ECU teams up with N.C. free and charitable clinics, Duke Endowment to bring diabetes management program to uninsured in Eastern N.C.

Dr. Lauren Sastre, the creator of the Fresh Start program, leads patients with Type 2 diabetes in an exercise segment during a recent class session. The program is helping uninsured patients of free and charitable clinics in Eastern North Carolina manage the chronic illness with virtual one-on-one health coaching and in-person group sessions like this that provide information on how to control diabetes through diet, exercise and other lifestyle changes. [Courtesy of Fresh Start]

Nutrition experts at East Carolina University and North Carolina’s free and charitable clinics have launched an innovative program to combat diabetes among low-income, uninsured residents in Eastern North Carolina, the region of the state hardest hit by the chronic illness.

Fresh Start, funded by a $365,000 grant from The Duke Endowment, provides one-on-one telehealth coaching, fresh produce, and a mobile kitchen delivering in-person cooking, nutrition and health classes to uninsured diabetic residents with limited access to health care.

The incidence of Type II diabetes among adults in Eastern North Carolina, at 14.4%, exceeds both the statewide rate for North Carolina (12.5%) and national rate (10.8%), and mortality rates for Eastern North Carolina residents with the disease are more than 50% higher than the rest of the U.S.

“Fresh Start addresses a critical health issue affecting our community in a comprehensive way,” said Dr. Lauren Sastre, assistant professor in theDepartment of Nutrition Science, who secured the grant and developed and leads the program. “Improving health outcomes for the uninsured in rural Eastern North Carolina is an important part of East Carolina University’s mission of transforming our region.”

Twice a month since mid-January, Fresh Start’s mobile unit has been making visits to work with patients of the Albemarle Hospital Foundation’s Community Care Clinic of Elizabeth City and the Community Care Clinic of Dare County in Nags Head. Another free and charitable clinic will be added in the program’s second year, with two more following in the third.

The Fresh Start program includes cooking demonstrations to show patients with Type 2 diabetes how to incorporate healthy foods into their diet. At a recent session, patients learned how to cook collard greens three ways and later sampled the results. Patients who attend the program also receive a bag of fresh produce to take home with them. [Courtesy of Fresh Start]
The clinics are members of the North Carolina Association of Free and Charitable Clinics (NCAFCC), a network of 73 clinics across the state that provide high-quality primary care and other services to the uninsured and underinsured, in most cases at no cost to the patient.

“Fresh Start is an excellent example of how free and charitable clinics provide innovative, high-quality health care to our state’s most vulnerable residents,” said Randy Jordan, CEO of NCAFCC. “We are grateful to partners like Dr. Sastre and The Duke Endowment for pioneering creative solutions that improve the health of North Carolina’s medically underserved and historically marginalized communities.”

Sastre and her department have partnered with free and charitable clinics in Eastern North Carolina since 2019 on “farm-to-clinic” programs that deliver fresh produce to the uninsured. Fresh Start takes a more holistic approach, adding coaching and in-person classes to help patients understand how and why to bring more healthy foods into their diet and prepare items they may not have cooked before.

“Nobody has connected the dots by combining individual coaching, fresh produce and cooking, nutrition and health classes,” Sastre said. “When you are just doing one of these things, you’re not accomplishing what’s really necessary to help people live healthy.”

Fresh Start uses student volunteers from Sastre’s department and ECU’s College of Allied Health Sciences to harvest and deliver fresh produce donated by local Eastern North Carolina farms through a partnership with the Society of St. Andrew, an anti-hunger group, and as health coaches providing individual counseling.

The Community Clinic of Dare serves uninsured residents (who meet income guidelines) of Dare, Currituck, Tyrrell, Hyde and Washington counties. The Community Clinic of Dare can be reached at 252-261-3041 or

The Fresh Start program attempts to break barriers by showing patients of various backgrounds that aren’t too familiar with fresh produce, like collard greens (pictured) that these foods can be a tasty incorporation into one’s everyday diet. [Courtesy of Fresh Start]
About North Carolina Association of Free and Charitable Clinics

The North Carolina Association of Free and Charitable Clinics supports 73 member clinics in expanding access to health care, reducing health disparities and improving the health of uninsured and underinsured individuals. Member clinics are a vital part of North Carolina’s safety net, providing care for 80,000 patients in 88 of the state’s 100 counties, including primary and specialty medical care; dental care; pharmacy services; optometry; behavioral health care; lab tests and hospital referrals. The association supports member clinics with education, advocacy, research, funding and collaboration, and promotes quality health care for all North Carolinians. Learn more at 

About ECU’s College of Allied Health Sciences

ECU’s College of Allied Health Sciences is the largest and most professionally diverse university provider of allied health professionals in the state of North Carolina. Its 25 degree and certificate programs share one common goal: to make a meaningful difference in the lives of others. The college educates the fastest-growing sector of the health care work force, including physical and occupational therapists, physician assistants, audiologists, dietitians, counselors, medical technologists and health information managers. Close to 1,500 students are enrolled in the college’s degree programs. The college is home to the departments of Addictions and Rehabilitation Studies, Clinical Laboratory Science, Communication Sciences and Disorders, Health Services and Information Management, Nutrition Science, Occupational Therapy, Physical Therapy and Physician Assistant Studies. It is also home to three community clinics that provide patient care and real-world experience for students.

About The Duke Endowment

Based in Charlotte and established in 1924 by industrialist and philanthropist James B. Duke, The Duke Endowment is a private foundation that strengthens communities in North Carolina and South Carolina by nurturing children, promoting health, educating minds and enriching spirits. Since its founding, it has distributed more than $4 billion in grants. The Endowment shares a name with Duke University and Duke Energy, but all are separate organizations.