1. MONTANA CARDIOVASCULAR DISEASE AND DIABETES PREVENTION PROGRAM

2. Diabetes is the seventh leading cause of death in Montana Why prevent diabetes? People with diabetes are at higher risk for: heart disease stroke blindness kidney failure extremity amputation nervous system damage …and more The number of people with diabetes is expected to rise to 1 in 3 by 2050 if current trends continue

3. Pre-diabetes Facts People with pre-diabetes have blood glucose (blood sugar) levels higher than normal but not high enough for a diagnosis of diabetes. It is estimated that 79 million American adults have pre- diabetes A fasting blood sugar test is a method for learning how much sugar there is in a blood sample taken after an overnight fast. There are 3 different blood tests to determine your blood sugar levels. If you are told you have pre-diabetes you can take action to prevent or delay onsite of diabetes. Pre-diabetes can be treated.

4. High Blood Pressure Central Obesity High Blood Sugar Dyslipidemia HDL TG Cardiometabolic Risk Type 2 Diabetes and CVD have many of the same Risk Factors A diagnosis of diabetes is a risk factor for heart disease and stroke

5. Know Your Numbers Blood Pressure Healthy blood pressure: below 120/80 Early high blood pressure: between 120/80 and 140/90 High blood pressure: 140/90 or higher Cholesterol LDL Cholesterol: Less than 100 mg/dl HDL Cholesterol: > 40 mg/dl for men, > 50 mg/dl for women is good, but an HDL 60 mg/dl or higher helps everyone lower their risk for heart disease. Triglycerides: Less than 150 mg/dl Fasting glucose (blood sugar) Body Mass Index (BMI ) = Weight (pounds) x 703/Height squared (inches 2 ) Waist circumference

6. Know Your Risks for Diabetes You are age 45 or older Being overweight, “apple” shaped or round in the middle You have a low physical activity level High blood pressure (140/90) Family history of heart disease or diabetes-if a mother, father, sister or brother has heart disease or diabetes, your risk goes up. History of diabetes during pregnancy (gestational diabetes) Race or ethnic background

7. I’m at risk, what can I do? The Montana Cardiovascular Disease and Diabetes Prevention Program has sites 14 across Montana and is growing. It’s not a diet. The program teaches people how to make lifestyle changes that work for them. Keys to the success: The little “Keep Track” book. It’s a journal of everything you eat in a day. There’s a place for logging physical activity. Coaches are healthcare professionals trained in the program. They are available for participants, past and present. They offer guidance and moral support. The participants support each other, too. They are all dealing with similar health concerns and struggles.

8. Target Goals Your target goal for physical activity – a minimum of 150 minutes per week, that’s 30 minutes a day 5 days a week. Nutrition goals-Eat more fruits and vegetables daily. Incorporate whole grains and use low-fat dairy and meat products. Keeping a daily log of your food intake will help you maintain weight loss. If you use tobacco get help to quit. 1-800-QUIT-NOW (784-8669) *Studies show you can prevent or delay onset of diabetes by losing 5 to 7% of your body weight by eating healthier and getting at least 30 minutes of physical activity 5 days a week.

9. Intensive Lifestyle Management First Line Therapy “ The preferred treatment approach for pre- diabetes is intensive lifestyle management …. given its safety and the strong evidence of efficacy in improving glycemia and reducing cardiovascular risk factors. “ “There is strong overlap between cardiovascular risk factors and pre-diabetes…. ‘metabolic risk’ … We recommend that lifestyle management be considered first-line therapy for patients at increased metabolic risk.” American College Endocrinology 2008Endocrine Society 2008

10. National Results of the Diabetes Prevention Program Participants who lost a modest amount of weight and made dietary changes and increased physical activity were found to have reduced their chances of type 2 diabetes by 58% Participants taking prescription drug, metformin, reduced their chances of type 2 diabetes by 31% Participants in the placebo group reduced their chances of type 2 diabetes by 11% The risk reduction was seen in ethnic groups and both men and women. http://diabetes.niddk.nih.gov/ dm/pubs/preventionprogram/#analyses

11. What is the Montana Cardiovascular Disease and Diabetes Prevention Program? ( MCVDDPP) The MCVDDPP is a lifestyle change program, it is not a diet A 10 month program, 16 weekly sessions then 6 monthly sessions Taught by trained healthcare professionals 7% weight loss goal 150 minutes physical activity per week

12. Overweight (BMI ≥25kg/m2) Diagnosis of Pre-diabetes And one or more of the following risk factors for diabetes or cardiovascular disease History of GDM IGT of IFG or A1C= 5.7 to 6.4 Dyslipidemia or treatment High BP (≥130/85 or tx) Baby >9lbs Medical Clearance 18 years and older Readiness Assessment Eligibility Criteria for Montana prevention program

13. Core Curriculum~ 16 Weekly Sessions 1. Goal Setting 2. Be a Fat Detective 3.Three Ways to eat less Fat 4. Healthy Eating 5. Move those Muscles 6. Being Active: A Way of life 7. Tip the Calorie Balance 8. Take Charge of What’s around You 9. Problem Solving 10. Four Keys to Healthy Eating Out 11. Take back the Negative Thoughts 12. 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

14.  Focused on 1 topic sessions, tailored to participant interest and educational needs  Examples:  Heart Healthy Cooking  “Mindless Eating: Why We Eat More Than We Think”  Understanding cardiometabolic risk  Managing stress  Chronic disease  Physical Activity  ….and more 6 Monthly Sessions

15. Physical Activity has positive results in people with diabetes or pre-diabetes Improves blood glucose and lipid levels Lowers blood pressure Reduces weight Increases insulin sensitivity and efficiency 30 minutes of physical activity per day is recommended or at least 150 minutes per week In the Montana program you will receive 2 supervised weekly activity sessions Physical Activity

16. Healthy eating includes: fruits, vegetables, whole grains and fat free or low fat milk and milk products Diets low in: saturated fats, trans fats, cholesterol, sodium and added sugars Includes lean meats, poultry, fish, beans, eggs and nuts Limited alcohol consumption  Up to 1 drink per day for women  Up to 2 drinks per day for men Healthy Eating

19. Average weight loss is 15 lbs Improvements in: ◦ Blood glucose levels ◦ Blood pressure ◦ LDL (bad cholesterol) ◦ Triglycerides ◦ Total cholesterol ◦ Increased physical activity For every 7 high risk adults treated in the lifestyle intervention, one case of diabetes will be prevented. Since the Montana program began in 2008~

20. Barrett Hospital & Healthcare-Dillon Benefis Health System-Great Falls Billings Clinic-Billings Bozeman Deaconess Hospital-Bozeman Butte Diabetes Network-Butte Community Medical Center-Missoula Holy Rosary Healthcare-Miles City Kalispell Regional Medical Center-Kalispell Missoula City County Health Department-Missoula St. John’s Lutheran Hospital-Libby St. Patrick Hospital-Missoula St. Peter’s Hospital-Helena St. Vincent’s Hospital -Billings Teton Medical Center-Choteau Sites in Montana

21. Lessons Learned Through early intervention, education and investment in training, diabetes can be prevented or onset delayed for people at high risk for developing diabetes

22. For more information About the program For materials For articles For resources visit the website~www.mtprevention.org

23. Thank you Would you like to have a speaker present more information? Have questions? Please contact Diane Arave (406) 444-0593 or darave2@mt.gov