Over the past eight years, Patricia Addie-Gentle, RN, BSN, has seen how much diabetes education has changed.

"We are more aggressive today in the way it is diagnosed - and we're seeing more comorbidity factors that we probably didn't attribute to diabetes back then," said Addie-Gentle, coordinator of diabetes patient education at DeKalb Medical Center in Decatur.

"We used to say, 'a touch of sugar' and 'borderline [diabetes],' and a '160 blood sugar' was OK," Addie-Gentle said. "Now we know those people are coming back 10 years later with changes in their cardiovascular systems, in their eyes and with neuropathy. The American Diabetes Association now is using a fasting sugar [level] of 126 or greater as a diagnosis of diabetes. There's earlier screening and early diagnosis."

Addie-Gentle also is finding that her audiences are younger - with an average age of 40 - and more diverse than eight years ago.

And, while hospital-based education classes are still used, her department has stepped up their efforts to reach DeKalb County's large Hispanic and Asian-American populations.

Targeting Hispanics

Last winter, DeKalb Medical Center began working with the Georgia Hispanic Chamber of Commerce, in an attempt reach Hispanics living in DeKalb.

"We recognized we needed to address this particular population which has a high percentage of gestational and Type 2 diabetes, and provide education in a language they could understand and be comfortable with," Addie-Gentle said.

According to the ADA, it's estimated that 2 million - or 8.2 percent - of Hispanic Americans older than 20 have diabetes, and that on average, Hispanic Americans are 1.5 times more likely to have the disease than non-Hispanic whites of similar age.

A U.S. Centers for Disease Control and Prevention report lists Mexican-American men and women ages 55-65 as having the highest rate of diabetes (12.6 percent) of all races and ethnicities. The only other group that comes close is African-American women (11.6 percent).

But knowing the stats is one thing; reaching the audience has proved daunting. Cultural attitudes toward health care and, in particular, diabetes, have been at times difficult to bridge, Addie-Gentle said.

Free wellness fairs

With advice from the chamber, the hospital has created free wellness fairs with door prizes and refreshments, omitting anything in the advertisements that hinted at doctors.

"We have to gain their trust," Addie-Gentle said.

The hospital has been more successful targeting the Asian-American community with free diabetes education classes at the International Medical Center on Atlanta's Buford Highway, an area where many Asian immigrants have settled. Using a Chinese-speaking diabetes educator, the staff recently taught the more than 30 attendees about blood and glucose monitoring, nutrition, foot care and a general overview of what diabetes is and how it affects the body.

For Addie-Gentle and other diabetes educators, just getting the word out about diabetes in any language is important. According to the ADA, research studies in the United States and abroad have shown that changes in diet and exercise can prevent or delay the onset of Type 2 diabetes among high-risk adults.

But, left untreated, heart disease, kidney failure, stroke, amputations and blindness are just some of the byproducts of the disease, which claimed more than 213,000 lives in 2000.

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