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Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 1998 Oct;90(10):605–613.

A project to reduce the burden of diabetes in the African-American Community: Project DIRECT.

M M Engelgau 1, K M Narayan 1, L S Geiss 1, T J Thompson 1, G L Beckles 1, L Lopez 1, T Hartwell 1, W Visscher 1, L Liburd 1
PMCID: PMC2608371  PMID: 9803725

Abstract

Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together) is the first comprehensive community diabetes demonstration project in the United States in an African-American community. This article describes its intervention components and evaluation design. The development and implementation of Project DIRECT has included the community since the project's beginning. Interventions are targeted in three areas: health promotion (improving diet and physical activity levels), outreach (improving diabetes awareness, detection of undiagnosed diabetes, and ensuring that persons with diabetes who are not receiving continuing diabetes care are integrated into the health-care system), and diabetes care (improving self-care, increasing access, and improving the quality of diabetes preventive care received within the health-care system). Evaluation will be internal (conducted by Project DIRECT staff to assess process outcomes in persons directly exposed to each specific intervention) and external (review of outcomes to assess the impact of the multi-intervention program at the level of the entire community). Because diabetes exacts a disproportionate toll among African Americans, the findings from this project should aid in developing strategies to lessen the burden of this disorder, particularly among minority populations.

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Selected References

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  1. Allen B. T., DeLong E. R., Feussner J. R. Impact of glucose self-monitoring on non-insulin-treated patients with type II diabetes mellitus. Randomized controlled trial comparing blood and urine testing. Diabetes Care. 1990 Oct;13(10):1044–1050. doi: 10.2337/diacare.13.10.1044. [DOI] [PubMed] [Google Scholar]
  2. Carleton R. A., Lasater T. M., Assaf A. R., Feldman H. A., McKinlay S. The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk. Am J Public Health. 1995 Jun;85(6):777–785. doi: 10.2105/ajph.85.6.777. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Centers for Disease Control and Prevention (CDC) Trends in the prevalence and incidence of self-reported diabetes mellitus -- United States, 1980-1994. MMWR Morb Mortal Wkly Rep. 1997 Oct 31;46(43):1014–1018. [PubMed] [Google Scholar]
  4. Eggers P. W., Connerton R., McMullan M. The Medicare experience with end-stage renal disease: trends in incidence, prevalence, and survival. Health Care Financ Rev. 1984 Spring;5(3):69–88. [PMC free article] [PubMed] [Google Scholar]
  5. Farquhar J. W., Fortmann S. P., Flora J. A., Taylor C. B., Haskell W. L., Williams P. T., Maccoby N., Wood P. D. Effects of communitywide education on cardiovascular disease risk factors. The Stanford Five-City Project. JAMA. 1990 Jul 18;264(3):359–365. [PubMed] [Google Scholar]
  6. Feinleib M. New directions for community intervention studies. Am J Public Health. 1996 Dec;86(12):1696–1698. doi: 10.2105/ajph.86.12.1696. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ferris F. L., 3rd How effective are treatments for diabetic retinopathy? JAMA. 1993 Mar 10;269(10):1290–1291. [PubMed] [Google Scholar]
  8. Harris M. I. Noninsulin-dependent diabetes mellitus in black and white Americans. Diabetes Metab Rev. 1990 Mar;6(2):71–90. doi: 10.1002/dmr.5610060202. [DOI] [PubMed] [Google Scholar]
  9. Helmrich S. P., Ragland D. R., Leung R. W., Paffenbarger R. S., Jr Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med. 1991 Jul 18;325(3):147–152. doi: 10.1056/NEJM199107183250302. [DOI] [PubMed] [Google Scholar]
  10. Herman W. H., Thompson T. J., Visscher W., Aubert R. E., Engelgau M. M., Liburd L., Watson D. J., Hartwell T. Diabetes mellitus and its complications in an African-American community: project DIRECT. J Natl Med Assoc. 1998 Mar;90(3):147–156. [PMC free article] [PubMed] [Google Scholar]
  11. Kahn H. A., Hiller R. Blindness caused by diabetic retinopathy. Am J Ophthalmol. 1974 Jul;78(1):58–67. doi: 10.1016/0002-9394(74)90010-5. [DOI] [PubMed] [Google Scholar]
  12. Klein R. Hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care. 1995 Feb;18(2):258–268. doi: 10.2337/diacare.18.2.258. [DOI] [PubMed] [Google Scholar]
  13. Knowler W. C., Narayan K. M., Hanson R. L., Nelson R. G., Bennett P. H., Tuomilehto J., Scherstén B., Pettitt D. J. Preventing non-insulin-dependent diabetes. Diabetes. 1995 May;44(5):483–488. doi: 10.2337/diab.44.5.483. [DOI] [PubMed] [Google Scholar]
  14. Litzelman D. K., Slemenda C. W., Langefeld C. D., Hays L. M., Welch M. A., Bild D. E., Ford E. S., Vinicor F. Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial. Ann Intern Med. 1993 Jul 1;119(1):36–41. doi: 10.7326/0003-4819-119-1-199307010-00006. [DOI] [PubMed] [Google Scholar]
  15. Luepker R. V., Murray D. M., Jacobs D. R., Jr, Mittelmark M. B., Bracht N., Carlaw R., Crow R., Elmer P., Finnegan J., Folsom A. R. Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health Program. Am J Public Health. 1994 Sep;84(9):1383–1393. doi: 10.2105/ajph.84.9.1383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Manson J. E., Nathan D. M., Krolewski A. S., Stampfer M. J., Willett W. C., Hennekens C. H. A prospective study of exercise and incidence of diabetes among US male physicians. JAMA. 1992 Jul 1;268(1):63–67. [PubMed] [Google Scholar]
  17. Manson J. E., Rimm E. B., Stampfer M. J., Colditz G. A., Willett W. C., Krolewski A. S., Rosner B., Hennekens C. H., Speizer F. E. Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet. 1991 Sep 28;338(8770):774–778. doi: 10.1016/0140-6736(91)90664-b. [DOI] [PubMed] [Google Scholar]
  18. Ohkubo Y., Kishikawa H., Araki E., Miyata T., Isami S., Motoyoshi S., Kojima Y., Furuyoshi N., Shichiri M. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995 May;28(2):103–117. doi: 10.1016/0168-8227(95)01064-k. [DOI] [PubMed] [Google Scholar]
  19. Pan X. R., Li G. W., Hu Y. H., Wang J. X., Yang W. Y., An Z. X., Hu Z. X., Lin J., Xiao J. Z., Cao H. B. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997 Apr;20(4):537–544. doi: 10.2337/diacare.20.4.537. [DOI] [PubMed] [Google Scholar]
  20. Pyorälä K., Pedersen T. R., Kjekshus J., Faergeman O., Olsson A. G., Thorgeirsson G. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S) Diabetes Care. 1997 Apr;20(4):614–620. doi: 10.2337/diacare.20.4.614. [DOI] [PubMed] [Google Scholar]
  21. Reichard P., Nilsson B. Y., Rosenqvist U. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N Engl J Med. 1993 Jul 29;329(5):304–309. doi: 10.1056/NEJM199307293290502. [DOI] [PubMed] [Google Scholar]
  22. Rose G. Sick individuals and sick populations. Int J Epidemiol. 1985 Mar;14(1):32–38. doi: 10.1093/ije/14.1.32. [DOI] [PubMed] [Google Scholar]
  23. Rostand S. G., Kirk K. A., Rutsky E. A., Pate B. A. Racial differences in the incidence of treatment for end-stage renal disease. N Engl J Med. 1982 May 27;306(21):1276–1279. doi: 10.1056/NEJM198205273062106. [DOI] [PubMed] [Google Scholar]
  24. Smith S. R., Svetkey L. P., Dennis V. W. Racial differences in the incidence and progression of renal diseases. Kidney Int. 1991 Nov;40(5):815–822. doi: 10.1038/ki.1991.281. [DOI] [PubMed] [Google Scholar]

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