1. Diabetes Self-Management Program Jane Mahoney, MD, Executive Director, Wisconsin Institute for Health Aging Professor of Medicine, UW School of Medicine and Public Health Betsy Abramson, WIHA Deputy Director Larry Epstein, DSMP Leader

2. Helping older people live healthier lives through evidence-based prevention programs.

4. Aging Research CAARN: Community-Academic Aging Research Network creates a bridge between university and community groups to do research in healthy aging CAARN provides training programs, networking opportunities, and resources to facilitate aging research

5. WIHA’s Evidence-Based Programs Living Well with Chronic Conditions: A self- management workshop for people with one or more chronic health problems Stepping On: A falls prevention self- management workshop Sure Step: one-on-one falls prevention assessment in the home for people with cognitive impairments Healthy Living with Diabetes: self- management workshop for people with type 2 diabetes Powerful Tools for Caregivers: A self- management workshop for caregivers

6. Diabetes in the U.S. and Wisconsin Annual U.S. cost exceeds $5 billion; Wisconsin 2009 data: $4.07 billion direct; $2.7 billion indirect By 2050, will be 40 million people with type 2 diabetes Wis: 475,000 adults with diabetes; 1.45 million adults with pre-diabetes Surgeon General’s report 2009: growing need for community-based service programs to complement clinic based ones.

7. Goal of Self-Management Programs Increase self-confidence to manage health and chronic disease Prove efficacious for all races Prove efficacious in multiple cultures, including Hispanic Americans

8. Stanford Diabetes Self-Management Program Modeled after effective Chronic Disease Self-Management Program Specifically for adults with type 2 diabetes 2-1/2 hour sessions, 1/week, for 6 weeks Community setting 2 leaders – one or both are non- professionals with diabetes Group size: 12-16

9. Topics Healthy Eating Sharing/Problem-Solving Action Planning Exercise for strength and endurance Preventing Hypoglycemia Monitoring glucose Stress/Depression Appropriate use of Medications Preventing Complications Working more effectively with health care providers

10. Process Weekly action plans Brainstorming Share experiences Help solve problems in creating or carrying out self-management plans Keys to Success Highly participative Mutual support and success builds self-confidence

11. Benefits Designed to enhance regular treatment and diabetes education Complements CDEs – increases referrals to them Can help with other chronic diseases

12. Research Focus groups with diabetes educators and with Latinos with diabetes Developed program to be similar to other self-management programs Randomized trial: 198 usual care wait list; 219 Spanish Diabetes Self- Management program Participants followed for 6 months Mean age 53; 7.5 years education; 62% women

13. Results of randomized trial  Compared to wait list control, diabetes self-management program group had: Lower HbA1C Less health distress Fewer hypo and hyperglycemia symptoms Better self-efficacy to manage disease

14. Pre-Post results 18 months after the workshop, compared to baseline, diabetes self- management group had: Lower HbA1C Decreased health distress Better self-reported health Fewer hypo/hyperglycemia symptoms Improved self-efficacy to manage disease Improved communication with provider Fewer ER visits in past 6 months

15. Summary Diabetes self-management program: Theory-based to change behavior Improves self-efficacy to manage disease and decreases health distress Proven to decrease HbA1c and hypo/hyperglycemia symptoms Results appear sustained out to 18 months Has established training program and track record with implementation Supplements patients’ clinical care and diabetes education

16. Program accepted by WIHA Board Consistent with other programs Excellent results Health care partnership potential High incidence of diabetes in minorities and low-income Existing Living Well leaders easily cross-trained Partnership with Network Health’s Master Trainers Potential for funding Potential for reimbursement

17. Began in 2013 “Healthy Living with Diabetes” Selected five pilot counties that: Had strong LW Leaders Committed to conducting workshops between March and June 2013 Strong health care partnerships Brown, Iron, Milwaukee, St. Croix and Waukesha counties Held cross-training March 2013 Network Health provided Master Trainers 24 Leaders cross-trained

18. Partnership with health care systems? Yes! 2/3: CDEs helped plan or deliver workshop Over 75% health systems provided facility, snacks and/or staff

19. Health systems involved because: Recognize that the program is complementary, not competition Proven product Incidence and prevalence of diabetes

20. Workshops and Participants 12 held in: Milwaukee, Waukesha, Outagamie, Brown, Calumet, Winnebago and MichiganU.P. 107 participants, 86 completers, Gender: 74 women, 33 men Race: 73 white, 15 African American, 2 Latinos Ages: Ranged from 22-92 ˂ 35: 3, 45-54: 9, 55-64: 15, 65-74: 30, 75-84: 22, 85-95: 7

21. Top 10 Chronic Diseases Diabetes: 67 Hypertension: 46 High Cholesterol: 40 Arthritis: 32 Depression/anxiety: 20 Heart Disease; 19 Lung disease; 17 Cancer: 11 Stroke: 7 Pre-diabetes: 7

22. Motivations for participants: Gathering info and knowledge Financial incentives* (50%) Newly diagnosed Frustrated or unclear directions from health care provider * $35 gift cards for Milwaukee and Waukesha counties

23. Leader Observations Participants very engaged, proactive Referrals from: Pharmacists Community-based programs County aging and disability resource centers Health plan, health provider, health system, including CDEs Parish nurse Health Club Community events Posters and newspaper ads

24. Observations from Larry Epstein Experienced Living Well leader and Master Trainer Experienced Healthy Living with Diabetes leader Type 2 diabetic Volunteer with Brown County ADRC HLWD pilot – Importance, Participants and Observations

25. Next Steps More leaders in 5 counties New counties – still pilot 2013 Both cross-training and initial 2013 Any “ready” county in 2014 Master Trainers More health care partnerships Reimbursement: Medicaid, Medicare, private plans?

26. Next Steps for WIHA More leaders in 5 counties New counties – still pilot 2013 Both cross-training and initial Any “ready” county in 2014 Master Trainers More health care partnerships Reimbursement: Medicaid, Medicare, private plans?

27. Next Steps with Partners Recommend participants Assist with marketing Host workshops in health care settings, provide healthy snacks Identify leaders Partner to develop reimbursement Provide funding Other…?

28. Betsy Abramson, Deputy Director (608) 243-5691 Betsy.Abramson@wihealthyaging.org www.wihealthyaging.org