Medical professionals have long argued that education can reduce the medical complications of diabetes.
But now Memorial Medical Center and H.E.B. Food Stores say they have the numbers to prove it.
The two organizations launched a diabetes management program last summer, which is projected to save at least $300,000 in hospital costs annually, based on the first four months of data.
And those savings are to county taxpayers, since the 178 patients participating in the pilot program are all covered by Nueces Aid, said Deborah Paganelli, vice-president of outpatient services at Memorial. Nueces Aid is the county's insurance program for the working poor, funded through the hospital tax district.
"We figured that it would probably require a year before we would see some really good outcome data," she said."We were amazed at the difference. We already have seen a reduction in emergency room visits, clinic visits, the hospital admissions."
The results have been so immediate that both Memorial and H.E.B. plan to expand the program's scope.
H.E.B. will establish similar programs in other areas of the state, said Debbie Lindsey-Opel, a company spokeswoman. The grocery chain supplied the trailer used for diabetes education, plus their own staff for the program's local launch. If it continues to prove effective, H.E.B. hopes to market it to managed care companies as a preventive tool.
"This is a nontraditional approach to health care," Lindsey-Opel said. "It gives the pharmacist a chance to come around from the other side of the counter and be a more active partner in health care solutions."
The crux of the local program lies in case management, led by H.E.B. pharmacists working out of the H.E.B. Community Care Center at the intersection of Morgan and Baldwin streets. But even some of the program's organizers expressed surprise at the commitment shown by the participants, many of whom number among the city's poorest and are struggling even to make ends meet.
Some patients take the bus or have to walk, despite their medical condition, to make their appointments, said R.C. Perez, an H.E.B. pharmacist and the program's director. About two-thirds of the classes are taught in Spanish.
"I came in with the expectation that it was going to be difficult to teach them," he said, shaking his head at how wrong he was.
"This is a new world for me," he said. "You are really working with the people. There is a reward here with what you see in the people's eyes."
Crisoforo Carralez said he learned that to avoid insulin shots, he would have to radically alter his lifestyle, including changing his diet and quitting smoking and beer. The 59-year-old was diagnosed with diabetes three or four months ago, after he came to Memorial complaining of excessive thirst and repeated bathroom visits.
"You will do anything for your life," he said. "No one will take care of me."
Carralez takes pills daily, watches what he eats and has reduced his smoking from a pack a day to only a few cigarettes.
Diabetes develops when the body fails to produce or properly use enough insulin to function properly.
Controlling the disease requires a strict regimen of medication, diet and exercise. If diabetes is not brought under control, the complications can be personally painful and costly for hospitals. They include heart disease, blindness, kidney damage and amputations.
One year of dialysis, for example, costs from $40,000 to $50,000, according to E2M Health Services, the Dallas-based chronic disease management company that designed the H.E.B.-Memorial program.
In the H.E.B-Memorial program, a urine test detected initial warning signs of kidney damage in seven patients, who were then referred for preventive medication.
Diabetes is a particular problem in Nueces County, where complications kill residents ages 40 and older at a rate that's 40 percent higher than in the rest of the state, according to the Texas Diabetes Council.
In the first four months, data from the Memorial-H.E.B. program shows that hospital admissions for those 178 patients in the study are down 44 percent for a projected annual savings of $138,750, according to E2M. Emergency room visits had dropped 47 percent at an annual savings of $26,597.
Those statistics should only improve now that ongoing complications have been diagnosed and patients have become more sophisticated about controlling their diabetes, said Maria Barnwell, president of E2M. The program, which was first implemented at Memorial, is now in development in four other U.S. cities, Barnwell said.
"What's unique is the pharmacist is acting as the community case manager," she said. "And we are taking it out into the community. Typically, health care is very fragmented.
"Chronic disease is a lifestyle issue. What better place to approach their education than in the pharmacy or the grocery store?"
Rather than traveling to Memorial, patients get regular checkups and educational sessions at the H.E.B. Community Care Center.
"We have a huge noncompliance rate with the patients not coming back for their diabetes education and follow-up," Memorial's Paganelli said. "They don't come back until they are sick again. Try as we can, we can not get them to come back."
During the education and follow-up tests, the pharmacists continuously hammer home the point that diabetes control is the patient's responsibility, H.E.B.'s Perez said. Pharmacists talk with patients about everything from diet to life's daily stresses, he said.
"You really get to know them," he said. "You really get to know whether their grandmother is living with them. And whether they don't like that."