In Puerto Rico, a personal connection to improve diabetes

Published July 17, 2019

When Maritza Santiago received a call from BlueCross BlueShield of Puerto Rico (BCBS Puerto Rico) inviting her to join a three-month educational program that could help her manage her diabetes, it was an easy yes. 

“My mother died of diabetes,” she says. “She was on dialysis for three years. It was a hard and very sad process.”

Santiago’s own A1C level was 10.7% and her blood glucose was 221 mg/dl. For context, diabetes diagnoses begin at 6.5% and 126 mg/dl, respectively. 

A growing health crisis on the island
Unfortunately, Santiago’s story is not unique. One in three Puerto Ricans over age 64 has diabetes. That’s according to the Centers for Disease Control and Prevention (CDC), which reports that the death rate of diabetes in Puerto Rico is three times higher than the rest of the U.S.  

To address this growing health crisis, BCBS Puerto Rico created the “Yo Controlo Mi Diabetes” program for their Medicare Advantage members. The name means “I Control My Diabetes,” and speaks to the program’s tenet that people with diabetes have the power to manage their disease with educated lifestyle shifts. 

Education and community building
“Education is the foundation for everything in life,” says Iván Viera-Cintrón, part of the preventive management team that created “Yo Controlo Mi Diabetes.” “We find out how much [participants] know about diabetes at the start and use that to guide the curriculum.” 

A multidisciplinary group of health professionals, including health educators, nutritionists, nurses, pharmacists, optometrists and psychologists, runs the 13-week program. Participants learn about nutrition, physical activity, self-monitoring, feet care, visual health, medication, mental health, hypertension and other complications that can arise with a diabetes diagnosis. They receive biometric screenings on their first and last day to measure their progress.

“Our program is designed to be culturally sensitive,” says Viera-Cintrón, who stresses the personal connection between the health educators and the participants. “It’s not the same as when you have someone clinical talking to you…We have a personal connection with these people—we speak their language.”

This connection begins even before participants sign up, with a personal phone call inviting them to join. Members are selected based on claims data showing that they have diabetes and either do not have their A1C levels under control or have not had them tested. 

“It’s a lot of time to ask them to spend with us,” says Viera-Cintrón. “So we include a lot of love and care. We want them to fall in love with the program.”

The results
In its first year, “Yo Controlo Mi Diabetes” graduated 216 participants in five municipalities across Puerto Rico. The program saw an 84% retention rate from week one to week 13. More than half of all participants lowered their BMI, while nearly the same amount lowered their A1C levels, and 99% demonstrated improved understanding of their condition. 

Santiago finished the program with an A1C 4 percentage points lower than she started with, and blood glucose levels reduced by 95 mg/dl. “When I saw my results at the end of the program, I cried tears of joy,” she says. “I don’t get tired of thanking God and all the people that helped me.”

Perhaps the most promising measure of success for the BCBS Puerto Rico team, though, was that time and time again, graduation participants asked them to keep the program going. “They didn’t want to lose touch with us or with [their fellow participants],” says Viera-Cintrón. “For them it was an outlet for social support, too. They didn’t want to lose that connection.” 

The team at BCBS Puerto Rico is now working on a follow-up program for their graduates, as well as a creating a separate program to support pre-diabetics. 

BlueCross BlueShield of Puerto Rico

BlueCross BlueShield of Puerto Rico is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.