Diabetes: Addressing Community-Level Need for Prevention and Control

Transcription

1 Diabetes: Addressing Community-Level Need for Prevention and Control Wisconsin Healthy Aging Summit August 6, 2015 Pam Geis Health Promotion Specialist, Chronic Disease Prevention Unit State of Wisconsin, Division of Public Health Sherri Ohly Special Projects Coordinator, Wisconsin Institute for Healthy Aging

2 An ounce of prevention...

3 Chronic Disease Prevention Unit State of Wisconsin, Division of Public Health Brought together three programs: Diabetes Prevention and Control Program Heart Disease and Stroke Prevention Program Nutrition, Physical Activity and Obesity Prevention Program What does Public Health bring to the table? Data Resources Partners

4 Fast Facts on Chronic Diseases and Risk Factors in Wisconsin Over half of Wisconsin residents (56%) are living with at least one chronic disease (BRFSS, ). One in five adults has not exercised in the last month (BRFSS, 2008). Three out of four Wisconsinites do not consume 5 or more fresh fruit or vegetable servings each day (BRFSS, 2007). One in five adults smokes cigarettes (Voskuil, et al., 2010). Nearly one in four adults binge drinks, and one in thirteen adults is a heavy drinker (BRFSS, 2009). The World Health Organization (2005) estimates that by eliminating the risk factors leading to chronic disease, at least 80 percent of all heart disease, stroke and type 2 diabetes would be prevented, as would over 40 percent of all cancers. Source: The Epidemic of Chronic Disease in Wisconsin: Why it Matters to the Economy and What You Can Do to Help, Wisconsin Department of Health Services, Division of Public Health.

5 Modifiable Risk Factors and Chronic Diseases A dot indicates a direct relationship between the risk factor and the disease. Source: The Epidemic of Chronic Disease in Wisconsin: Why it Matters to the Economy and What You Can Do to Help, Wisconsin Department of Health Services, Division of Public Health.

6 Estimated Annual Costs to the Medicaid System from Six Major Chronic Diseases Diabetes and Hypertension costs account for 61% of total Source: The Epidemic of Chronic Disease in Wisconsin: Why it Matters to the Economy and What You Can Do to Help, Wisconsin Department of Health Services, Division of Public Health.

7 How Widespread are Diabetes and Prediabetes in Wisconsin? DIAGNOSED DIABETES 365,114 adults age 18 or older (8.3%). Enough people to fill Lambeau Field 4.5 times! DIAGNOSED PREDIABETES 346,600 adults age 18 or older (7.9%). That s 1.5 times the population of Madison! Source: 2013 BRFSS

8 Economics of Diabetes 15% of all hospitalizations in Wisconsin are diabetes related, accounting for 17% of total charges Total cost of diabetes in Wisconsin is $6.10 billion $4.07 Billion for direct costs (medical care) $2.04 Billion for indirect costs (lost productivity) Source: 2011 Burden of Diabetes in Wisconsin

9 Evidence-Based Health Programs Prevention(CDC Program): National Diabetes Prevention Program (DPP) Control(Stanford-Licensed Programs): Partners: Healthy Living with Diabetes / Vivir Saludable con Diabetes Living Well with Chronic Conditions / Tomando Control de su Salud YMCAs Worksites Community-based and Faith-based Organizations Health Systems Wisconsin Department of Corrections Wisconsin s Aging Network United Voices Community Health Worker Collaborative WI Local Public Health

10 PREVENTION

11 Pre-Diabetes Blood sugar levels not quite high enough to be type 2 diabetes. A1C (percent) Fasting Plasma Glucose (mg/dl) Oral Glucose Tolerance Test (mg/dl) Diabetes 6.5 or above 126 or above 200 or above Prediabetes 5.7 to to to 199 Normal About 5 99 or below 139 or below Source: Adapted from the American Diabetes Association. Standards of Medical Care in Diabetes Diabetes Care. 2012;35(Supp1):S12, table 2.

12 National Diabetes Prevention Program Why Prevent Diabetes? Diabetes is the leading cause of kidney failure, amputations, and adult-onset blindness in the United States. Diabetes is a major cause of heart disease and stroke. Diabetes is the seventh leading cause of death in the United States. According to the CDC, 1.7 million Wisconsin adults have prediabetes(that s 1 of every 3 people you know). People with prediabetescan prevent or delay the onset of type 2 diabetes by making modest behavior changes: Eat healthy Stay active Maintain a healthy weight Control blood pressure Control cholesterol Stop smoking or using tobacco products

13 National Diabetes Prevention Program The Program Criteria Age 18 or older BMI of 24 or greater (Asian Americans 22 or greater) Medical diagnosis of prediabetes History of gestational diabetes Screen positive for prediabetesbased on National Diabetes Prevention Program Risk Test 1-year Program 16 Core Sessions, one hour once a week 6 Post-core Sessions, one hour once a month Group of 8-15 individuals is facilitated, not taught

14 Know your score! 3 to 8 Points Low risk for having prediabetes now. 9 or More Points High risk for having prediabetes now. How Can I Get Tested? See your health care provider. Can I Reduce My Risk? Participate in a local Diabetes Prevention Program Lose weight Eat healthy low-fat meals with fruits, veggies, and wholegrain foods

15 National Diabetes Prevention Program The Benefits Participants: Lose 5%-7% of their starting weight, or more Become more physically active Learn to identify and address barriers to healthy eating and physical activity Reduces risk of developing type 2 diabetes by 58% in participants achieving a minimum of 5%-7% weight loss Fewer missed work days Reduces need for blood pressure or cholesterol medications in many

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17 CONTROL

18 Types of Diabetes Self-Management Education (DSME) Clinical-based DSME is delivered one-on-one or in a group setting by a diabetes educator (perhaps an RN, RD or Pharmacist). Clinical-based diabetes can assist with: Education about diabetes Medication adjustments Specific dietary plans Sick-day management Community-based DSME is delivered in a group setting by trained lay leaders, one of whom has diabetes or lives with someone who has diabetes. Community-based diabetes does not replace clinical DSME but teaches skills to help put advice from health care professionals into practice: Appropriate exercise to improve strength and endurance Appropriate use of medication Techniques for dealing with symptoms of diabetes, fatigue, pain, hyper/hypoglycemia, stress and emotional problems such as anger, fear, frustration, etc.

19 Healthy Living with Diabetes The Program Criteria Has diabetes or lives with someone who has diabetes Living in a home or apartment Not suffering from dementia 6-week Program 2 ½ hours once a week for 6 weeks Group of individuals is facilitated, not taught Process includes: Weekly action plans Brainstorming Shared experiences Help in solving problems in creating or carrying out self-management plans

20 Healthy Living with Diabetes The Benefits Designed to enhance clinical treatment and diabetes education Improves ability to self-manage disease Improves communication with health care provider Improved symptom control (lower A1c, fewer episodes of hyperglycemia/hypoglycemia) Reduces health care expenditures Fewer emergency rooms visits Fewer hospitalizations Fewer days in the hospital Fewer outpatient visits

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22 Why care about these programs? Impact on population health Perfect example of integration work: If individuals participate in classes and make successful changes but return to an environment that is not supportive of those changes they will not thrive In Milwaukee, Healthy Living with Diabetes classes are in CORE/El Centro s movement Studio and they have included the rooftop garden into the programming In West Bend (Washington County), the Kettle Moraine YMCA offers the Diabetes Prevention Program and works with the local ADRC to serve as the host site for both Healthy Living with Diabetes and Living Well

23 Success Depends on Community Partnerships and Robust Referral System Community-based organizations Local coalitions County ADRC Pharmacists Health systems, healthcare providers, health plans Parish nurses Health clubs Community events

24 Do you see opportunity in your county for these programs? We can connect you to existing programs to partner in building a supportive community and referral systems We can talk to you about what it takes to bring these programs to your area

25 Resources National Diabetes Prevention Program Healthy Living with Diabetes Living Well

26 Resources for Health Care Providers

27 Resources for Patients side 1 side 2

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29 Thank you! National Diabetes Prevention Program Pam Geis Chronic Disease Prevention Unit State of Wisconsin, Division of Public Health (262) Healthy Living with Diabetes or Vivar Saludable con Diabetes Sherri Ohly Wisconsin Institute for Healthy Aging (414)