“At first, migrant workers just assumed they’d get diabetes. With education, patients bring in friends and relatives and ask for testing. They now know that diabetes can be prevented.” — Loretta Heuer

Nursing prof Loretta Heuer teaches diabetes management for an "invisible" population

Diabetes is sometimes called an “invisible” disease in the United States because so many individuals are unaware they have it. Then consider the challenges of dealing with this disease within an “invisible” population.

Loretta Heuer, a nursing professor and interim chair of practice and role development in the College of Nursing, is developing innovative ways to help treat and reduce diabetes in mobile farm workers.

“Migrant farm workers are an ‘invisible’ population,” Heuer said. “They are impoverished, uninsured, vulnerable, and they don’t vote.”

Those qualities moved her to develop a diabetes program and later expanded it to include diabetes lay educators. These individuals are trained “lay educators” from the farm worker communities. They provide education, language interpretation and advice, and act as case managers and advocates, ensuring that patients get the treatment they require. They also lead support groups or diabetes prevention screenings, which often meet after Sunday mass. They travel with their communities, living in North Dakota and Minnesota during the summer and moving back to Texas in the fall and winter.

Heuer, a practicing nurse who is also the chronic disease coordinator at Migrant Health Services Inc. in Moorhead, Minn., has been serving people with diabetes since 1998, when she developed a pilot program to provide health care services and education to people with the chronic disease. She believes that patients need consistent health care services and education on how to self-manage their diabetes and prevent long-term complications.

“Patients need support when they return to Texas in the winter,” Heuer said. “It’s difficult for them to receive care when it takes two or three months to see a doctor.” She was also concerned about comments from other nurses in the seasonal clinics, who noticed that patients often had their hemoglobin A1c levels under control and were managing diabetes fairly well when they left the north in the fall. But when they returned from Texas, they had often stopped taking medications and were no longer managing their conditions as well. She began gathering data and learned that it was indeed the case.

Overall, the diabetes education program has helped patients care for their diabetes during the winter months; it is hoped that these patients will experience fewer long-term complications.

Seven years of data show that patients have lowered their hemoglobin A1c levels from 9.8 to 8.3 (HbA1c levels below 7 are considered ideal). When the program began in 1998, just 50 patients were served. Since 1998, more than 2,000 migrant workers are documented in the Chronic Disease Registry, with 650 annually receiving health care services in North Dakota, Minnesota, and Texas.
The program has paid off in other ways. “At first, migrant workers just assumed they’d get diabetes,” said Heuer. “With education, patients bring in friends and relatives and ask for testing. They know that diabetes can be prevented.” And those with diabetes can better care for themselves and avoid complications such as blindness and limb amputations.

Along with focusing on individual patient health, Heuer has become an advocate for underserved populations and is increasingly interested in health policy. She was named a Robert Wood Johnson Executive Nurse Fellow in 2002, one of two from North Dakota. She has spent three years collaborating with peers and working with politicians in Washington, D.C., North Dakota, Minnesota, and Texas, advocating for migrant workers and serving as an expert on minority health care. Last fall she was selected as a fellow in the American Academy of Nursing, the most prestigious honor bestowed on a professional nurse. Just five North Dakotans have previously been named to the Academy.