El Rio Health Center Provides Specialized Care, Free Diabetes Education

El Rio community health center dietician Leticia Martinez counsels patient Marta Eagle during a diabetes education class on Monday, February 10.
El Rio community health center dietician Leticia Martinez counsels patient Marta Eagle during a recent diabetes education class.  (Photo by Caitlin Schmidt.)

Marta Eagle’s family history of diabetes began when her mother and brother were both diagnosed years ago.

Eagle herself was diagnosed only three months ago, but through a program offered at El Rio Community Health Center, she has access to education, counseling and collaborative care her family never had.

Sembrando Nuestro Mañana, or “Sowing Our Tomorrow” is a bilingual diabetes education and nutrition counseling program offered by the health center that tailors a health plan to fit each patient’s needs. A registered dietician acts as program manager and works with each patient through follow-up visits to ensure their diabetes is controlled. The patient also sees a clinical pharmacist to ensure they receive the correct medication and dosage for their specific treatment plan.

Leticia Martinez is the diabetes educator and registered dietician for Sembrando Nuestro Mañana. She has been an employee of El Rio for 18 years. Nutrition counseling can be beneficial for all patients enrolled in the program, she said, and often makes a significant impact.

“I’ve made quite a bit of changes to my diet [since my diagnosis],” Eagle said. “I’ve had to limit the amount of fruit that I eat, which is hard.”


If you go:

  • What: Bilingual Diabetes Education Classes
  • When: English class, Monday 10:00 to 11:30 a.m.
  • Spanish class, Thursday 1:00 to 2:30 p.m.
  • Where: El Rio Community Health Center Congress Clinic
  • 839 W. Congress Street
  • Cost: Free

Series of four classes that repeat every month. “Understanding Diabetes,” “Diabetes Nutrition,” “Medications and Maintaining a Healthy Blood Pressure and Blood Sugar,” and “Prevention of Complications and Exercise.”

For more information, call 670-3909


Martinez explains in her classes the impact that food has on a person’s blood sugar. Since beginning counseling, Eagle has also switched from corn to flour tortillas and has been complication-free.

A 2011 study by the Arizona Department of Health Services found that 8.9 percent of Arizona’s population, or 489,000 people, are diagnosed diabetics. That indicates an 80 percent increase from 1995, when only 4 percent of the population suffered from diabetes. The study also estimates that since a third of the population is undiagnosed, the real figure may be closer to 600,000 adults with diabetes in Arizona.

As the program’s only dietician, Martinez meets with six to eight patients a day Monday through Friday for 30-minute appointments.

“I see patients on a one-to-one basis when they first begin the program,” Martinez said. She follows up with patients whose blood sugar is out of control or people who need more nutritional counseling.

She also follows up with her patients’ physicians to adjust medications as necessary and continues counseling patients if they need it.

As the diabetes educator for El Rio she teaches the bilingual education classes that are free and open to the public. Every week there is a 90-minute course on Mondays in English and Thursdays in Spanish.
At an English class in February, there was only one participant, Eagle, who was instructed on a class titled, “Prevention of Complications and Exercise” that catered specifically to her health needs. Martinez and Eagle also discussed her annual doctor’s appointment and tests that have become more important for her to keep since her diagnosis.

The classes are a series of four that repeat every month.  People can attend as many classes as they want. If additional counseling with Martinez is desired, a person only needs to enroll in nutrition counseling.

“Everyone can learn a lot from the classes,” Martinez said.


What it is:

Diabetes is a chronic disease characterized by high blood sugar due to a lack of insulin, the blood sugar regulating hormone produced by the body. Type 1 diabetes is an autoimmune disorder where the body does not produce insulin. Its causes are not entirely understood, but scientists believe that both genes and environment are factors.

By comparison, Type 2 diabetes occurs when the body either does not produce enough insulin or the body’s cells ignore the insulin that is produced. There is a genetic connection with Type 2 diabetes, but lifestyle and obesity are strong risk factors for the disease.  Type 2 diabetes usually occurs in adults, while Type 1 is most commonly diagnosed in children.


Working in conjunction with “Sembrando Nuestro Mañana,” is the El Rio Clinical Pharmacy Demonstration Project. Started in 2005, the project’s goal was to provide complete pharmacy services to those in Tucson with little or no access to healthcare services. The project promotes the idea of pharmacists as members of a larger health care team. Other goals such as increasing access to affordable prescriptions, promoting quality management of these services and increasing positive patient outcomes have also been accomplished since the program’s inception.

Some patients see their primary care physician for a variety of health needs, including diabetes.  Through El Rio’s program, a patient’s diabetes care is managed by the dietician and pharmacists, who communicate with the primary care physician.  The patient receives focused treatment for their diabetes, something that might not get as much attention if the patient has other health problems that need to be addressed by their physician.

“We have worked with over 3,500 patients with diabetes,” said Dr. Sandra Leal, Director of Clinical Pharmacy at El Rio’s Broadway location.

Legislation passed in 2005 changed Arizona law to allow pharmacists in settings such as community health centers to implement, monitor and modify drug therapy while collaborating with physicians.

Shortly after the change in law, Leal, the other clinical pharmacists at El Rio and the medical team determined together that a diabetes-focused management clinic would serve the needs of the center’s patients. El Rio serves a large population of Tucson’s diabetic and pre-diabetic patients as well as genetically high-risk populations, such as Hispanics and Native American patients. Pre-diabetes means that the body is producing less insulin or becoming resistant to it. With changes to one’s diet, exercise and medication, it’s possible that one with pre-diabetes will never develop Type 1 or 2 diabetes.

El Rio’s Clinical Pharmacy Consultation Service that works in conjunction with the University of Arizona College of Medicine specifically services diabetic patients, 62 percent who are at or below the poverty line. 35 percent of those patients are under 14 years old.

With Arizona being 10th in the nation for obesity, pre-diabetes has also become a growing problem in the past decade. The number of adults with Type 2 diabetes has doubled in the past 10 years.

“Some of the increase is related to the fact that we are doing earlier screening,” Martinez said. “On the other hand, our lifestyles play a significant role in the increase of diabetes.”

An increased number of obese people are being diagnosed at earlier ages, including children and teenagers.

“Diabetes is preventable, and we must eat healthier,” Martinez said.

Her patient, Eagle is sharing with her family the education she is receiving through El Rio and lifestyles changes she has made.

“When my mother was diagnosed many years ago, she received no education,” Eagle said. “This would have helped her.”





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