Welcome everyone. Thank you for joining us today. Welcome to our community health workers webinar brought to you by the American Diabetes Association. Today's session topic is preventing diabetes complications from head to toe. My name is Wandi Hernandez, and I am one of the speakers on today's program. To share a little bit about myself, I am a certified doula, a certified birth doula through Dona International, a CLC certified lactation counselor, and a certified childbirth educator, as well as a CHW. I received my degree in human service management and I have been involved with the community health workers since I was a child growing up as a consumer of services, as well as a community health worker in different phases of this field for more than like 29 years. And as a bilingual and bicultural advocate speaker, as well as a long term advocate for community health workers, not only where I reside, which is in Illinois, as well as in the national arena. And so with that, I'm going to actually pass it along to Betsy Rodriguez so she can actually provide a little bit information in terms of who she is. Betsy? Buenas tardes, good afternoon. So yes, my name is Betsy Rodriguez. I'm a senior public health advisor in the Division of Diabetes Translation. By training, I'm a nurse, I'm a diabetes educator, I'm an ABCS fellow, and I'm also a CHW ally, who has been working with community health workers in Latin America and in the United States for over 30 years. I have been involved in many projects that are CHW related, like the C3 project, where I serve as a senior reviewer. This is the project that highlights the CHW core competencies, roles, and skills. I was also part of the CDC community guide team that worked to develop the systematic reviews, looking at the evidence of the effectiveness of community health workers in diabetes prevention, in diabetes management, in cardiovascular diseases, and diabetes. I recently worked with a federal work group to modify the CHW profile in the Department of Labor. So as a result of that, we have a new version of the Labor of Code profile for community health workers that I will encourage you all to visit there. I will post the link on the chat so you can have access to it. So it is my pleasure and my honor to be here working with Wendy, my dear friend. We have been working together in the field of community health workers for so many years. I'm also a National Association of Community Health Workers organization board member. So it is my pleasure to be here so we can highlight today the role that community health workers play in diabetes management, in this case, related with diabetes-related complications. Wendy? All right. Thank you, Betsy. And so I'm so grateful, Betsy, that you actually stated that because I am also one of the co-founders and former presidents of the National Association of Community Health Workers, which Betsy was alluding to, along with a co-founder and vice president of the Illinois CHW Association. So thank you, Betsy. So let's see. And so I wanted to actually state, as this is an accredited program for the Continuing Education Credit, please note the following disclosures. As I don't have any and Betsy has the findings and conclusions in this presentation, are those for the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank you, Betsy, for that disclosure. Next, please. Thank you. And listed on the slide on the learning objective, we will receive the cause of diabetes applications. We'll talk about some of the most common types of complications and review ways to identify community resources and identify tools that community health workers can use to assist clients and communities to prevent or delay diabetes complications. That's what our learning objectives are. And we, as mentioned in the previous slide, our webinar today will address the roles of CHWs, the basics of diabetes and diabetes complications, exact diabetes complications that we're going to actually disclose, and resources to help CHWs assist a person with diabetes and communities in effort to prevent diabetes complications. And so we're going to actually do a poll here. And so please, everyone chime in. Our question is, if you are a CHW, what type of organization are you employed with? A, private organization. B, community organization. C, a state or federally funded organization or other. And our results have come in. Thank you so much. And so the first one is CHWs, a lot of them are employed through a state or federally funded organization. And the second one is a community organization, along with other. And then there are CHWs in the private sector of the organization. So thank you all so much for that. And moving right along, I'll pass it along to Betsy. So let's start with the basic statics and the definition and type of diabetes. There is approximately 37.3 million people in the United States have diabetes, and 96 million have prediabetes. This is where blood glucose levels are higher than normal, but not yet higher than normal. enough to be diagnosed as diabetes. So diabetes is a disease where the body is unable to use the insulin properly. Some people can manage their blood glucose or blood glucose level with diet and physical activity. And some people will need to take auto medications, pills, like insulin or other type of injections. Right now we have so many options for medication treatment when it comes to diabetes, type 2 diabetes, precisely. So in this slide, you see the different type of diabetes that we have so far. There are many others, but these are the basic ones, like for example, type 1 diabetes. That one is precisely where the pancreas does not produce insulin, and it requires blood glucose monitoring. And I would like to add also diabetes education to this aspect as well. And then on type 2 diabetes, which is that compromise like 90% of the whole population versus 10% approximately for type 1 diabetes. Here, the body does not make enough insulin or does not use it well. It is managed through a balanced diet, active lifestyles, and medication, which might include insulin. And then you have gestational diabetes, which is a type 2 diabetes where the body does not produce enough insulin or does not use it well. It is managed through a balanced diet, active lifestyles, and medication, which might include insulin. And then you have gestational diabetes, and that's the one that happens during pregnancy where a person's body is unable to make and use the insulin needed or hormones affect the body's ability to use insulin well. We will be discussing the different types of diabetes, and this webinar will focus on type 2 diabetes, which is the most common one, as I already said, and prevention of complications associated with type 2 diabetes. So, the progression of diabetes over time, especially diabetes that is not well managed, meaning that blood glucose level is too high for a long period of time, can lead to complications from head to toe. And that's the name of our webinar today, right? Some complications of diabetes include hearing loss, vision loss, heart disease, kidney disease, and foot damage. There are other potential complications as well, but these are some of the most common, and these are the five complications we will discuss today. So, here in the slide, you see what are the risk factors associated with type 2 diabetes, which is high blood glucose level over time, high blood pressure, unmanaged cholesterol, being overweight or having obesity, not being active, distress played a pivotal role as well, and smoking and tobacco use. Preventing complication of diabetes can be impacted by the same type of activities that can help prevent diabetes in the first place. As we go through the webinar, we're going to be talking about ways that community health workers can help individuals and communities dealing with diabetes by offering culturally appropriate assistance and resources, such as regular visiting a healthcare provider, focusing on healthy eating and physical activity in healthy weight, and taking medication as prescribed. So, the most frequently reported CHW roles on care teams are listed in this slide, like helping people gain access to medical services, advocating for individual needs, teaching people how to use healthcare and social services, and helping people manage chronic conditions. And as you can see, 86% of that time is working hand by hand with people with diabetes. And teen diabetes complications. Can help. Individuals better understand their diagnosis and assist and the symptoms and complications and their native language and level of understanding. This is also a very genuine thing that we do, right? The other thing that we can do is in a culturally and appropriate manner, CHW support people with diabetes and a risk for developing type 2 diabetes. And and this is unique. About the type of work that CHWs play in in assisting. Participants with diabetes, another role that we can play is. CHWs may visit people with diabetes in their homes and meet with their support systems to encourage and support the family to make lifestyle changes as we are discussing. Like nutrition, physical activity, disease management, as these are some of the main factors. Within the diabetes. So, let's take a look, Wendy, at a case study now. This is Shayla. Okay. She is 58, 54 years old, African-American woman who has type 2 diabetes. She weighs 293 pounds and has a sedentary lifestyle. Shayla also has poor eating habits and feels she cannot afford to buy healthy foods. She lives with her mother and her sister who are also sedentary lifestyle and are overweight. Her A1c is 9.5, oh God, and her fasting blood sugar is 215. She has exhibited some possible complication of diabetes as she has numbness and tingling in her legs. She previously participated in Healthy Living class to gain information about diabetes management. Think about some of the barriers Shayla is facing and some of the challenges she might face in trying to manage her diabetes and prevent complications. I would like to people to start putting in the chat box right now some of those barriers that you are taking out of this case study that I'm sharing with you. I would like to see some of those, please. I see food insecurity, good. What else? Weight, A1c, poor eating habits, access to food, low income, weight, discrimination in health. Oh, wow, they're providing us a cascade of responses. Housing, lifestyle, culture, education, financing, stigma, transportation, education. Yes, yes, health education, bias, racial bias, medical cost, overwhelmed, low health literacy, lack of resources. Yes, lack of insurance, family dynamic. Yes, discrimination. You have done an amazing job. So known barriers here are overweight with poor eating habits, mom and sister whom she lives with are also sedentary lifestyles and overweight, elevated A1c and fasting blood glucose. We have also limited access to healthy food and food insecurity. We have also financial situation. You did an amazing job listing those barriers. Now let's talk about some possible solution. Please enter your ideas in the chat box. I will give you a couple of minutes so you can now move into letting us know some of the possible solutions using the Community Health Workers hat. Let's see. Nutrition, OK, apply to SNAP, support groups, provide education, refer to food banks, exercise programs, help apply for insurance. Education, exercise, yeah, peer support, diabetes classes, nutrition. Refer to health educator, educating families, physical therapy. Planned meals. Refer to look at that. Connect with dietician, yes, transportation vouchers, yes, medical counseling. There's a lot going on here, Betsy. Indeed, indeed. You could actually review healthy meal plan options such as the ADA, diabetes plate and budget friendly healthy food options. You can review physical activity options such as walking and in-home exercises and encourage her to start slow and gradually increase. You can encourage her to review her labs with a health care provider to discuss ways to lower her A1C. You can discuss the SNAP for food assistance or you can either connect her with food banks and local pantries for food assistance. So, Wendy, I believe that you have something to share with us now. Let me move this slide so you can have it on your side. Yes, thank you so much, Betsy. So the American Diabetes Association Standards of Care 2023 highlights the importance of CHWs. Many studies have shown that CHWs are effective in helping improve the management of diabetes, especially in the underserved communities. CHWs are trusted bridge between systems and local communities. There are many ways CHWs can assist community members, such as helping them navigate healthcare systems, as you guys were actually alluding to, connecting them to available services, all the services that you all actually mentioned, and resources in their communities, and provide health education and outreach to community members in need. One key strength of CHWs are the ways we support the person with diabetes in a unique, culturally appropriate manner. One of the ways that CHWs may help people and communities to prevent diabetes are also effective in preventing or delaying complications for those who are diagnosed with diabetes. There are several areas of self-care behaviors that have been identified as being most helpful for a person with diabetes. In today's webinar, we will focus on some of those healthy behaviors, such as healthy eating, being active, taking medications, and managing stress, as those are important ways of CHWs can support a person with diabetes. We'll talk more about these healthy self-care behaviors. CHWs can encourage a person with diabetes to follow healthy safe care behaviors to prevent or delay diabetes complications, including healthy eating, being active, taking medication, and managing stress. And so, Betsy, looks like we have another poll. Yes. So, using the same poll process as before, let's see what you think about the diabetes and heart disease. Okay. So, people with diabetes are twice as likely to have a heart attack or stroke than people who do not have diabetes. And look at that. We're getting cascades. The poll is open. So, please, insert your response on the poll. So, the results, oh, my God, a whopping true. Betsy, look at that. So, we'll find out more on the next slides. But according to the CDC, if you have diabetes, you're twice as likely to have heart disease or a stroke than someone who doesn't have diabetes. And at a younger age, the longer you have diabetes, the more likely you are to have a heart disease. Food for thought. All right, diabetes. All right, Betsy, take it away. As we learned from the poll, people with diabetes are twice as likely to have heart attack or stroke according to the CDC. Heart disease is a very common and serious. It is the leading cause of death for both men and women in the United States. Heart disease includes several kinds of problems that affect the heart. The term cardiovascular disease is similar, but includes all types of heart diseases like stroke and blood vessel disease. Coronary artery disease is caused by the buildup of plaque in the walls of the coronary arteries. The blood vessels that supply oxygen as well as blood to the heart. Plaque is made of cholesterol deposits, which make the inside of the artery to narrow and to create those plaque, which makes the inside of the arteries to narrow and then to decrease the blood flow. This process is called arteriosclerosis or hardening of the arteries. Decreased blood flow to the heart can cause a heart attack. Decreased blood flow to the brain can cause a stroke. The CDC says to call 911 immediately if you notice the symptoms of the heart attack in yourself or someone else. In addition to the symptoms shown on the WHO graphic, CDC knows that other symptoms of heart attack could include unusual or unexplained tiredness, nausea, or vomiting. Actually, women are more likely to have these other symptoms. To determine if someone may be having a stroke, use the assessment from CDC and think fast. I believe the link has been posted on the chat box, so it is important here to think about how you can actually help people identify, and we're going to be using here some words to explain that. F as face. Ask the person to smile. Does one side of the face drop? A for arms. Ask the person to raise both arms. Does one arm drift downward? S for speech. Ask the person to repeat a simple phrase. Is the speech slower or strange? And T for time. If you see any of these signs, call 911 right away. It is important to be familiar with these symptoms, and then in doubt, don't hesitate to call 911. As we talked about already over time, high blood sugar can damage blood vessels, and the nerves that control the heart. People with diabetes are also more likely to have another condition that raises the risk for heart disease, such as high blood pressure, high LDL, cholesterol, and high triglycerides. Unfortunately, none of these conditions have symptoms, so that's another reason it is so important for people with diabetes to have regular visits with a healthcare provider. As you see listed on the slides, other factors can also raise the risk for heart diseases, like smoking, being overweight, or having obesity, not getting enough physical activity, eating a diet that is high in saturated fat, trans fat, cholesterol, and sodium or salt, drinking too much alcohol, just to mention a few. So, CHWs can actually help their patients, their clients, by explaining to them the importance of taking care of their heart by using these easy tips to manage the ABCs of diabetes. Managing a healthy weight and getting adequate sleep is so important. As we talk about already over time, high blood glucose can damage blood vessels and the nerves that control your heart. As you just heard, that people with diabetes are also more likely to have other conditions that raise the risk for heart disease, such as high blood pressure, high cholesterol, and high triglycerides. As with the other conditions, high blood glucose can damage triglycerides. As with the other complications we have discussed, CHWs can help people with diabetes by encouraging healthy behaviors, such as healthy eating, physical activity, smoking and tobacco sensation, taking medication as prescribed, keeping blood sugar and blood pressure and cholesterol levels at the target range, and managing stress, and of course, having regular visiting the health care provider. Diabetes self-management education and support services, known before as diabetes education, are available in many locations and are excellent ways for people with diabetes to learn how to manage their disease. So, to find local BSMES services, you can actually visit the American Diabetes Association education locator web page on the CDC BSMES toolkit, and I do believe that we're putting on the chat box some links so you can find out those program locators. We might be sounding like a broken record as we continue to emphasize that high blood glucose over time damage blood vessels. We already talked about how that damage can lead to hearing loss, vision loss, heart diseases, heart attack, stroke, and now we're going to be talking about loss of kidney function. Diabetes and high blood pressure are the leading causes for kidney disease. So, you can see how important it is to keep to keep blood glucose and blood pressure under control. Having kidney disease can also increase the risk of heart attack and stroke. The kidneys are made up of millions of nephrons which filter the blood to remove the waste and excess fluid which is excreted from the body in urine. When blood vessels are damaged, they can't work effectively. Long-term kidney damage could result in the need for a kidney transplant or dialysis, a treatment that filters the blood. The kidneys work hard to make up the failing capillaries, so kidney disease produces no symptoms until almost all the function is gone. Also, the symptoms of kidney disease are not specific. The first symptom of kidney disease is often fluid buildup. Other symptoms include loss of sleep, poor appetite, upset stomach, weaknesses, and difficult concentrating. Wandy, can you help us here? Of course I can, Betsy. So, within the CHW lens, right, it is vital for CHWs to encourage their patients to see a doctor regularly. The doctor can check blood pressure, urine for protein, blood for waste products, and organs for other complications of diabetes. CHWs can help a person with diabetes find healthy food options that are culturally appropriate but still focus on the foods that are lower in salt and sugar and include more fruits and vegetables. They can also encourage a person with diabetes to drink water and other liquids that don't contain sugar, such as unsweetened iced tea. Many people will not have resources to meet with a registered dietician, so CHWs can check their local extension offices for a nutrition educator in their county that may be available at little to no cost. CHWs, once again, are vital to provide education. CHWs can educate on benefits for drinking water versus soda or juice. The CDC has a flyer called, Take Care of Your Kidneys, and they will take care of you. That is free to download for their website, and so I know that this link will be in the chat box as a resource to you all as well. So, Betsy, amiga, take it away. Thank you, Wendy. About half of the people with diabetes have some kind of nerve damage. It might be in any part of the body, but often happens in the feet and the legs. From risk slides, anyone with diabetes can develop nerve damage. It is common. You can probably guess the risk factors You can probably guess the risk factors as they are the issues we have been talking about throughout the webinar. If a person with diabetes has elevated low glucose level, especially over a long period of time, and has had diabetes for a long time, they are at higher risk. If the person living with diabetes is overweight, has obesity, if they are over 40, if they have high blood pressure and or high cholesterol, they are at a higher risk. Nerve damage can cause numbness, tingling, or pain, or a person with diabetes may have no symptoms. Having nerve damage can also decrease the ability to feel pain, heat, or cold. It might sound great not to feel pain, but if a person living with diabetes can feel pain in their feet, they may not know they have a foot wound, or a cut, or a blister, or a sores, or something that has, you know, damaged their feet. They cannot feel that either. So, because of the poor circulation, which is another complication of diabetes, this won't become infected or become worse. If this happens, it could result in the lust, meaning an amputation of a toe, or a foot, or part of the leg, in order to stop spread the infection. Early treatment can decrease the chances for amputations. Wendy, take it from here. All right, thank you, Betsy. So, yes, daily foot care is one of the best ways to prevent foot complications, and a person with diabetes should check their feet for cuts, redness, swelling, sores, blisters, calyxes, anything and everything that doesn't look normal to the foot. They don't need to soak their feet, and don't need to apply lotion between their toes due to the risk of infection. Going barefoot, even in the house, can lead to injury. So, encourage a person with diabetes to wear socks and slippers inside the house. Their shoes should fit well, and not rub or cause blisters, and recommend that they always wear socks. If they have trouble trimming their own toenails, they should actually go to a foot doctor to get them trimmed. They should not remove any corns or calluses, you know, for themselves, and should not use other, you know, anything over-the-counter products to remove them. A person with diabetes should get their feet checked at every visit. Encourage them to proactively take care, you know, to take off, rather, their socks and shoes as a visual reminder for the provider to check their feet, which is very important. Good blood flow is important for good foot health. Encourage, also, a person with diabetes to put their feet up when they're sitting, and just wiggle their toes throughout the day to keep the blood flow going. Being physically active can also help with blood flow, so encourage feet-friendly activities as appropriate, like walking, riding a bike, or even swimming. If a person with diabetes has any symptoms of foot disease, they should reach out to their health care provider or foot doctor right away. Symptoms may include pain or cramping in the feet or legs during activities, tingling, pain, or burning in the feet, loss of sensation or ability to feel heat or cold, change in the shape of the feel over time, loss of hair on their toes, feet, lower legs, dry cracked skin, a change in color or temperature of the feet, thick yellow toenails, fungal infections, or a blister, sore, ulcer, infected corn, or ingrown toenail. All of that, please make sure that they actually, you know, if they feel anything, encourage them to go seek care. Thank you. Betsy. Those were great tips that you were just sharing. So let's do another quick poll and let's see what you think about hearing loss in diabetes. Are we having the pull up? Okay, we have it here. Okay, so hearing loss is as twice as common in people with diabetes as people who do not have diabetes. And you have a single choice here, true or false. Let me give you a couple of minutes so you can answer this poll question. Okay, so 83% think that it is true versus 17% who think that are false. Well, let me tell you something. According to CDC, hearing loss is twice as common in people who have diabetes and it is in people of the same age who don't. As we learn from the poll, hearing loss is more common in people with diabetes. The same nerve damage that can lead to hearing loss can also lead to damage in the eyes, in the feet, and kidneys. We will talk more about that in the coming slides. Interestingly, even people with diabetes, remember those that low glucose level are higher than normal but not high enough yet to have type 2 diabetes, have a 30% higher rates of hearing loss than people with normal blood glucose level. Yet again, the importance of helping people with diabetes keep their blood glucose level as much as possible close to normal targets. Be aware of the signs of hearing loss. People with diabetes may often ask others to repeat themselves, have trouble following conversation with more than one person, think that others are mumbling, have problem hearing in noisy places such as busy restaurants, have trouble hearing the voices of small children and others with quiet voices, turn up the TV or radio volume too loud for others who are nearby. These are some of the symptoms that you have to watch out. There are many ways that community health workers can help people with diabetes to prevent hearing loss. As mentioned previously, many of the healthy behaviors that can help prevent diabetes can also help prevent diabetes complications. So focus on healthy eating, being physically active, smoking and tobacco sensation, taking medication as prescribed and the regular visits to the healthcare providers. CHW can support people with diabetes in taking to their healthcare providers about getting a hearing test and discussing medications, finding and sharing local communities for hearing loss can also be very helpful. And I'm having issues here moving my slide. Thank you. According to the CDC, retinopathy is a common IDC that is the leading cause of blindness. As we talked about before, high blood glucose over time can damage blood vessels and nerves. People with diabetes can have vision loss if the blood vessels of the retina are damaged. It is important to know that anyone with diabetes can develop vision loss. Many of the risk factors we have previously talked about are also in play here, such as elevated blood glucose. Other factors that we talk about soon, such as elevated blood pressure and elevated cholesterol are also contributors. Race and ethnicity also play a role here as African-American, Hispanics, Latinx and American Indian and Alaska Natives are at a higher risk. Anyone with diabetes can develop diabetes retinopathy. Okay. Thank you. People with diabetes may not notice symptoms in the early stage of retinopathy. This is why it is very important to get a dilated eye exam at least once a year to catch any problem early when treatment is more effective. Wendy, talk to us about... All righty. Go ahead. Yeah, so we've talked previously about the many ways CHWs can help a person with diabetes prevent complications. The healthy behaviors of healthy eating, being physically active, smoking slash tobacco sensation, taking medications as prescribed, keeping blood pressure and cholesterol levels in target range and regularly visiting their healthcare provider. For people with low vision, they may benefit from using a magnifying glass or special lenses. Encourage a person with diabetes to contact their eye doctor or primary healthcare provider if they notice any changes in their visions, especially if they happen suddenly. Vision changes may include blurring, spots, flashes, blind spots, distortion, difficulty reading or doing detailed work. CHWs can also support a person with diabetes in talking to their healthcare providers about getting a vision test. Binding and sharing local community resources for vision loss can also be very helpful in this situation. Betsy. So let's take a look at one more case study here, Wendy. Robert is a 45 years old Caucasian man with type 2 diabetes who was controlling his hypoglycemia by drinking sodas to increase the blood sugar level. He works 12 hours a day. He say he doesn't have time to eat healthy or exercise at the suggested 150 minutes per week. He experiences dizziness. He doesn't own a glucose meter to check his blood glucose level. He fainted at his home, which he believed was due to hypoglycemia. What are some of the barriers you see that he might be facing? So let's use that chat box and see what are the barriers that you see here in Robert. I wanna see that cascade of comments coming up in the chat box. All right, here they go. No glucose monitor, lack of equipment, physical symptoms, busy schedules, works too much, economic, working too much, excessive work, diabetes class. What are the barriers? Not taking time to plan, healthy eating, poverty, no exercise, he feels alone, unable to get time off of work, lack of health education, too much soda, self-esteem, lack of education. Let me see, lack of education, stress, not accepting diabetes, poverty, family support, no planning meals. And the list goes on and on, food deserts. Yeah, it's all of that, Betsy, all of it. We certainly don't have a shy attendance here. I'm so happy- And that's great. To see that activation over there in the chat box. So some of the barriers are, you just said some of them, like consuming sodas, hyper or hyperglycemia, elevated glucose level, the 7.30 lifestyle, the lacking glucose meter. I hear our endos sometimes saying that a person with diabetes not checking her blood sugar is like trying to drive a car being blind. So that's how- Yeah, without their glasses, without their prescription glasses. So lacking glucose meter, dizziness, fainting, long work hours. Well, let's move on now to find or talk about some possible solution. So let the cascade drain through the chat box. I wanna hear your ideas around possible solutions to help Robert. CHW, a water, a diet, help him with getting, let me see, visit a PCP, buy a glucose monitor, educate the person, meal planning, exercise, walking with him, nutrition consulting, meal modification, education, time management, online support groups, connect to resources, adjust work schedules, connecting with his family support, educate him on the importance of self-care, apps on different types of support that he can receive, and so the list goes on and on, Betsy. Support and resources, that last one. And I do believe that that's exactly where community health workers, Wendy, can play an important role. So I have nothing to say. You have come up with wonderful solutions to Robert's situation. So let's move on. And so here we have like educate him about hypoglycemia or hyperglycemia, or how to properly treat them, share resources on how to get a glucose meter. There are many pharmacy programs that are out there that community health workers can connect Robert toward those. So discuss how to incorporate healthy eating by using the ADA diabetes plate, educating him on healthy snacks, encourage him towards physical activity into his weekly daily routine, including descriptions for physical activity, and addressing his time limitations. Encourage him to limit or eliminate soda, and give him advice on increasing water and other unsweetened beverage. Encourage him to schedule a checkup with his healthcare provider, and discuss options to enroll in diabetes support program, either in person or virtually. And the many, many other great solutions that you provided to the chat box. I think that Robert has a lot of hope, especially if it's hand by hand by a community health worker. Don't you think that Wendy? Yes, Betsy, we are a movement, not a moment. And we're continuing to impact our community. So thank you so much for that. And so here we are with the summary, Betsy. We have spent a lot of time talking about diabetes complications, the risk factors that contribute to them, and ways that CHWs can help. As you've learned, there are many common risk factors for a person with diabetes that can lead to complications. But luckily, focusing on healthy self-care behaviors can address these common risk factors all at one time. You've also heard some common themes in ways CHWs can help a person with diabetes manage their disease to prevent or delay these complications. This slide summarizes some of the many areas in which CHWs can help. And one final resource to share, the CDC has a flyer called Steps to Help You Stay Healthy with Diabetes. This is a free, this is free to download. The information on the flyer can help a person with diabetes focus on healthy behaviors to get and keep their diabetes under control. It has been, it also has a worksheet to help keep track of their goals and progresses. Wow, Betsy, that's really nice. Indeed, indeed. So I think that we're moving up right now to questions. I want to encourage you all to post your questions on the chat box or in the Q&A section. All right, so we have some here, Betsy. The question is, does a nerve damage can also occur to a person that doesn't have diabetes? I will say that people with diabetes has a higher risk because they have issues with the blood flow and the hardening of the arteries that I was talking about, which will increase the risks for having those type of things. But that doesn't preclude the fact that anyone who might not have diabetes, who might also have issues with circulatory problems or low blood flow can also have this. So there are many people, for example, with pre-diabetes, those that are not necessarily having diabetes diagnosed already, right? But they might have high blood pressure. They might have high cholesterol. And then the high cholesterol makes that deposit of plaque that I was making reference before, which will narrow the arteries and then will decrease the flow, creating all of those situations. I mean, think about a person that is having obesity. It might not have diabetes. It might have pre-diabetes, but it might not, because not every obese person have type 2 diabetes and not every obese person may have pre-diabetes. But the obesity itself, it creates kind of the same issues because everything is related the way people eat and how they are having those results around blood pressure and on cholesterol levels and triglyceride levels, which are the contributors to develop those plaque that in fact, again, the circulatory system. Yeah, and there's one here before we actually, we're gonna take just one more. How does diabetes affect oral health, especially the gums? Well, that's another complication that we didn't talk about here, but yes, indeed. By the same token, where the blood glucose levels are high in your bloodstream, it will be high in your saliva, creating the perfect environment for bacteria growth. And that's why many people with diabetes end in having losing all their teeth just because the blood glucose level has been out of range. So it is, yes, another complication that could be happening in people with diabetes. And it goes back to what we have been talking about, the importance of helping people manage their blood glucose level so they can keep it most of the time in time range. Okay, wow, yeah. So everything does affect, and that's something that a CHW needs to know and needs to be able to provide the access resources and provide the information in the language that they understand it in terms of being able to make that slight change, because it does take time, change does take time. And that's the reason why CHWs are there, to be able to assist them with that time commitment of change, right? So thank you so much, Betsy. It was an honor to work with you, amiga, amiga, lady of mine. And this concludes our presentation for today. Thank you for joining. Be sure to visit ADA CHW's website for more information and resources. And thank you again for your time. Bye-bye.

preventing diabetes complications

community health worker

healthy self-care behaviors

nerve damage

vision loss

foot care

blood glucose levels

CHW strategies

oral health