1. NEWAYGO A COMMUNITY PLAN TO ADDRESS ADULT DIABETES PRESENTED BY: MOLINA ALLEN, CHERIE MCKAY-HORST, JESSICA RUTHIG, BRITTANY TOROK, SANDRA WERNSTROM

2.  Review current statistical data of Newaygo Analyze current health concerns that fall below Michigan’s benchmark  Identify a nursing diagnosis of one of the health concerns of Newaygo County  Develop a plan to reduce the occurrence of diabetes and provide improved outcomes for those diagnosed  Evaluate the effectiveness of the plan OBJECTIVES

3. Statistical Analysis for Newaygo Data obtained from District Health Department (DHD) #10, 2013 Education: 1. High school grad 85.3% 2. College grad 13.2% Persons below poverty 18.3% Median Income $43,180 Education: 1. High school grad 88.7% 2. College grad 25.5% Persons below poverty 16.3% Median Income $48,471 NEWAYGOMICHIGAN

4. Access to Health Care NEWAYGO No provider 11.4% No access due to cost 13.9% Uninsured 19.3% (DHD #10, 2013) MICHIGAN No provider 13.2% No access due to cost 12.9% Uninsured 15.1%

5. Leading Causes of Death NEWAYGO Diabetes 29.3 Diabetes Related 80 (DHD #10, 2013) MICHIGAN Diabetes 24.1 Diabetes Related 76.9

6. Leading Cause of Death 2012 (DHD #10, 2013)

7. Leading Causes of Death 2013 (DHD #10, 2013)

8. 2012 & 2013 Comparable (DHD #10, 2013)

9. Problem Statement The purpose of this community plan is to address the risk of adult diabetes among the citizens of Newaygo county related to knowledge deficit of proper nutrition, lack of access to healthcare, and higher percentage of poverty, which is demonstrated by a high percentage of diabetes in Newaygo County.

10. DIABETES OCCURRENCE OF DIABETES  Newaygo 12.2%  Michigan 9.3% MORTALITY FROM DIABETES RELATED ILLNESS 2013  Newaygo 80 per 100,000  Michigan 76.9 per 100,000  Healthy People (HP) 2020 goal is 65.8 per 100,000 (DHD #10, 2013)

11. Cost of Diabetes Per Person in 2010  Diagnosed diabetes$9,963  Undiagnosed diabetes$2,864  Pre-diabetes$443  Gestational $3,305 These values reflect data obtained in 2010 for Michigan.  (Mi.gov, 2010)

12. “ ” “The cost to treat diabetes is expected to triple over the next 25 years…” ( M ICHIGAN D EPARTMENT OF P UBLIC H EALTH, 2010). COST OF DIABETES

13. Social Ecological Model Consider change at the community level through educational programs. Approach community leader to develop policies that may provide healthcare access to more community members who have limited income or insurance.

14. Analysis of Assessment findings: What is causing an increase in Diabetes in Newaygo County? Health Care Access Poor Nutrition Increased Poverty Rate (DHD #10, 2013)

15. Available Resources  Michigan State University is holding a Diabetes PATH (Personal Action Towards Health) Workshop October 3-November 7, 2014. “Which provides the skills and tools to manage chronic health conditions” (MSU, 2014, para. 1).  Metro Health Hospital in Cedar Springs, MI located within Newaygo County does a diabetes education class free of charge. They focus on diet and lifestyle changes. (Metro Health, 2014, para. 2).  Live Well An organized movement to help the community maintain a healthy weight a reduce risk factors associated with obesity (Live Well, 2014).

16. Available Resources  Diabetes Prevention Program Participants receives support from a coach in a group setting for weight reduction, healthy eating and healthy exercise. This is a one year program

17. Available Resources  Women, Infants and Children (WIC) Helps people eat and stay healthy Provides bridge cards to buy healthy foods Provides nutritional information which includes web based learning, individual learning, and group learning Provides healthcare referrals for immunizations and other resources in the community

18. Planning and Interventions

19. Health Care Access  Initiate volunteer program that assists Newaygo county residents in choosing a market under the Health Care Act and filing out accompanying paperwork.  Recruit five volunteers willing to assist needy Newaygo county residents with transportation to and from doctors appointments and lab work.  Initiate communication with three pharmacies that may be willing to form a prescription delivery to homes of Newaygo county residents that are unable to pick up their own prescriptions.

20. Wellness/Nutritional Counseling  Engage at least 20 Newaygo county residents in a healthy eating/wellness class  Nutritional counseling is tailored to meet the needs of the community.  This counseling is tailored to the communities customs and willingness to make change.  Proper nutrition will be addressed.  Nutritional counseling is important for people who are diabetic, pre-diabetic, or anyone wanting information on healthier living.

21. Wellness/Weight Loss  Weight loss is recommended for people who are either diabetic or pre-diabetic.  Weight loss has been shown to improve insulin resistance (American Diabetes Association, 2008).  Because of the effects of obesity on insulin resistance, weight loss is an important therapeutic objective for individuals with pre-diabetes or diabetes” (American Diabetes Association, 2008).

22. Wellness/Healthy Lifestyle  “Lifestyle changes characterized by increased energy intake and decreased physical activity appear to have together promoted overweight and obesity, which are strong risk factors for diabetes” (American Diabetes Association, 2008).  Eating healthy can prevent or slow the development of diabetes.  Low carbohydrates, low fat, and calorie restricted diets are effective for controlling diabetes.  “Exercise and physical activity are to be encouraged because they improve insulin sensitivity independent of weight loss, acutely lower blood glucose, and are important in long-term maintenance of weight loss” (American Diabetes Association, 2008).

23. Diabetic Screening  Genetics can play a roll in the occurrence of type 2 diabetes.  It is important to have your blood checked for diabetes during your annual doctor’s visit.  “The American Diabetes Association recommends testing to detect pre-diabetes and type 2 diabetes be considered in adults without symptoms who are overweight or obese and have one or more additional risk factors for diabetes. In those without these risk factors, testing should begin at age 45” (American Diabetes Association, 2008).

24. Diabetic Teaching  Hold a class for newly diagnosed diabetic patients of Newaygo County with goal of at least 10 patients return demonstrating correct blood check and insulin administration techniques.

25. Reducing Poverty  Collaborate with five local food pantries to incorporate screening for government assistance/foods stamps during application process  Identify and collaborate with 20 local business to hold a job fair  Assist at least 20 Newaygo county residents in updating resume and filling out applications

26. Evaluation

27. Healthy Care Access  Newaygo projections for increased access to health care:  No provider <3%  No access due to cost <7%  Uninsured <5%

28. Nutritional Counseling  Community focus:  20% increased number of eligible clients receiving Project Fresh, WIC or SNAP funds.  At least 80% of newly diagnosed diabetic clients participate in diabetic education with goals of being able to return demonstrate proper diet choices and insulin administration.  For individuals with diagnosed diabetes:  5 appointments with nutritional counselor have been attended.  Goals and projected benchmarks have been formed and documented.  Patient able to list 10 healthy foods to incorporate into diet and 10 foods to limit.

29. Wellness  Blood glucose, cholesterol, and blood pressure screenings initiated with at least 10 local events per year  Opportunities used to provide information on enrollment to Metro Health Diabetes Education, Live Well, and the Diabetes Prevention Program.

30. Reducing Poverty  Poverty rate reduced to Michigan average of 16.3% by 2016.  In 2015, 100% of those identified through screening as eligible for State benefits are assisted in the application process for monetary and food aid.

31. References American Diabetes Association. (2008). Nutrition Recommendations and Interventions for Diabetes. Retrieved from: http://care.diabetesjournals.org/content/31/Supplement_1/S61.full Diabetes Education. (2014). Metro Health. Retrieved from http://metrohealth.net/medical- services/diabetes-education/ District Health Department #10. (2013). Newaygo County Chart books. Retrieved from: http://dhd10.org/dhd10-community-statistics Live Well. (2014). About the live well movement. Retrieved from: http://www.livewell4health.org/#!page2/cjg9

32. References Michigan Department of Community Health. (2010). Cost of diabetes in Michigan. Michigan Department of Community Health. Retrieved from: http://michigan.gov/mdch/0,1607,7-132-2940_2955_2980_3168-237778--,00.html Newaygo County. (2014). Michigan State University. Retrieved from http://msue.anr.msu.edu/events/diabetes_path_workshop The National Diabetes Prevention Program. (2014). Diabetes Prevention Program. Retrieved from: http://www.dhd10.org/diabetes-prevention-program WIC. (2013, January 1). Retrieved November 15, 2014, from http://dhd10.org/wic- landing