A registered nurse runs the program, dubbed Project Dulce, meeting with patients as often as necessary, with the goal of helping patients keep their blood sugar levels, blood pressure, and cholesterol levels down long-term.

The program also includes a self-management training program run by a peer educator, or promotora, who comes from the Hispanic community.

"It's a collaborative education model so it's not just didactic," Gilmer explained. The promotoras "can address some misrepresented cultural beliefs...and hopefully connect to the patients on a peer level that complements the nurse management."

He and his colleagues used a computer model to project how 3,893 participating patients would fare over the next 40 years in terms of their health and life expectancy.

Based on their projections, Gilmer and his team found the program was most beneficial for uninsured patients, who gained an additional 1.1 years of life expectancy, compared to 0.6 years for patients with County Medical Services insurance, which covers low-income or indigent adults; 0.3 years for patients insured by Medi-Cal, a state program for low-income people; and 0.2 for patients with commercial insurance.

Uninsured patients tended to be younger than the other patients, Gilmer noted. "By addressing this early, you get a lot of long term benefits," he said.

The program was most cost-effective for the patients with the least insurance coverage, costing $10,141 per year of life in perfect health gained, the researchers found.

The initiative is described in the latest online issue of the journal Health Services Research. Feb. 16, 2007

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FACT:
Nearly 3 in 4 people with diabetes at high risk for amputation have diseased toenails. These are the findings of a recent study presented at the Council of Nail Disorders in advance of the American Academy of Dermatology in Washington, DC. "This study is something of a confirmation of what many have felt, but the ubiquity of the results is something of an eye-opener," noted Dr. Wu. "It appears that if you have certain pre-existing risk factors for amputation coupled with a clinically diseased nail, chances are you have a significant fungal infection based on laboratory cultures. It is our hope that this study will assist us in making more rapid assessments and embark on much-needed therapy for these high-risk patients."

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