Welcome to Native Lifestyle Balance

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Native Lifestyle Balance

• Northern Navajo Medical Center
• Diabetes Education Counseling Center
• Started October 2002

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Approximately 18 million Americans have Type 2 DM
13.9 million have been diagnosed 5.2 million have
not
Approximately 41 million Americans have Pre-DM
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BETWEEN FY 1997 AND FY 2002,NAVAJO DIABETES
PREVALENCE RATES INCREASED 33.
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NAIHS FY 2002 DIABETES PREVALENCE BY AGE
U.S. ALL RACES RATE 6.3 PER 100 POPULATION
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Diabetes Prevention

• Lifestyle Change
• Acarbose
• Metformin
• Rosiglitazone
• Vitamin E

• Bezafibrate
• Coffee
• Gastric banding
• ACEI/ARB
• Alcohol

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Diabetes Prevention

• Diabetes Prevention Program (DPP)
• Goal 7 weight loss achieved by
• 25 of calories from fat
• 150 minutes of exercise per week
• Outcome
• Wt loss was the dominant predictor of dec DM with
• 16 RRR with every kg of weight loss
• Only 5kg wt loss resulted in RRR 58
• Physical activity was importance for maintenance

NEJM 346393-403, 2002
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Diabetes Prevention

• Lifestyle Change
• Meta-analysis of 8 RCT
• Lifestyle intervention which included dietary
• intervention
• Outcome
• Decreased 2-h glucose
• Decrease 1-yr incidence of DM 50 (CI 0.44-.69)

DC 28(11) 2780-6, 2005 Nov
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Wt Loss in Pts with DM

• ICAN study
• Improving Control with Activity and Nutrition
• 12 month RCT 147 pts with DM and BMIgt27
• Lifestyle case-management vs. usual care
• Outcome
• Greater wt loss, improved A1c
• Less rx meds, improved quality of life

DC 27(7) 1570-576, 2004 July
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Native Lifestyle Balance

• What is it?
• Weight loss program based on the successful
  curriculum of the Diabetes Prevention Program
• NLB is name chosen for Navajo Area

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Native Lifestyle Balance

• DPP Key Features
• Individual coaches
• Frequent contact with participants
• Core curriculum for 16 weeks
• Physical activity sessions
• Maintenance interventions
• Adherence Strategies
• Ethnically tailored materials

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Native Lifestyle Balance

• What are the goals?
• Achieve a 7 weight loss from starting weight
• Log at least 150 minutes of exercise each week

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Native Lifestyle Balance

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Native Lifestyle Balance
165 grams of fat
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Native Lifestyle Balance
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Native Lifestyle Balance
Example patient 35 yo female, Starting
wt200lbs Goal Weight186lbs Fat Gram Goal per
day42 Calorie Goal per day1500
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Native Lifestyle Balance

• Shiprock Service Unit Data
• First Group started October 2002
• 18 initial participants
• 13 completed the core curriculum
• 5 drop outs
• 16 week core curriculum

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Native Lifestyle Balance

• Shiprock Service Unit Data-NLB Group 1
• Weight Loss
• Entire Group (including 5 drop outs, 18)
• Mean 12.6 lbs
• Range 2.8-24.4 lbs
• Median 11.4 lbs
• Completed Participants (13)
• Mean 15.1 lbs
• Range 5.8-24.4 lbs
• Median 13.6 lbs

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Native Lifestyle Balance
Shiprock Service Unit Data-NLB Group 1 Weight
groupings (entire group)
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Native Lifestyle Balance

• Shiprock Service Unit Data-NLB Group 1
• Cholesterol Reductions
• Mean LDL Reduction-4.4 mg/dl
• Mean HDL Increase-1.1 mg/dl
• Body Fat Percentage
• Mean Reduction-6.1
• Range-2.2-16 reduction

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Native Lifestyle Balance

• Shiprock Service Unit Data-Data Summary
• Participants
• 110 Completed Participants (155 total)
• Age Range 18-65
• Drop Out Rate 29
• Weight Loss
• Mean 12.7 lbs, Range 3.8lb gain to 30.4lbs
  lost
• Total 1890 lbs lost by group

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Native Lifestyle Balance

• Shiprock Service Unit Data-Data Summary
• Cholesterol
• LDL mean decrease 6.7mg/dl
• HDL mean increase 1mg/dl
• Body Fat Percentage
• Mean reduction 4.1
• Range 2.9 to 50 reduction

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Native Lifestyle Balance
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Native Lifestyle Balance

• Staff
• Joann Lameman, RD Dietitian
• Vangie Benally, Fitness Specialist
• Nora Benally, RN
• Mamie Denetclaw, RN CDE
• Earlinda Keeswood, Program Assistant
• Marcellina Benally, NA JVN Tech
• Lyle Lee, RN
• Shelley Thorkelson, CNM CDE
• Shannon Dunn, RN CDE
• John Liesse, RN