigate is blood glucose.” The most recent survey in 2012 reported a type 2 diabetes prevalence of approximately 9% in the entire county. However, there were seven Mexican states with a prevalence ranging from 10% to 12 %. One of the states is Tamaulipas, which is on the northern border of Mexico and in close proximity to the United States.

Many Hispanic patients of Mexican heritage face challenges in receiving treatment for diabetes. Unlike the United States, where individuals who live with diabetes test their blood glucose several times a day, most patients in Mexico do not own blood glucose monitors due to the prohibitive cost. Therefore, they typically don’t check their glucose before and after meals. Instead, they go to a clinic and have a fasting blood glucose test once a month. Lacking the valuable information of home-based glucose tests, many patients in Mexico with type 2 diabetes try to manage their diabetes with medication.

The diet in Mexico has also changed. Fast food is now widely available, which has led many Mexicans to adopt a diet that is higher in carbohydrates. The change in diet has led to higher blood sugar, which lead to higher levels of glycated hemoglobin (A1C). “Patients with higher A1C face increased risk of microvascular and macrovascular complications, such as heart attacks,” said Dr. Compeán.

Dr. Compeán and her colleagues are taking multiple steps to better understand and address this growing health care issue. “We are exploring self-care behaviors through seventeen community health centers,” said Dr. Compeán. “Part of our research includes looking at how family members can influence self-care behaviors for people who have diabetes and for themselves.”

Dr. Berry and Dr. Compeán meet each year either in Mexico or the United States to plan research, grants, and manuscripts. Recently, Dr. Compeán and Professor Aguilera (who is also a PhD candidate at the University of Alicante Spain) traveled to Chapel Hill for a two-week research stay with Dr. Berry. During this most recent trip, they worked on a small grant, wrote a paper based on results from a recent study, met with multiple individuals on campus as well as health centers in Raleigh, North Carolina. If their grant is funded, they will test the feasibility of a 12-week intervention Dr. Berry designed for Spanish-speaking patients with type 2 diabetes.

Professor Aguilera is completing data analysis for her PhD dissertation examining the relationship between breastfeeding and obesity in infants in Mexico. An increasing number of children and adults in Mexico are struggling with obesity, whereas the percentage of infants who are breastfed has decreased dramatically over the last ten years. Professor Aguilera wants to determine if beliefs about breastfeeding influence how mothers feed their children. So far, she has shown Mexican women largely follow in the footsteps of their own mothers when it comes to breastfeeding. Professor Aguilera believes their research team might find similar familial influences as they investigate the behaviors of individuals who have diabetes.

Dr. Berry hopes they will continue to find resources to sustain and grow their collaboration. “This has been a very rewarding partnership,” she said. “I hope the three of us, and our nursing schools, continue to work together towards improving the health of our communities for a very long time.”