Three times a week, Julia Hart, who walks with the aid of a cane, becomes a down-to-earth superwoman, using bottles of Diet Coke, fresh fruit and lots of positive encouragement to try and save the lives of people dealing with diabetes.

It is Friday morning. Ms. Hart, diabetes program director with the Centers for Healthy Hearts and Souls, is at Hosanna House, a spirit-filled community center in Wilkinsburg, and she arrives early to set out her diet soda and fruit.

		Video Outreach worker Julia Hart talks about her work with diabetes patients.

The Centers for Healthy Hearts and Souls -- a nine-year-old program connected to local churches -- is on a mission to restore wellness to minority communities by using faith to promote fitness, smoking cessation and better diets.

Ms. Hart travels from Wilkinsburg to East Liberty to Homewood fiercely battling some of the toughest issues related to diabetes in the African American community: denial, stigma and medication compliance.

She follows her clients into pool halls, she prays for them, at least once a month, she calls them at home.

The diet soda? It goes along with the fat-free low-sodium chips, the cherries and the message that it is possible to eat a good, healthful diet.

If her clients don't know where to get healthful food, she tells them.

She also tells them about calorie counts, specific brands of food, portion advice and walks with them through the costs.

In a voice that is as cajoling as it is compassionate, she admonishes, "We can enjoy food without killing ourselves, right?"

She is talking to a group where 11 of the people in the class have raised their hands to indicate they have high blood pressure, now considered to be a risk factor for diabetes.

Ms. Hart starts the meeting with prayer and then a call to respect the ground rules, which asks for confidentiality and a concerted effort to take action to improve one's health.

People come and go in the sessions, but organizers say that in the past five years, 400 people have been connected to the groups.

Here's a snapshot of who's there: 96 percent of the clients are black, 80 percent female and their average age is 62. Eighty percent of the participants are diabetic, others take care of someone who has diabetes or are at risk of developing the disease.

A social glue binds the members and instructional encounters drift toward the emotional: There is applause for a member who just finished a college degree, a promise to exercise with a member struggling with her weight, a hand on the shoulder for someone who recently lost a loved one.

There is evidence to suggest that this type of social intervention and peer-to-peer advocacy is potent, said Dr. Bruce Block, the medical director of Healthy Hearts and Souls, a program he co-founded.

These groups can enable patients to overcome denial, mistrust, financial issues and the time-consuming compliance that it takes to manage diabetes, said Dr. Block. "For most doctors it is frustrating to get patients to take care of themselves, but with these groups people say they want to do just that. They feel empowered."

Though drawn from a small sample, A1C levels of the group dropped from 8.41 to 7.37 percent. The A1C test is taken every few months, to measure the amount of glucose in the blood over a long period. Most physicians like to see it at 7 or below and the lower numbers can be tied to reducing kidney complications or lessening the chance of neuropathy in the feet. Members of the outreach group also saw their bad cholesterol, or LDL, drop from 121 to 106; and there was an average weight loss of 10 pounds, dropping from 200 to 190 pounds.

The success, said Dr. Block, is built on the foundations of concentrated care and shared culture.

In these sessions people spend about two hours together every few weeks -- more time than most have with their physicians. The sessions are more relaxed, people share stories, the same cultures, they give advice and reinforce the information they get from their doctors in an environment that feels like one big caring family.

With Ms. Hart, as with other outreach workers, the goal is to get each participant to pledge action steps, or small movements to better manage their disease: For some it's walking an extra mile a week, it's eating 100 percent whole-wheat bread, it's moving from three pieces of bacon at breakfast to two.

"I like to think that the little steps become a part of our lifestyle and we don't even know it," she said.

Diabetes can be controlled, but it is never going away, Ms. Hart reminds the group. She pounces on the language some physicians use that characterizes her clients as "borderline" diabetic.

"There is no such thing," she says. Such a notion only inclines people toward delaying lifestyle choices that will improve their diabetes management.

Diabetes is a disease that you take with you, she says. "When you go on vacation, you take your diabetes. When you go to a cookout, you take your diabetes."

You can't forget that, Ms. Hart reminds her clients. The depression, confusion and physical assaults of diabetes make it one of the most feared and misunderstood diseases today.

About 33 million Americans struggle with it. And black Americans -- the population Ms. Hart is reaching out to -- are disproportionately affected.

Throughout the United States, African Americans over age 20 are diagnosed with diabetes in greater percentages than any other race or ethnic group in this country.

According to the American Diabetes Association, 3.2 million blacks, or 13.3 percent, have the disease. After adjusting for population age differences, blacks are 1.8 times more likely to have diabetes as non-Hispanic whites.

A quarter of black Americans between 65 and 74 have diabetes. One in five black women over age 55 has diabetes.

All of these issues show up at Ms. Hart's table. Her clients are poor, elderly, professional. There are the twin sisters who struggle with changing their eating habits; the husband and wife who use exercise to manage their diabetes; the obese, the smoker, the stroke survivor and the heart disease patient.

The biggest breakthrough, says Ms. Hart, is teaching the group members that, contrary to popular belief, diabetics don't have to suffer from the disease.

In the black community, diabetes is commonly referred to as "sugar diabetes" and is associated with eating cakes, pies and being considered a glutton. No one was anxious to talk about it, but the effects of being ignorant and passive are all around. Relatives go blind, lose limbs and have to undergo dialysis.

"So when you get a diagnosis," says Ms. Hart, "the first thought is, 'Is this what I'm going to face?' "

Hard to believe

"One of my clients had seen all of his uncles on dialysis because of diabetes and they all died," she says. "He was scared to accept it."

Ms. Hart knows such fear.

A former nurse at Montefiore, she has lived with type 2 diabetes for at least 10 years. To help manage her disease, she's lost 70 pounds and is aiming to lose 60 more.

Moreover, her son, 32, has type 1; her daughter, 30, does too; and one of her nephews died of complications of diabetes.

But she's heartened by the progress of such people as Pearl and Maurice Poole, a husband and wife, who followed her from sessions in a Homewood church to the Hosanna House.

In one recent meeting, Pearl Poole sits next to her husband. They both have diabetes and credit the sessions with motivating them to do the right thing.

Diabetes has ripped through both sides of the Poole family, striking aunts, uncles, brothers, sisters and children. With exercise and diet, Mr. Poole takes no medication; Mrs. Poole is insulin-dependent and has treatments for diabetes-related eye problems.

With what they have learned about diabetes management, they have tried to share with family and neighbors.

"It's been a difficult conversation," confides Mrs. Poole. "No one wants to believe it can happen to them."

It's a different experience in the class with Ms. Hart, where a shared bond and a common enemy teaches everyone.

"We all have the same problems and it gives us incentive to learn and be supportive," says Mrs. Poole.

Class is over.

Ms. Hart packs up her diet soda and cherries and believes she has persuaded her clients that it's going to take everybody to tackle the crisis of diabetes.

Or, at least one super woman who is ready to make a difference.