Diabetes Primary Prevention Initiative Intervention Focus Area

1
Diabetes Primary Prevention Initiative
Intervention Focus Area

• CDC Division of Diabetes Translation Conference
  2009

2
Focus Area Goals

• To develop, test, and evaluate models for the
  planning and implementation of diabetes
  prevention programs by DPCPs and their partners
• To pilot test potential interventions that DPCPs
  can implement to prevent type 2 diabetes
• To explore cross-sector partnerships and
  collaborations for diabetes prevention
• To gain experience which could lead to the
  acceleration of the adoption of best practices,
  new tools, models, and methods which would serve
  as a process roadmap for DPCP program planning

3
Focus of Interventions

• Interventions were targeted towards five
  stakeholder groups
• Community Based Organizations
• Businesses and Employers
• Health Care Systems
• Consumers and High-Risk Populations
• Policymakers

4
Primary Prevention Pilot Outcomes

• California
• Implemented screening and primary prevention
  programs at 3 worksites
• 2.2 avg weight loss, 47.9 with 150 min avg
  PA/week (n45)
• Educated gt300 healthcare providers about
  prediabetes and diabetes prevention guidelines
• Pilot tested a prediabetes treatment algorithm
  13 week intervention within a healthcare system
• 4.2 avg weight loss, 47 with 150min avg PA/week
  (n22)

5
Primary Prevention Pilot Outcomes

• Massachusetts
• Partnered with local health care system and
  community-based organization to implement
  diabetes prevention programs in two worksites.
• 3.8 average weight loss in worksite 1 (n21) and
  3.0 average weight loss in worksite 2 (n8)
• By week eight, approximately 62 reported 150 min
  of PA/week in worksite 1 (minutes of PA for
  worksite 2 not available )

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Primary Prevention Pilot Outcomes

• Michigan
• Collaborated with a regional health partnership
  to reach providers and those at high risk of
  diabetes in Northern Michigan with prevention
  guidelines and messages
• Partnered with the WISEWOMAN and WIC programs to
  target women at risk of prediabetes and diabetes
• WISEWOMANLenawee Pilot (n49)
• Weight loss
• 22 lost lt5 weight
• 12 lost 5-7 weight
• 6 lost gt7 weight
• Physical Activity
• Of the 18 doing gt 150 minutes/week at baseline
  27 at follow-up
• 10 of the 35 under 150 minutes/week increased PA
  at follow-up
• Preliminary Data

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Primary Prevention Pilot Outcomes

• Washington
• Implemented primary prevention programs (8wks)
  for high risk ethnic populations accessing
  community clinics in Seattle
• Cantonese/Chinese group the avg weight loss over
  8 weeks was 3.8
• 47 of participants reported an increase in
  minutes or days of PA during the intervention
• Group continues to meet for weekly PA sessions
• Facilitated awareness of pre-diabetes and
  diabetes prevention in a small rural county

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Primary Prevention Pilot Outcomes

• Minnesota
• Influenced health care system changes through
  states ICSI (Institute for Clinical Systems
  Improvement)
• Developed diabetes prevention educational
  materials for high risk populations (6 languages)
• Developed on-going DPP programs in 4 communities
  using public health clinic-YMCA model
• gt 5.7 avg wt loss (n36)

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Primary Challenges

• Creating partnerships and developing consensus on
  project goals and intervention strategies among
  diverse stakeholders with different agendas and
  core values
• Facilitating the sharing of information between
  clinical and community partners
• Establishing an effective process to screen
  individuals in the community and refer to a
  healthcare provider for diagnostic testing

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Primary Challenges

• Motivating providers and increasing their sense
  of urgency to identify patients with prediabetes
• Establishing an effective strategy to raise
  awareness among potential participants, enhance
  attendance, and limit drop-outs
• Working within various pre-existing program
  structures to incorporate primary prevention
  activities and enhance sustainability
• Evaluating diverse primary prevention programs in
  different settings

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Lessons Learned

• Identify and build strong partnerships with
  organizations with skilled and motivated staff
  (e.g., ICSI)
• Educate and involve local health care systems,
  providers, and health plans in the planning
  process to obtain buy-in and also involve them in
  prediabetes screening and diagnostic activities
• Build on the evidence-based work of others (e.g.,
  DPP, Health Disparities Collaborative, DPPI
  states)
• Use materials that have already been developed
  and translated for raising awareness about
  diabetes prevention among high-risk populations
  (e.g., NDEP)

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Lessons Learned

• Begin to educate the target population early and
  develop motivational strategies to enhance
  participation
• Utilize familiar community organizations to
  enhance appeal to intervention participants
  (e.g., YMCA, and Curves)
• Link DM prevention efforts to the benefits and
  activities of partner programs accessing similar
  populations (e.g., WIC, WISEWOMAN)
• Achieving participant outcomes takes ongoing
  support and time

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Recommendations for Future Work

• Develop campaigns to raise consumer awareness
  about prediabetes and diabetes risk
• Consider strategies for educating and supporting
  providers to increase their likelihood to screen,
  diagnose, and monitor prediabetes
• Consider how the various components of the
  Chronic Care Model can support primary prevention
  in healthcare systems and the community

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Recommendations for Future Work

• Work towards standardizing and validating several
  primary prevention curriculums which would be
  applicable to diverse target audiences and which
  could help begin to build a greater business case
  for primary prevention
• Collaborate with policy makers to develop
  reimbursement strategies for primary prevention
  interventions
• Explore which systems and policy changes would be
  most critical to facilitating the establishment
  of an effective delivery system primary
  prevention

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Focus Area Tools

• Key Tools Developed
• Primary Prevention Resource Lists
• Prediabetes Frequently Asked Questions
• Prediabetes Identification Treatment Algorithm
• Primary Prevention Planning Process Roadmap
• Common Measures Evaluation Matrix
• Primary Prevention Bibliography
• Tools developed in the DPPI will be made
  available on the NACDD website

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In Conclusion

• The DPPI has laid the groundwork for DPCPs as
  they begin the work of primary prevention
• DPCPs are well positioned to facilitate the
  implementation of primary prevention programs and
  policies statewide and on a local level

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Intervention Focus Area Contacts
Rita Mays MS, RD, LN Diabetes Plan
Planner Diabetes Prevention Control
Program Minnesota Department of
Health Rita.mays_at_state.mn.us 651-201-5433 Jeanne
Harmon MBA,RD, CDE Health Promotion
Specialist Diabetes Prevention Control
Program Washington Department of
Health Jeanne.harmon_at_doh.wa.gov 253-395-6758
Roger Chene MPH, RD Area Health Promotion
Specialist California Diabetes Program California
Department of Public Health rogerchene_at_yahoo.com 9
09-796-6758 Pattie Daly MS, RN Health Systems
SpecialistDiabetes Prevention Control
Program Massachusetts Department of Public
Health Patricia.R.Daly_at_state.ma.us
617-624-5435 Kristi Pier MHS Public Health
Consultant Diabetes Prevention Control
Program Michigan Department of Community
Health pierk_at_michigan.gov 517-335-6937