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 | PRESENTATION TITLE HERE | ©2010 YMCA of the USA PREDIABETES 79 million Americans (35% of all adults) with progression to diabetes at rate of 5 – 15% per year DIABETES 25.8 million Americans

Size of the problem: 2011 Snapshot in Minnesota Age GroupApproximate number of adults living with diabetes Percentage living with diabetes All adults290,0007.3% Adults 65 years and older 110, % * 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, Retrieved 4/18/2013www.cdc.gov/diabetes/statistics

Why are numbers increasing? Better care longer, healthier lives with diabetes 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% with prediabetes (A1c or fasting glucose) years22% years41% 65+ years44% James et al Diabetes Care 34:

Prediabetes by age: Who knows they have it? The same study also asked people if they had been told they had prediabetes. Age Group% with prediabetes (A1c or fasting glucose) % who said they had diagnosed prediabetes years22%5% years41%10% 65+ years44%12% James et al Diabetes Care 34:

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 Data Source: 2013 Nielsen Zip Code Highway Water County Border 1 dot = 50 people

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 – 2 hour glucose challenge test 23

Clinical diagnostic criteria

Is there a treatment for prediabetes? YES!

Goal: lose 5-7 % body weight 150 minutes of weekly physical activity Major multicenter clinical research study Best option: Lifestyle Change 26

27 Diabetes Prevention Research Study Results Diabetes Prevention Program Research Group NEJM 2002; 346, No. 6:

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 Best Option: Lifestyle Change 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

Key Strategies Group sessions Track food and activity Weekly weigh-ins

National Diabetes Prevention Program NDPP Video

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 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 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 Skills

Control the external environment 8. Take Charge 9. Problem Solving 10. Healthy Eating Out Core Curriculum: 2 nd Part

Core Curriculum: 3 rd Part 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 Psychological and emotional

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 We Can Prevent Diabetes Medicare YMCA’s Diabetes Prevention Program Minnesota Department of Health I Can Prevent Diabetes Health Care System Programs 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 Rita Mays Sheryl Grover We gratefully acknowledge data sources from Renee Kidney, Epidemiologist, MN Dept of Health