The diabetes patients of Susan Spratt, MD, assistant professor of medicine (Endocrinology, Metabolism, and Nutrition), don’t always come to see her. Sometimes she goes to see them.
“Although there have been numerous therapeutic advances in diabetes treatment, there remain huge disparities in outcome,” she says. “I want to be a voice and advocate for patients with high-risk diabetes.”
A recent Wednesday afternoon found her at a nonprofit resource center in downtown Durham, demonstrating how to make a quick and healthy salad and passing around samples to about two dozen low-income people with diabetes. Next she distributed three-ring binders and offered suggestions for keeping a health log. Throughout both activities, she and a representative from the Durham County Health Department fielded questions about medications, carb counting, and dealing with spikes in blood sugar. After the program, she met with people individually to address concerns.
Q: What motivates your approach to healthcare disparities?
A: Health and health disparities are strongly influenced by poverty. As advocates for improved health, we not only need to look to basic science and clinical research to find solutions but we need to work on social and government policies that improve and sustain health.
Q: You are the physician lead of the Durham Diabetes Coalition (DDC). What is the DDC?
A: The DDC is a multifaceted and multi-partner program, funded by Bristol Meyers Squibb Foundation, that’s designed to reduce death and disability in patients with diabetes in Durham County. We identified patients with diabetes, diabetes complications, and gaps in care using geospatial and secondary data. Using a risk algorithm to identify those at highest risk for adverse outcomes, a clinical team of nurse practitioners, social workers, dieticians, and community health workers visit patients in their homes. The DDC also identified three neighborhoods in Durham with the highest proportion of people with diabetes. Partnering with the Durham County Department of Health, we organized health fairs, distributed health information, and held media events in those neighborhoods. Building on the success of DDC, we obtained a grant from the Center for Medicare and Medicaid Services (CMMS) to create the Southeastern Diabetes Initiative to begin similar programs in three other communities in the south: Cabarrus County, NC, Quitman County, MS, and Mingo County, WV.
Q: What are some of the most pressing causes of disparities in diabetes outcomes among DDC participants?
A: Access to food and medicine, transportation. I asked one of the dietitians who was making home visits what she was finding in the pantries of our highest risk patients. I expected her to say, "Junk food." She responded, "No food." Diabetes is a disease whose treatment is based on three well-balanced, portion-controlled, carbohydrate-controlled meals a day. How can we treat diabetes when our patients don’t have access to healthy food and don't have access to a steady supply of any food?
Q: What have you done to address the issue of food security?
A: The DDC, which includes the Durham County Health Department and Healing with CAARE, opens a diabetes food pantry every Wednesday from 1-3 at CAARE, which is a nonprofit that provides free prevention and case-management services related to physical, mental, and social health. We demonstrate a healthy recipe, answer questions, check blood pressure and blood sugar, and provide each participant with a bag of food that’s healthy for people managing diabetes. We serve at least 45 patients monthly. We welcome anyone.
Q: What about access to medicine?
A: Time and time again, we’d go to patients’ houses and find blood pressures of over 200 and glucose over 400 because patients were out of medications. They often didn’t have a phone to call for refills, a way to go pick up the refills, or the money to pay the copay, even if the copay was only $4. Many insurance companies cover the full cost of life-sustaining medications because doing so reduces future complications and ED visits. In Tulsa, OK, physicians pick up unused medications from deceased patients in nursing homes and deliver them to the health department for dispersal to patients who would otherwise go without. I'd like to see how we can change the law in North Carolina to allow a similar program.
Q: Final thoughts?
A: The DDC was based and/or was developed from previous Duke Community programs such as Durham Health Innovations (DHI).
The DDC has been a collaboration among many partners at Duke:
- Department of Community and Family Medicine
- Division of Endocrinology
- Center for Predictive Medicine
- Duke Health Technology Solutions
- Children’s Environmental Health Initiative
- Division of Cardiology
- Center for Community and Population Health Improvement
- School of Nursing
- Department of Psychiatry
a dedicated team from the Durham Department of Health, under the leadership of Gayle Harris and Michele Easterling,
Community stakeholders:
- Sharon Elliott-Bynum from CAARE
- Lincoln Community Health Center
- Durham Parks and Recreation
- County Extension
- and many more)
and patients.
The people with whom I work closely on the clinical team and at the food pantry
- Marjorie Pierre-Louis
- Bradi Granger
- Lisa P. Davis
- Brooke Heidenfelder
- Heidi Schoeppner
- Edith Slack
- L’Tanya Gilchrist
- Crystal Dixon
- Keyanna Terry
- Aubrey Delane
- Carla McCoy
embody what Francis Weld Peabody taught, “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”