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