Local Examples: Innovations in Preventing Diabetes
Since its launch in 2012, the Centers for Disease Control and Prevention’s (CDC) National Diabetes Prevention Program has certified over 500 community-based groups, health care providers, employers, and health plans that offer proven diabetes prevention programs covering every state in the country. They succeed one person at a time, as the story of a heart doctor from North Carolina below shows. To spread this success across the nation, the CDC awarded funding to six national organizations. Following the doctor’s story below are descriptions of the way each of those programs help people with prediabetes conquer their health challenges and prevent diabetes. Also listed are some new national programs that are seeking CDC approval and could dramatically expand access to prevention programs.
The CDC’s diabetes prevention program has programs in every state.
North Carolina: A Doctor Prevents Diabetes—For Himself
It’s hard to believe that even a heart doctor in North Carolina would need help improving his health, let alone receive a diagnosis of prediabetes. But that’s exactly what happened to Dr. Don Graham, a pulmonologist in North Carolina. He had long known about the physical consequences of diabetes, but a busy job and poor diet had led to him gaining weight to the point of receiving a prediabetes diagnosis from his doctor. Hearing that was a major trigger for him to implement a lifestyle change. That’s when he joined his local YMCA, which was running a Diabetes Prevention Program, where a trained lifestyle coach discussed with him and others in a small group behavior changes that could help with healthy eating, increasing physical activity, and reducing stress. The year-long program included 16 weekly small-group sessions followed by monthly check-ins. Dr. Graham noted that in the group sessions, “We could share what we were struggling with that week, and being weighed was great accountability.” He is now 40 pounds lighter and received good news from his doctor—he is no longer prediabetic.
Y-USA: Community-Based Help
As Dr. Graham’s story has illustrated, it’s easy to find your local YMCA: there are 2,700 YMCA locations in over 10,000 neighborhoods across the United States. As an inaugural partner with the CDC during the launch of the diabetes prevention program, the Y is by far the largest organization involved, enrolling 40% of participants nationally. Participating Ys use a licensed version of one of the six NDPP approved curricula to provide counseling sessions in small groups lead by a lifestyle coach to develop a plan for improving their health. In addition, the Y’s amenities for physical activity, like gymnasiums and swimming pools, provide a one-stop shop for someone enrolled in the diabetes prevention program. The YMCA currently has participating sites in 40 states.
American Association for Diabetes Educators: Marshaling an Army of Expert Helpers
It takes a lot to keep from getting really sick when you have a chronic condition—and you would naturally rely on experts to help educate you on how to make new daily habits and take medications regularly in order to keep you healthier. Diabetes educators are experts to whom physicians refer patients once they’re diagnosed with diabetes to help patients learn how to better care for themselves. The American Association for Diabetes Educators has a network of over 13,000 diabetes educators—nurses, dieticians, and pharmacists—and has partnered with the CDC to expand their role to help prevent people with prediabetes from developing the disease.
The American Association for Diabetes Educators currently funds the development of diabetes prevention programs in a total of 35 sites across 14 states with professional diabetes educators acting as lifestyle coaches leading the group sessions. One of the main goals for the their prevention program is to demonstrate that educating patients with prediabetes has just as high of a return on investment as educating patients with diabetes for health plans and employers covering these kinds of programs.
Black Women’s Health Imperative: Active Outreach Community by Community
Diabetes affects one in four women, regardless of race, but the risks go up for certain ethnic groups. Through their Change your Lifestyle, Change Your Life program in California, Maryland, Tennessee, Indiana, Missouri, and Michigan, the Black Women’s Health Imperative and their community partners are reaching Black women and other minority groups, such as Latina women, by going out into the community—through area employers, community and faith-based organizations, and local health-care providers, among other groups. Community partners in these states offer the year-long prevention program and help train community health leaders to provide education about managing and preventing diabetes for the Black and Latina women that they serve.
America’s Health Insurance Plans: Coverage for Programs that Produce Results
The cost of a diabetes prevention program may be an obstacle for some people. For others, making it free can be the push needed to get them to join. Still others may not know about the programs in their area. That’s where health plans can help. America’s Health Insurance Plans (AHIP), which represents health plans that cover about two-thirds of all Americans, is breaking down those obstacles in a prediabetes initiative with four of its member companies: Aetna, EmblemHealth, Florida Blue, and Molina Healthcare. They are all implementing the National Diabetes Prevention Program in Florida, New Mexico, New York, and Texas.
The plans are using a range of models to deliver the program—some are offering the classes through their brick and mortar retail locations in neighborhoods, while others are partnering with community organizations, like the Y, to run their program. All the plans are marketing the National Diabetes Prevention Program to their employer members and providers within their network to reach more patients at risk for diabetes to let them know that this new benefit is available for them.
The two main goals for this partnership with CDC are for AHIP to help demonstrate the value and scalability of these kinds of programs. AHIP will compile the data reported from the plans and report outcomes to the CDC.
National Association of Chronic Disease Directors: Public Education Campaigns
Preventing diabetes has to fight for the attention it deserves. Advertising is a critical way to push diabetes prevention programs to the top of the mind for doctors and patients. In New Mexico, doctors have seen ads that warned, “You’d jump in front of a bus for your patients… but what do you do if the bus is diabetes?” In West Virginia, ads targeting mothers asked what if their baby had weighed nine pounds or more because a big baby means the mom and child could both be at risk for developing diabetes.
These ads were a marketing and awareness effort as a part of the State Diabetes Prevention Project run through the National Association of Chronic Disease Directors, which serves the officials in every state who have the responsibility for reducing chronic disease prevention and the risks associated with them. The association has partnered with eight state health departments in Washington, Colorado, Minnesota, New Mexico, New York, Kentucky, West Virginia, and Virginia to promote and increase use of statewide or regional diabetes prevention programs. The State Diabetes Prevention Project has helped participating states implement and promote diabetes prevention referral systems which cover geographically a total of 3.4 million adults with prediabetes, and three states have gone so far as to add the diabetes prevention lifestyle change program as a health benefit covering nearly 86,944 state employees.
OptumHealth Care: Program Networks and Online Classes
As a company that supports and administers health benefits for employers, OptumHealth Care Solutions and its parent company, United Healthcare Inc., is providing prevention program coverage for employees and any family members who have prediabetes. Optum has been establishing a new network of program sites in Colorado, New Mexico, Southern California, Tennessee, and Washington. It is also offering an online diabetes prevention program available called You Lose, You Win, which consists of a lifestyle coach, 16 live weekly online classes, a wireless scale, and a full year of coach and team support
New Programs Pending CDC Approval
Weight Watchers: Expanding the Reach of Prevention
The National Diabetes Prevention Program has been very successful with the people it’s reached—all 50,000 of them. But that’s nowhere near enough participants to address the estimated 86 million Americans with prediabetes.
Weight Watchers has been helping millions of overweight people lose weight and simultaneously help them decrease their risk for many chronic diseases, including diabetes. Much like the YMCA, leveraging Weight Watchers' foothold nationwide would help scale up the diabetes program prevention quickly and efficiently.
Weight Watchers has been implementing intensive behavioral counseling very similar to the National Diabetes Prevention Program curriculum for their dietary programs for decades, with group-based interventions in classroom settings, tracking mechanisms, and regular weigh-ins.
Weight Watchers is currently holding clinical trials using their program and working with the CDC to adjust the way with certification occurs for each specific site in order to leverage their national franchises and administer prevention programs nationwide.
OmadaHealth: There’s an App for That
OmadaHealth’s "Prevent" software delivers a group-based prevention curriculum virtually where you can hold group sessions lead by a coach on a Facebook-like interface, either from your desktop or from your mobile device.
Users participate in a four-month, friendly competition among their small group to get to their goal weight through exercise and diet tracking, with the coach providing weekly lessons on diabetes prevention, and texting and calling periodically to check in with individuals. Both the web and mobile apps provide notifications, reminders, and positive peer pressure as the group creates a small social network. In addition, packages are mailed along the way with small rewards as the person makes progress.