Diabetes Prevention and Outreach Program a Translation of Diabetes Prevention within the Hispanic Co

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Diabetes Prevention and Outreach Program a
Translation of Diabetes Prevention within the
Hispanic Community

• Oklahoma City County Health Department
• Allyson Drain, MS, RD/LD
• Allyson_Drain_at_occhd.org
• 405-419-4052
• CDC Chronic Disease Prevention
• April 24th, 2009

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Hispanics and Diabetes

• Hispanic Americans are 1.7 times more likely to
  have diabetes than non-Hispanic whites of similar
  age.
• 25 of Mexican American over 45 have diabetes.
• Hispanics became the largest minority group in
  2003 and the largest uninsured group.

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Objective

• To implement a nutrition education program
  within the Hispanic community in order to prevent
  or delay the onset of diabetes in this high risk
  population.
• Equip participants with the tools to modify
  habits in order to prevent diabetes so they could
  teach others the lifestyle changes

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Diabetes Prevention Classes

• Based on the National Institute of
  Health-Diabetes Prevention Program (NIH-DPP) Core
  Curriculum
• Conducted 12 one hour lifestyle classes
• Provided exercise time after each class
• Provided weekly individualized review of
  activity, food diaries and Keeping Track of
  Weight graph

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Lessons that were modified

• Welcome to the Program the connection
• Idaho Plate Method
• Healthy Eating lowering fat and meal planning
• Being Active a way of life
• 7. Negative Thoughts and Problem Solving
• 9. Slippery Slope of Lifestyle Change

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Intervention Recruitment

• 829 participants screened from 6/07 to 10/08
• screenings held quarterly
• Screenings held at a large Spanish speaking
  church
• Spanish speaking news media has been our greatest
  source of free advertising

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Intervention Screening

• Community Screenings included
• Anthropometrics, lipid panel, fasting glucose and
  blood pressure
• An assessment of risk for diabetes
• at-risk was defined as 3 or more risk factors
  from the NIH list of risk factors for type 2
  diabetes
• (National Diabetes Information Clearinghouse
  NDIC)

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At screenings each participant received

• Education regarding the results of labs and
  measurements collected
• Referrals for medical and/or socioeconomic needs
• Invitations to attend diabetes prevention classes
  if identified as at risk or
  pre-diabetic

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Numbers of Participants

• 829 screened
• 111 attended at least one class
• 84 completed at least 6 of the 12 classes
• Few of the participants attended the church where
  the screenings and classes were held

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Screening Participation
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Screening Participants BMI/Glucose
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Medical Homes

• Everyone who came to a screening that had a
  medical need was given a medical home they could
  afford
• We utilized many different types of clinics
• Health Alliance a free clinic association
• Several sliding scale clinics
• Doctors who agreed to see 1 patient a month free
  of charge

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Participants

• 84 completed at least 6 of the 12 classes
• 3 men
• 97 women
• Min. age 24, Max. age 79, Age range 55
• 96 Hispanic, 4 Non Hispanic

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Participant Outcome Goals

• Each participant was given 2 goals
• Reduce weight by 5
• Engage in 2 ½ hours of physical activity a week
• This was modified depending on needs of
  participants

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Program Goals

• 50 will reduce weight by 5
• 50 will lower fasting glucose by 5
• 90 reduction in tobacco use
• 30 cholesterol gt200 would reduce cholesterol by
  gt10
• 50 with blood pressure gt140/90 will reduce by 10

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OutcomeChanges in Elevated Lipids

• Reduction in LDL (gt130mg/dl)(n27)
• 59.3 decreased LDL by gt20
• Reduction in total cholesterol (gt200mg/dl)(n31)
• 69 decreased cholesterol by gt10
• 34 decreased cholesterol by gt20
• Reduction in Triglycerides (gt150mg/dl)(n38)
• 66 decreased Triglycerides by gt10
• 47 decreased Triglycerides by gt20

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OutcomeGlucose Changes

• Reduction in Pre-Diabetes (100-125mg/dl)
• Out of the 36 participating pre-diabetics 12
  (33.3) reduced glucose level to normal
• 3 (8) pre-diabetics did not convert to normal
  but decreased fasting glucose more than 10
• Reduction in all participants
• 47 decreased fasting glucose by gt5 (n84)
• 72 decreased fasting glucose (n84)

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OutcomeWeight Loss

• 90 of participants lost weight (n84)
• 39 lost gt5 of body weight
• 40 of obese lost gt5 (n44)
• 30 of over weight lost 5 (n30)
• 32 of normal weight lost 5 (n10)

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Factors Impacting Acceptance

• Time of day
• Classes were translated to Spanish
• 88 did not speak English
• 48 had an elementary education or less
• 84 did not finish high school
• OK House Bill 1804
• Reliance on Free advertising

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Class Goals
Small sample size
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Programmatic Changes

• Changes have been made to help our program meet
  the community needs while serving a greater
  number of participants with less costs from the
  county
• Graduate volunteers are trained to teach classes
  within the community
• Volunteer teachers help to recruit class members

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Programmatic Changes

• Reliance on change in weight and knowledge
• Screening for health risks is voluntary and not a
  condition of classes participation
• Using ADA screening tool since lab screening is
  not a condition of classes
• Weekly dietitian consults will be by appointment
  only, no appointments have been made so far

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New Program with Changes

• At week 6 of the community lead classes have an
  average weight loss of 2.6 for all who attended
  at least 3 weeks
• 2 classes are being held at the same location
• 3 new sites will open summer 2009
• Currently have 4 leaders that are teaching and a
  waiting list of others wanting to start train the
  trainer
• Focus groups are being held for other populations
  in May 2009

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Thank you

• Allyson Drain, MS, RD/LD
• 405-425-4469
• Allyson_Drain_at_occhd.org
• Imran Ahmed, MD, MPH
• 405-425-4437
• Imran_Ahmed_at_occhd.org
• Nancy Dayton, RN
• 405-425-4469
• Nancy_Dayton_at_occhd.org