Prevent Diabetes in Minnesota through Community Partnerships

Marsha Hughes, Director Community Health Improvement HealthEast Care System Rita Mays, Diabetes Prevention Planner Minnesota Department of Health Sheryl Grover, Director of Chronic Disease Prevention, YMCA’s of the Greater Twin Cities

Objectives

• • • Describe: Prediabetes and diabetes in Minnesota – How does this impact seniors?

Who is at greatest risk?

How the National Diabetes Prevention Program helps prevent type 2 diabetes – Especially for seniors

Problem • Prediabetes can lead to type 2 diabetes • Solution Prediabetes can be identified early, reversed and type 2 diabetes can be prevented – Help people lose weight, eat more healthy foods and be more active

4 •

DIABETES 25.8 million Americans

•

PREDIABETES 79 million Americans (35% of all adults) with progression to diabetes at rate of 5 – 15% per year

| PRESENTATION TITLE HERE | ©2010 YMCA of the USA

Size of the problem: 2011 Snapshot in Minnesota

Age Group All adults Adults 65 years and older Approximate number of adults living with diabetes 290,000 Percentage living with diabetes 7.3% 110,000 15.8%

* In reality, numbers are higher because some people have not been diagnosed.

What are trends for older adults over the last 16 years?

CDC, National Diabetes Surveillance System, www.cdc.gov/diabetes/statistics Retrieved 4/18/2013

Why are numbers increasing?

• • • Better care diabetes longer, healthier lives with Changes in diabetes testing Our population is: – Getting older – Becoming more diverse – Becoming more obese (we can change this)

Prediabetes: What is it?

• Blood glucose (sugar) levels higher than normal – Not yet high enough for a type 2 diabetes diagnosis – People with prediabetes are more likely to get type 2 diabetes

Many adults in Minnesota have prediabetes but don’t know it • Estimate as many as 35% have prediabetes • Around 6 % say (or know) they have prediabetes

Prediabetes by age

• US study on prediabetes examined prediabetes rates in different age groups

Age Group

18-44 years 45-64 years

65+ years % with prediabetes (A1c or fasting glucose)

22% 41%

44%

James et al. 2011. Diabetes Care 34:387-391

Prediabetes by age: Who knows they have it?

• The same study also asked people if they had been told they had prediabetes.

Age Group 18-44 years 45-64 years

65+ years

% with prediabetes (A1c or fasting glucose) 22% 41%

44%

% who said they had diagnosed prediabetes 5% 10%

12%

James et al. 2011. Diabetes Care 34:387-391

Why we care

• Diabetes can lead to serious health conditions: – Heart attack – Stroke – Blindness – Kidney failure – Loss of toes, feet or legs

Complications of Diabetes

Why we care about Prediabetes • • •

Prediabetes increases:

Type 2 diabetes Heart disease Stroke

Who is at risk?

Risk factors for diabetes and prediabetes • • • • • • Increases with age Overweight or Obese Inactive Family History of Diabetes History of Gestational Diabetes when pregnant Given birth to baby weighing 9 lbs

MINNESOTA’s AGING POPULATION

1 dot = 50 people County Border Zip Code Highway Water

Data Source: 2013 Nielsen

Minnesota increasing obesity rates

+ +

Weight for Minnesota adults 65 years and older • 65 % are considered overweight or obese

Physical activity for Minnesota adults 65 years and older • • What they said: 32 % had no physical activity in the last 30 days • 55% had 150 minutes of moderate activity per week

Are you at risk?

Risk assessment

• Take the paper risk assessment test

How do we identify prediabetes?

Diagnosis is confirmed by one of three glycemic measures: – – – Hemoglobin A1c between 5.7%-6.4% Fasting Plasma Glucose between 100-125 2 hour glucose challenge test 23

Clinical diagnostic criteria

Is there a treatment for prediabetes?

YES!

Best option:

Lifestyle Change

Goal: lose 5-7 % body weight 150 minutes of weekly physical activity

Major multicenter clinical research study

26

Population

Diabetes Prevention Research Study Results

Overall Seniors (over 60)

Lifestyle

Intervention vs. Placebo 58% 71% Metformin vs. Placebo 31% 11%

Diabetes Prevention Program Research Group NEJM 2002; 346, No. 6: 393-403 27

Best Option:

Lifestyle Change

• • • Follow evidence-based program Offer program in community settings Strive to reach study goals Goal:

Lose 5-7 % body weight

150 minutes of weekly physical activity 28

Several Minnesota programs meet these goals: • • • • • YMCA’s – Diabetes Prevention Program We Can Prevent Diabetes Indian Health Board Veteran’s Administration I CAN Prevent Diabetes – Average shows 5% or more weight loss

Example of weekly weight change

10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0%

Average % Change in Weight in 12 weeks of an I CAN PD Group

Key Strategies

• Group sessions • Track food and activity • Weekly weigh-ins

National Diabetes Prevention Program NDPP Video http://www.cdc.gov/CDCTV/ChangeForLife/index.html

National Diabetes Prevention Program Who is eligible?

• • • • Have prediabetes or at risk for diabetes Overweight Adult 18 + years of age Cannot have diabetes or be pregnant

National Diabetes Prevention Program • 16 weekly group sessions Core Curriculum – One hour per week discussion – During the week each person tracks what they eat and how active they are • Followed by monthly post-core session – One hour per month for 8 months – Continued support

Core Curriculum: 1st Part

Skills

1. Welcome 2. Fat and Calorie Detective 3. Ways to Eat Less Fat and Fewer Calories 4. Healthy Eating 5. Move Those Muscles 6. Being Active: A Way of Life 7. Tip the Calorie Balance

Core Curriculum: 2 nd Part

Control the external environment

8. Take Charge 9. Problem Solving 10. Healthy Eating Out

Core Curriculum: 3

rd

Part

Psychological and emotional

11. Talk Back to Negative Thoughts 12. The Slippery Slope of Lifestyle Change 13. Jump Start Your Activity Plan 14. Make Social Cues Work for You 15. You Can Manage Stress 16. Ways to Stay Motivated

Facilitated groups

• • Trained Lifestyle Coach – Uses group techniques – Active listening Motivational Interviewing techniques – Open ended questions – Reflecting back – Summarizing

Meeting the needs of the community • Identify lifestyle coach who is sensitive to: – Age – Economic situation – Cultural diversities – Group dynamics

Deliver program in community settings Examples: • YMCA’s • Faith Community • Community Centers • Work Place • Adult Day Care

Community Diabetes Prevention Programs in Minnesota

Medicaid Medicare Minnesota Department of Health Health Care System Programs

We Can Prevent Diabetes YMCA’s Diabetes Prevention Program I Can Prevent Diabetes Diabetes Prevention Awareness

Facilitated Group Exercise

• Topic: Where can you provide a program like this in your community? • Will Seniors participate? – Why or Why not?

• Who are the partners?

Diabetes Prevention Program

Example of successful community partnerships

     HealthEast Care System – St. Paul, Minnesota  HealthEast Foundation  Faith Community Nurses Entira Clinics Lion’s 5M-6 Clubs YMCA’s of Greater Twin Cities Minnesota Department of Health

YMCA’s of Greater Twin Cities

• • • Medicare enrollment Demonstration Pilot Offered in limited geographic area Fee-for-service Medicare

Legislative Update

• Watch for more changes in coverage • Senator Franken has actively promoted the National Diabetes Prevention Program – As part of the Affordable Care Act – As part of the Centers for Medicaid and Medicare Services program

Thank you!

• • • Marsha Hughes [email protected]

Rita Mays [email protected]

Sheryl Grover [email protected]

We gratefully acknowledge data sources from Renee Kidney, Epidemiologist, MN Dept of Health [email protected]