Diabetes Prevention and Control
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Transcript of Diabetes Prevention and Control
Diabetes Prevention and Control
Best and Promising Practices
Prevent and Control Diabetes
Rick Schwertfeger, M.A.T.
Program Manager
Steps to a Healthier Austin Program
Division of the Medical Director
Austin/Travis County Health & Human Services
Austin, Texas
The Biggest Impact:
REDUCE OBESITY
Prevent and Control Diabetes
Increase physical activity throughout a population
Prevent and Control Diabetes
Improve nutrition throughout a population
Prevent and Control Diabetes
Case Management
Prevent and Control Diabetes
Formalized patient education
Prevent and Control Diabetes
Clinicians refer
high risk individuals
to preventive services
Prevent and Control Diabetes
HbA1c = or < 7.0
Prevent and Control Diabetes
Foot Checks:• Self Check: Daily
• Clinical at least 1x / Yr.
• Posters in Exam Room
Prevent and Control Diabetes
Eye checks at least 1x / year
Prevent and Control Diabetes
Yearly Flu Shot
Prevent and Control Diabetes
Define, analyze and intervene on your
Community Diabetes System
Prevent and Control Diabetes
Local Diabetes Coalition
Steps to a Healthier Austin
• Reduce the burden of Obesity
• Reduce risk behaviors– Poor nutrition– Lack of physical activity
• Overarching Goals4. Prevent overweight and obesity6. Improve nutrition7. Increase physical activity
Austin/Travis County Health and Human Services Department
The Data
What does our data say?
Baseline: Obesity Rates
Disease/behavior Number % 95% CI
Overweight 188,784 34.8 % 27.8 – 41.8
Obese 102,938 19.0 % 9.7 – 28.3
Overweight/Obesity 291,722 53.8 % 46.7 – 60.9
Nutrition – 5 or more vegetables and fruit per day
174,929 30.5 % 21.5 – 39.5
Physical Activity – Any leisure time physical activity
490,251 85.6 % 80.6 – 90.5
Source: 2003 BRFSS Data
180,796 - 221,740 Overweight/Obese
Baseline: Obesity Rates
Disease/behavior From To
Overweight 127,891 192,297
Obese 44,624 130,192
Overweight/Obesity 214,839 280,165
Nutrition – 5 or more vegetables and fruit per day 98,909 181,716
Physical Activity – Any leisure time physical activity 370,793 416,337
Source: Stratified from the 2003 Travis County BRFSS data.
Austin/Travis County Health and Human Services Department
Baseline: Intervention Area Causes of Death
Cause of DeathIntervention
Area
Rest of A/TC
Heart disease 253.6 209.8
Cerobrovascular disease
67.1 63.2
Asthma 1.9 0.9
Diabetes mellitus 34.1 15.2
Hypertension 9.9 7.4
2000-2001 Age adjusted mortality rate per 100,000
Obesity Trends 2004-2006
Weight Status
3
3834
17
92
158
210
40
60
4136
59
3935
37
17
36
63
0
10
20
30
40
50
60
70
80
Perc
en
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e
2004
2005
2006
Source: BRFSS 2004-2006Question:This was calculated from the self-reported height and weight.
Obesity Trends 2004-2006
Overweight or Obese Individuals
63 64 60 6160 59 6357 55
01020304050607080
SHA 200
4
SHA 200
5
SHA 200
6
A/RR20
04
A/RR20
05
TX 200
4
TX 200
5
US 200
4
US 200
5
Source: BRFSS 2004-2006Question:This was calculated from the self-reported height and weight.
Obesity Trends 2004-2006
Population Upper 95 CI% Lower 95 CI%
Obesity Yr 12004
Yr 22005
Yr 32006
Yr 12004
Yr 22005
Yr 32006
Yr 12004
Yr 22005
Yr 32006
SHA 54.6 59.3 62.8 55.7 63.4 67.7 51.7 55.0 57.5
White 47.0 56.7 57.8 51.1 62.1 63.7 43.0 51.2 51.8
African American 74.1 67.8 77.2 80.6 79.6 84.9 66.3 53.2 67.1
Hispanic 59.1 62.4 68.1 64.0 70.0 77.5 54.2 54.2 57.0
Male 62.3 65.4 67.8 66.6 71.5 75.7 57.7 58.8 58.8
Female 46.4 51.9 57.1 50.0 57.0 62.4 42.9 46.6 51.6
Texas 63.0 64.1 65.9 38.7 60.1 25.5
US 60.1 61.1
Source: BRFSS 2004-2006Question:This was calculated from the self-reported height and weight.
% trying to lose weight
Trying to Lose Weight
5147
0
10
20
30
40
50
60
2005 2006
Source: BRFSS 2005-2006.Question: Are you now trying to lose weight?
Eating Fewer Calories/Fat to Lose Weight
Eating Fewer Calories or Less Fat
21
35
2519 18
22
38
22
05
101520253035404550
Yes, fewer calories Yes, less fat Yes, fewer caloriesand less fat
No
2005 2006
Source: BRFSS 2005-2006. Question: Are you eating fewer calories or less fat either lose weight or keep from gaining weight?
Fruit and Vegetable Consumption Stages of Change
Do you consistently eat 5 servings of fruits and vegetables a day? Year N Rate (%)
95 % CILower
95 % CIUpper
Yes, I have been for more than 6 months
2005 434 29 25 32
2006 500 35 30 40
Yes, I have been for less than 6 months 2005 118 8 6 11
2006 86 6 5 8
No, but I intend to in the next 30 days 2005 334 22 19 26
2006 314 22 18 26
No, but I intend to in the next 6 months 2005 177 12 9 14
2006 186 13 10 17
No, and I do not intend to in the next 6 months
2005 449 30 26 34
2006 343 24 21 28
Source: BRFSS 2005-2006Question: Do you consistently eat 5 servings of fruits and vegetables a day?
People Who Report Eating 5 or More Fruits and Vegetables Daily
5 or More Fruit and Vegetable Servings per Day
23 2325 25
232322
29
0
5
10
15
20
25
30
35
40
SHA 2004 SHA 2005 SHA 2006 A/RR 2005 TX 2003 TX 2005 US 2003 US 2005
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Source: BRFSS 2004-2006
Number of Fruit and Vegetable Servings per Day
Fruits and Vegetables Consumed Daily
5 4 4
2732
37
25
3239 38
29 29
0
10
20
30
40
50
Less than 1 perday or never
1 to less than 3times per day
3 to less than 5times per day
5 or more timesper day
2004 2005 2006
Source: BRFSS 2004-2006Question: Five Fruit and Vegetable Servings per Day Index-DSHS calculated
Leisure Time Physical Activity in the Past Month
Leisure Time Physical Activity
73
70
72
79
74.773.9
72.6
77.576.2
64
66
68
70
72
74
76
78
80
SHA2004
SHA2005
SHA2006
A/RR2004
A/RR2005
TX 2004 Tx 2005 US 2004 US 2005
Source: BRFSS 2004-2006Question: During the past month, other than your regular job, did you participate in any physical activities or exercises?
% Using Physical Activity to Lose Weight
Physical Activity or Exercise
7273
62
64
66
68
70
72
74
76
78
2005 2006
Source: BRFSS 2005-2006.Question: Are you using physical activity or exercise to lose weight or to keep from gaining weight?
Recommended Physical Activity Levels
Percentage of Respondents Meeting Physical Activity Recommendations
10
30
60
15
34
51
13
38
50
0
10
20
30
40
50
60
70
Meets Recommendations Some Physical Activity butdoes not meet
recommendations
No Physical Activity
Per
cen
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e
SHA 2004 SHA 2005 SHA 2006
Source: BRFSS 2004-2006Question: Meets Recommendations for Moderate or Vigorous Physical Activity is a calculated value from multiple questions about level of physical activity.
Percentage of People Meeting Recommended Moderate or Vigorous Physical Activity Levels
Percentage Meeting Recommendation for Moderate or Vigorous Physical Activity
47 494745485051
60
0
10
20
30
40
50
60
70
SHA 2004 SHA 2005 SHA 2006 A/RR 2005 TX 2003 TX 2005 US 2003 US 2005
Per
cen
tag
e
Source: BRFSS 2004-2006Question: Meets Recommendations for Moderate or Vigorous Physical Activity is a calculated value from multiple questions about level of physical activity.
Physical Activity Reported Stages
Reported Stages for Physical Activity
47
1320
129
54
1217
9 8
0
10
20
30
40
50
60
perc
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2005 2006
Source: BRFSS 2005-2006Question: (Based on a definition of physical activity) Do you exercise regularly according to that definition?
How People are Lowering Their Risk of Health Problems
Source: BRFSS 2005
Lower Risk of Health Problems by:
6873 75
0
10
2030
40
50
6070
80
90
…Eating fewer high fat orhigh cholesterol foods?
…Eating more fruits andvegetables?
…More physically active?
Use of Areas Conducive to Physical Activity
Source: BRFSS 2004-2006
Access to Areas for Physical Activity
57 54
2718
29
18
NA
26
NA
59
27 30
0
10
20
30
40
50
60
70
Walking Trails.Parks,
Playgrounds,Sports Fields
Schools Open forPublic Recreation
Shopping Malls Public Rec Centers
2004 2005 2006
Level of Physical Activity in the Neighborhood
Source: BRFSS 2004-2006
7
21
57
1513
56
26
69
17
60
14
0
10
20
30
40
50
60
70
Very physically active Somewhat physically active Not very physically active Not at all physically active
2004 2005 2006
Approximately75% of Neighborhoods
are physically active
Step’s Approach
Community based physical activity and nutrition approaches
Medical Model
• Limited approaches
• Medicines– Slow– Lack of effectiveness in the long term
• Bariatric Surgery– Costly– Complications– Lifelong medical management
Steps Model
• Working through collaborative partnerships to increase outreach capacity
• Build capacity of partners to reach target
• Work at the systems level
• Focus on community actions and community changes
• Focus on nutrition and physical activity strategies
Overall Impact
*A community change is a new program, policy or practice**A community action is an action taken to lead to a new program, policy or practiceSource: SHA Online Documentation Surveillance System (ODSS) (9/22/2003-9/21/2006)
Community Capacity Building
Community Actions**
Community Changes*
Overall 1402 878
Asthma 338 251
Diabetes 353 181
Obesity 625 410
Blank 86 35
Collective Consortium
Achievements
Steps Unique Encounters
Total Number of Encounters = 964,314
Source: SHA Partner Reports
Years 1-3
Physical Activity 141,395
Nutrition 215,549
Diabetes 607,112
Obesity 258
OVER ALL TOTAL 964,314
These are unique encounters.
Individual persons may have had more than one encounter.
Obesity Yr 1 Yr 2 Yr 3 Total
Obj.1 - Reduce Adult Obesity… 22 49 44 115Obj.2 - Increase Daily Consumptions Of
Fruits And Vegetables… 4 42 47 93Obj.11 - Increase Child And Adolescent
Engagement In Physical Activity… 6 26 22 54Obj.12 - Increase Child And Adolescent
Engagement In School Physical Activity… 5 6 5 16
Obj.3 - Increase Adult Engagement In Physical Activity… 31 59 65 155
TOTAL 68 182 183 433
Community Changes per Objective
Obesity Yr 1 Yr 2 Yr 3 TotalObj.1 - Reduce Adult Obesity… 30 77 101 208Obj.2 - Increase Daily Consumptions Of Fruits And
Vegetables… 10 31 71 112Obj.11 - Increase Child And Adolescent
Engagement In Physical Activity… 13 37 78 128Obj.12 - Increase Child And Adolescent
Engagement In School Physical Activity… 26 68 19 113Obj.13 - Increase The Proportion Of Schools That
Offer Physical Education Classes… 2 2 1 5Obj.3 - Increase Adult Engagement In Physical
Activity… 26 10 73 109
TOTAL 107 225 343 675
Community Actions per Objective
Nutrition Strategies
• Community Cooking Classes– Sustainable Food Center
• Train the Trainer Model• Individual participants
• Improved Early Childhood Nutrition– Family Connections
• Health Worker Certification for Child Care Centers• Outreach to new mothers to increase
breastfeeding and create awareness of services
Nutrition Strategies
• Farmer’s Markets and Farm Stands– WIC sites– Sustainable Food Center
• Lone Star Card to wooden tokens – Increased access• Manor’s Farmers Market
• School Gardens– Sustainable Food Center and Marathon Kids
• Collaborative effort• Targeting schools• Increase availability and awareness
Nutrition Strategies
• School Nutrition Improvements– AISD
• Vending machine offering changes• Revamped the school cafeteria menu
– MISD, DVISD & PISD• Vending machine offering changes• Revamped the school cafeteria menu• Adoption of school Wellness Policy• AISD is sharing knowledge and tools with other
districts
Nutrition Strategies
• Soda and Snack Vending Machine Offerings• Fruit Basket Mini Project• Wellness Wednesdays at Schools
– Foods of the Month (Vegetable, Fruit, Dairy or Grain and a Food for Thought)
• HEB Initiatives – In the works– Environmental System Changes at 4 locations– Suggested change to Meal Deals– Suggested changes to Combo Loco– Suggested healthy shopping list
Physical Activity Strategies
• Increase the Use Underutilized PARD Facilities– Summer Splash Pool Parties approx. 867– P3 Initiatives
• Expand the Participation of Marathon Kids– Year 3 SHA Area MK Participants: 14,239– Year 4 SHA Area MK Participants: 15,897 = +12%– Year 3 SHA Area Completed 26M: 11,018– Year 4 SHA Area Completed 26M: 12,026 = + 9%
Physical Activity Strategies
• YMCA Swim Safe – 800+ in 1st year• YMCA Walking Trail• Walk with WIC
– Stroller Program– Peer Support Group
• Walk Texas Austin Chapter– Supported by an Active Austin Guide
• Walk Across Texas – Texas Cooperative Extension Agency Program
Physical Activity Strategies
• Texas Round Up– Support of the Texas-wide Governor’s Fitness
Initiative
• Healthy Built Environment– 6 locations– Walking Trails (new, extensions, &
renovations)– Outdoor Fitness Equipment– Mileage Markers
Physical Activity Strategies
Model Programs:
• Capital Metro
• Mayor’s Fitness Council
Capital Metro Success Story!
Comprehensive worksite wellness program• Consultations with dieticians and personal trainers• 24-hour company fitness center (NEW!!!)• personalized health assessments• Healthy food choices discount in the company’s
cafeteria• A myriad of weight and nutritional management
programs• Childcare program
Since 2003
Capital Metro Success Story!
Health Impact• Reduced health care costs
• Employee absenteeism rates decreased more than 44%, from a high of 12.4% in March 2004 to 6.9% in June 2006.
Year Cost increase
2005-06 6% predicted
2004-05 9.6%
2005-06 26.8%
Participants report: • increased exercise• healthy food consumption• weight loss• better blood pressure
management• reduced stress levels • better overall general health
Capital Metro Success Story!
Why is this program working?
Studies indicate that comprehensive worksite health programs focused on lifestyle behavior change lead to improvements in health behaviors among employees and a return on investment or employers, in terms of improved employee health and saved health care costs.
Mayors Fitness Council
Partner Certification
Benefits of Being an MFC Certified Partner
General
(All Areas)
• Add value to the business• Build and protect reputation and license to operate• Reduce perceived company risk ( a better reputation)• Manage stakeholder expectations and regulatory pressure• Build a sustainable business
Workplace • Preferred employer, recruit talented people• Broader risk management generating rationalization and cost savings• Improve employee morale• Improve productivity
Marketplace • Enhance brand value and customer loyalty• Create competitive edge• Become a preferred supplier or partner• Improve supply chain performance
Environment • Improved environmental performance• Resource conservation• Waste reduction• Cost savings
Community • Increased access to local resources• Create mutual advantage within the community
Austin/Travis County Health and Human Services Department
Mayor’s Fitness Council Partner’s Certification - Next Steps
• Contact the Mayor’s Fitness Council and meet with a council member to begin the partnering process
• Implement the Austin Fitness Index in your organization.
• Work with the MFC Nutrition and Physical Activity teams to implement effective change programs in each area.
• The MFC can provide programs, tools, messaging and support.
• Commit to health and fitness at both an individual and at the organizational levels.
Austin/Travis County Health and Human Services Department
Physical Activity Strategies
• In the works…– Safe Routes to School Application– Point of Decision Prompts in COA buildings– COA PE Dept. Walk/Run and Swim Programs– Retrofitting some COA buildings with showers
How Far Have We Come?
Data Speaks…
General Obesity Numbers
• 467 CCs with Obesity as the General Goal
• Total SPs on Obesity: 223
• Total Number of People Served by Obesity SPs: 37,668
• Total Number of Hours of SPs on Obesity: 3,872
General Nutrition & Obesity Numbers
• 108 CCs on Nutrition
• Total SPs on Nutrition: 235
• Total Number of People Served by Nutrition SPs: 109,056 people
• Total Number of Hours of SPs on Nutrition: 6,329
Community Changes with Objectives in Nutrition & Obesity• 127 CCs with Objective as reduce adult obesity• 108 CCs with Objective as increase fruit and
vegetable consumption• 178 CCs with Objective on increasing adult
physical activity• 61 CCs with Objective on increasing child and
adolescent physical activity• 20 CCs with Objective to increase child and
adolescent participation in school physical education
Services Provided with Objectives in Nutrition & Obesity• 223 SPs with Objective to reduce adult obesity• 235 SPs with Objective to increase fruit and
vegetable consumption• 269 SPs with Objectives to increase adult
physical activity• 87 SPs with Objective to increase child and
adolescent physical activity• 28 SPs with Objective to increase child and
adolescent participation in school physical education
Nutrition Community Changes by Program
• SFC 33 CCs
• WIC 3 CCs
Nutrition Services Provided by Program
• SFC Farmers' Market SPs served 3,855 people with 125 hours of services
• SFC THK SPs served 35,191 people with 375 hours of services• Walk with WIC served 414 people with 42 hours of services• WIC nutrition education served 299 people with 10 hours of service• SHA Core Staff presentations on nutrition served 1700 people with
8 hours of service• ACS Worksite Wellness programs on nutrition served 12,374 people
with 42 hours of service• FC reached 46,283 people with nutrition education with 5,363 hours
of service (thru trainings, expo, and the newborn packets delivered at hospitals)
• H&L served 3,597 people with nutrition programs with 514 hours of service
Steps to a Healthier Austin
Thank you!
For more information:
Visit www.iThriveAustin.org
Call (512) 972-6761