Diabetes & Pre-Diabetes Program Prevention, Management & Reversal
Diabetes Prevention Program Demonstration Project
description
Transcript of Diabetes Prevention Program Demonstration Project
DIABETES PREVENTION PROGRAM DEMONSTRATION PROJECT
Navajo Nation Human Research Review Board ConferenceNovember 15th, 2011
Kristin Graziano, DO, MPHDirector, Diabetes Treatment and Prevention ServicesTuba City Regional Health Care Corporation
OBJECTIVES Diabetes…why do we care? Discuss the landmark
Diabetes Prevention Program study
Results of the 5-year DPP Demonstration Project
Lessons learned
WHY WE CARE
Increasing rates of diabetes AI/AN diabetes disparities
2.2 times higher prevalence rates 3.5 times higher rate of kidney failure 3 times the risk of cardiovascular disease
Diabetes is now affecting our children and young people
Health care costs: In 2007, $174 billion
WHY WE CARE
Impact on individuals, families, and communities
THE QUESTIONS…
Can diabetes be prevented by eating healthier and exercising regularly?
And if so, is this as effective as medication?
THE RESEARCH:TURNING THE TIDE ON DIABETES
Diabetes Prevention Program Research Study
3234 people with prediabetes
16 lesson curriculum: Lifestyle Intervention
Program goals 150 minutes exercise per
week 7% loss of body weight in 6
months
CAN DIABETES BE DELAYED OR PREVENTED?THE GOOD NEWS…
YES!!! The Lifestyle
Intervention reduced diabetes by 58%
In participants older than 60 years: 71%
Eating healthier and exercising worked better than a pill
Results published 2002
THE REAL-LIFE QUESTIONS
Can we take the science and put it into practice to benefit Native Americans across the country?
Will the Lifestyle Balance Intervention help prevent diabetes here in our communities?
THE BEGINNINGS… In 2004,Congress
appropriates additional competitive grant dollars for Native Communities to participate in a national Demonstration Project based on the DPP study
DEMONSTRATION PROJECT GRANTEES ACROSS THE COUNTRY
THE DPP DEMONSTRATION PROJECT:TRANSLATING THE SCIENCE Based on the science Same participant goals
Reduce total fat intake Exercise 150 minutes/wk 7% weight loss
Same 16 week curriculum Lifestyle Intervention with some cultural adaptations
Can we achieve similar results? Group setting taught by para-
professionals?
WHO HAVE WE REACHED?2,939 Contacts
1006 Labs Completed
207 Consented to Participate
110 Completed Intervention
RESULTS, OUTCOMES, AND OBSERVATIONS: 2-HOUR GLUCOSE TOLERANCE TEST
1006 Glucose Tolerance Tests
Normal 58%Prediabetes 37%Diabetes 5%
PARTICIPATION, PROGRAM COMPLETION, AND RETENTION
Lifestyle intervention offered to 381 individuals
207 (54%) signed up 110 (53%) have completed the intervention
RESULTS, OUTCOMES, AND OBSERVATIONS
Participant Ages
18 < 40 (31%)40 < 50 (27%)50 < 60 (32%)> 60 (10%)
RESULTS, OUTCOMES, AND OBSERVATIONS:PHYSICAL ACTIVITY CHANGE
Physical Activity Minutes/Week
None (25%)
< 89 (21%)
90-149 (22%)
> 150 (32%)
Physical Activity Minutes/Week
None (3%)
<89 (7%)
90-149 (15%)
>150 (75%)
BASELINE AT FOLLOW-UP
All
NBaseline
MeanFollow-up
MeanMean
Change % Change
Weight (lbs) 75 185.7 178.7 -6.9 -3.7%Body Mass Index (BMI) 75 32.1 30.9 -1.2 -3.7%
Waist (inches) 71 41.8 39.8 -2.0 -4.7%Hip (inches) 70 43.9 42.6 -1.3 -2.9%
Waist to Hip Ratio 70 1.0 0.9 -0.0 -1.7%Systolic BP (mm Hg) 72 127.8 128.9 1.1 1.7%
Diastolic BP (mm Hg) 72 78.0 78.0 -0.0 0.9%LDL (mg/dl) 60 104.0 103.5 -0.5 2.0%HDL (mg/dl) 61 45.8 47.0 1.2 4.0%
Triglycerides (mg/dl) 61 155.4 141.2 -14.2 -2.5%Total Cholesterol (mg/dl) 61 180.6 179.1 -1.6 0.4%
Fasting Blood Glucose (mg/dl) 68 101.9 99.9 -2.0 -1.8%
RESULTS, OUTCOMES, AND OBSERVATIONS:CLINICAL INDICATORS
THAT ALL LOOKS NICE, BUT…
Did you prevent diabetes???
THE ANSWER IS…
Yes ! 3,396 participants
among 36 health care programs serving 80 tribes
Crude incidence of diabetes was 4.0% per yr
Improvements in weight, blood pressure, lipids, and physical activity
Cum
ulative Incide
nce of
Diabe
tes (
%)
0
10
20
30
40
Year
0 0.5 1.0 1.5 2.0 2.5 3.0 3.5
SDPI-DP DPP Placebo DPP Lifestyle
“Not everything that can be
counted counts, and not
everything that counts can be
counted.”
-Albert Einstein
PARTICIPANT VOICES:BEYOND THE NUMBERS
“My family…they really started taking care of themselves…sometimes we would all go for a walk. Or we would just drive out somewhere and go nature-walking…we never used to do
that.”
PARTICIPANT VOICES:BEYOND THE NUMBERS
“I have more confidence in myself…my self-esteem boosted, my confidence that I have in what I do at work and what I do at
home, it boosted…”
PARTICIPANT VOICES:BEYOND THE NUMBERS
“I feel better because I know that I’m doing something for myself to prevent me from having diabetes, prevent me from having heart problems, getting on dialysis…I feel
better because the possibility of me developing those problems is always going to be there because its hereditary, but yet I’m
doing something…”
IN SUMMARY: CHALLENGES Ongoing recruitment into program Retention Getting to that weight loss goal Keeping motivated, sustaining change Maintaining partnerships
IN SUMMARY: SUCCESSES AND LESSONS LEARNED Diabetes CAN be prevented, in our
communities, taught by our staff, in a group setting.
People ARE interested in preventing diabetes Can be implemented by para-professionals The curriculum is easily adaptable to be culturally
appropriate Collaboration and integration of clinic-based and
community-based services can work. Partnerships, partnerships, partnerships