Taking charge of diabetes

By Lois Caliri

"The food demonstration and tasting has far-reaching benefits because participants can share the information with friends and family." – Linda Jackson Cole, family and consumer sciences Extension agent in Chesterfield County

In the past, when diabetic of 35 years James Vaughan was asked how many biscuits he ate, he’d sport a mischievous grin and answer, “It depends on how much gravy I have.”

These days, Vaughan is much more cautious and serious about managing his blood sugar and laughs when he thinks of his old eating habits. Ask him the same question about his biscuit consumption and his shining eyes and radiant smile show the proud look of achievement.

“Two. Two is enough,” he says.

Vaughan is one of 10 African Americans who recently participated in a three-month reunion that followed four weekly sessions in the Balanced Living with Diabetes program for people with Type 2 diabetes.

Kathy Hosig, associate professor in population health sciences at the Virginia-Maryland Regional College of Veterinary Medicine; Eleanor Schlenker, professor and Extension nutrition specialist; and Eileen Anderson-Bill, research assistant professor in the Department of Psychology in the College of Science, developed, implemented, and coordinated the Balanced Living with Diabetes program with a $2.1 million grant from the National Institutes of Health. The program was created for Virginia Cooperative Extension.

The Baptist General Convention of Virginia, a project partner, assists in delivering the program to 27 churches in nine locations throughout the commonwealth. The program targets medically underserved areas, using a community-based, participatory approach.

“The NIH grant is an excellent example of interface among Extension, research, and partnerships with public health agencies,” Hosig said.

There are an estimated 20.8 million diabetics in the U.S., and that figure is projected to rise to 39 million by 2050. Non-Hispanic African Americans are 1.8 times more likely to have diabetes than non-Hispanic Caucasians. The journal Disease Management & Health Outcomes reported that African Americans benefit more from controlling blood sugar compared to Caucasians. African Americans benefit even more from improving blood sugar control through self-management.

Participants in Extension’s diabetes program learn how to self-manage their disease by choosing healthy foods, eating appropriate portions several times a day, developing a fitness program, keeping track of their progress, and setting realistic goals. They receive a kit with tools that includes a pedometer.

The pedometer became the ideal incentive for Lessie Oliver-Clark, a participant in the Chesterfield county classes.

“I came to the class because I wanted to manage my blood sugar better. I wanted to get more motivated to exercise more and to eat right,” Oliver-Clark said. “The pedometer got me motivated to walk.”

She tends to eat more while traveling for business, especially when traveling outside the U.S. Still, she found the discipline to write down the number of her walking steps on a calendar. A phone call from her husband also helps. “He will call, asking me if I walked,” she said.

Bernard Surley, (left) who has had diabetes for 20 years, talks to Vanessa Johnson, a registered nurse with Richmond City Health District.

The first class and the reunion class include an assessment of hemoglobin A1c (a measurement of average blood glucose control during the past three months), blood pressure, and daily practices. An Extension educator conducts the food demonstration and tasting at each class.

Hosig and Anderson-Bill collect the medical data as well as records from the participants about their food and physical activity habits. The information will be used to gauge the success of the program.

“The food demonstration and tasting has far-reaching benefits because participants can share the information with friends and family,” said Linda Jackson Cole, family and consumer sciences Extension agent in Chesterfield County. For the reunion, she prepared a bean and brown rice dish, an autumn salad, and southern banana pudding, all of which emphasized sugar-free, unsalted, and low-sodium products.

“The crux of successful diabetes management is portion control,” said Schlenker. Schlenker’s message resonated with participants in the Chesterfield class.

Julia Gilliam, whose A1c level dropped to 6.9 percent from 10.2 percent, said she focuses on what she eats and how much she eats. “I eat in moderation. I eat less starch and more veggies,” she said. While she hasn’t mastered the exercise program yet, she’s confident she’ll reach that goal.

Self-management underscores the purpose of the program. “We provide people with the experiences they need to build confidence and self-manage,” said Anderson-Bill. If people self-manage, then they can avoid difficult behavior down the road, such as giving themselves daily insulin shots.

Ultimately, this program can be a model for developing partnerships between Extension and public health professionals, according to Hosig.


Virginia Cooperative Extension’s diabetes education program, funded by the Virginia Department of Health, began in 2006. The careful collection of data showing people’s improvements in managing their blood sugar levels helped Virginia Tech and its partners write a successful National Institutes of Health proposal.

Today, the NIH-funded project provides resources to revise and strengthen the diabetes education program. Plans are underway to disseminate information to other state Extension offices once the NIH project is evaluated.

In addition, grants from the Obici Healthcare Foundation made it possible for Extension and the Virginia Diabetes Council to expand the Balanced Living with Diabetes program to other regions within the commonwealth.


Balanced Living with Diabetes has been a partnership of several entities:

  • Virginia Cooperative Extension; Virginia Tech and Virginia State University
  • Department of Population Health Sciences, Virginia Tech
  • Center for Research in Health Behavior, Virginia Tech
  • Baptist General Convention of Virginia
  • Virginia Diabetes Council
  • Obici Healthcare Foundation
  • Virginia Diabetes Prevention and Control Project, Virginia Department of Health