Guided grocery stores are helping
diabetes patients manage their disease.
ON ROUNDS | FALL 2016
BY BRETT JAILLET
PHOTOS BY JEFF HANSON
Suzanne Henson picks up a green apple from a produce display at the Piggly Wiggly in Alberta City in Tuscaloosa. She turns and shows it to a group standing beside her.
“This is a big apple,” she says. “It’s really two servings.”
She turns back to the produce and points to a mesh bag filled with a smaller variety, nearly half the size of the one in her hand.
“Now these are a better size.”
The group is made up of diabetes patients and their family members, and Henson, registered dietitian and assistant professor of Family Medicine for the College of Community Health Sciences, is teaching them how to manage their disease through food.
A tour through a grocery store is a recent addition to the Diabetes Self-Management Education courses that have been offered for more than five years to patients at University Medical Center, which the College operates.
Started by Angela Hammond, CRNP, a nurse practitioner for the College, and Dr. Robert Ireland, a Family Medicine physician now retired from the College, the course consists of two classes that are three hours each. The sessions are taught by various CCHS faculty and providers: Hammond teaches patients the basics of the disease—how to monitor glucose and blood sugar levels, how and where to give insulin shots and how insulin works with the body.
Dr. Dana Carroll, a clinical assistant professor of Family Medicine, covers the types of medications available and their potential side effects. Robert McKinney, LCSW, assistant professor of Psychiatry and Behavioral Medicine and director of Social Services for UMC, provides information about social services and explains how to treat depression, a major side effect of diabetes. And Dr. Mark Richardson, professor of exercise science at UA, talks about the importance of exercise.
But Kim McMillan, LPN, a nurse in Family Medicine and a primary care patient advocate for UMC, identified the need for something more: After listening to feedback from participants, which, in addition to coordinating classes, recruiting patients and handling referrals, has been one of her key responsibilities with the course, she realized the course was missing something.
“We give them all this information, and then they go to the grocery store and scratch their heads,” she says.
In stepped Henson, who was teaching the nutritional component of the course. While she had introduced new foods to class participants (some tried avocados for the first time in a session) and had provided advice on what to pick up at the grocery store, she says that walking patients through the supermarket is a game changer.
“We all go to the store and pick up the same thing over and over again,” Henson says. “If you grew up eating certain foods, or maybe you grew up in a household where no one really cooked and you always had takeout or fast food, you might feel lost when you go into a supermarket.”
“WE GIVE THEM ALL THIS INFORMATION, AND THEN THEY GO TO THE GROCERY STORE AND SCRATCH THEIR HEADS.”
—Kim McMillan, LPN, Nurse in Family Medicine and Primary Care Patient Advocate for University Medical Center
She says that before taking a tour, many patients think making a change in their diet will be too difficult or too expensive.
“One of my goals is to show people that it is possible to eat healthier items and that they can do it on a budget,” says Henson.
The first tour was held in February. Henson starts off in the produce section and talks serving sizes of fruit—cautioning participants from picking up oversized apples or oranges—and introduces them to new foods and new ways to use them: An avocado can substitute for mayonnaise on a sandwich, a dark leafy green, like spinach, goes great on top of a frozen pizza and adds serious nutrition, and squeezing lemon into water is a simple way to add flavor.
Henson also teaches participants how to decipher what is in the foods they buy.
“I think nutrition label reading is a mystery to many of our patients,” she says.
For instance, she says salad dressings contain more sugars than patients might think. And a reduced-fat product isn’t always a healthier option.
“A lot of people think reduced-fat peanut butter, for instance, must be a better choice. But it actually has more sugar than plain old peanut butter to make up for the volume.”
Valerie Battocletti joined the Piggly Wiggly tour in May. Though she was diagnosed with diabetes more than 20 years ago, her physician told her a lot had changed in regard to education about the disease since she was first diagnosed and suggested she take the self-management course as a refresher.
And because her daughters handle a lot of the cooking at home, she brought them along on the grocery store tour.
“I’m just starting, but hearing everyone’s stories and learning how they manage has been helpful,” she says.
“Before I had known about looking for sugars, but now I know to look at the carbs, too. If I see anything over 10 carbs, I just know I’m going to skip it.”
Alabama is ranked third in the United States for percentage of adults who have diabetes, according to the US Centers for Disease Control and Prevention.
Diabetes prevalence in Tuscaloosa County was 10.5 percent in 2010, 11.1 percent in neighboring Bibb County, 19.4 percent in Greene County, 16.3 percent in Hale County and 15.7 percent in Pickens County, according to a report from the Alabama Department of Public Health.
University Medical Center and its second location in Northport make up West Alabama’s largest multispecialty practice and serve West Alabama.
UMC offers self-management courses about 10 times a year, Hammond says, and the goal is to pinpoint and address patients’ particular needs.
“We want to provide ways for patients to live full lives without the diabetes just totally making a wreck of it,” Hammond says. “A lot will tell us that diabetes is totally ruining their life. Every minute of the day they are thinking, ‘What am I supposed to be doing next?’”
McMillan says the grocery store tours are helping patients and that she has heard positive feedback since the first tour in February.
“We’re teaching them how to save time and how to shop, and they have more insight into what they are buying,” she says. “I think that was one of the things we were missing. Now they can keep healthy items at home so they are ready when they are trying to make better choices.”
DIABETES IN ALABAMA
• Prevalence of diabetes in Tuscaloosa is 10.5 percent and higher in surrounding counties, according to the Alabama Department of Public Health. The national prevalence is 9.3 percent, according to the US Centers for Disease Control and Prevention.
• University Medical Center and its second location in Northport make up the largest multispecialty medical practice serving West Alabama. Diabetes self-management courses are offered about 10 times a year.
• Alabama is located in the diabetes belt, identified by the CDC as a southern portion of the US covering 644 counties in 15 states. People who live in the diabetes belt are more likely to have Type 2 diabetes than those who live in other parts of the US.
• Alabama is ranked third in the US for percentage of adults who have diabetes.
The University of Alabama
College of Community Health Sciences
850 Peter Bryce Boulevard
Tuscaloosa, AL 35401
Tuscaloosa, AL 35487