Public domain resources to

address the epidemic of

diabetes

Pamela Allweiss MD, MPHCDC Division of Diabetes Translation

pca8@cdc.gov

The findings and conclusions of this presentation are those of the presenter and

do not necessarily represent views of the Centers for Disease Control and Prevention.

26 millionwith Diabetes

79 millionwith Pre-Diabetes

Epidemic of Diabetes• Diabetes affects almost 26 million Americans

(8.3%), one quarter of whom don’t know they have it.

• Another 79 million Americans have pre-diabetes, which raises their risk of developing type 2 diabetes, heart disease, and stroke.

• About 1.9 million new cases of diabetes were diagnosed in people aged 20 or older in 2010.

www.yourdiabetesinfo.org www.DiabetesAtWork.org

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1958 61 64 67 70 73 76 79 82 85 88 91 94 97 00 03 06 09

Nu

mb

er

wit

h D

iab

ete

s (

Millio

ns)

Perc

en

tag

e w

ith

Dia

bete

s

Year

Percentage with Diabetes

Number with Diabetes

Number and Percentage of U.S. Population with Diagnosed Diabetes,

1958-2009

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System

available at http://www.cdc.gov/diabetes/statistics

Age-adjusted Percentage of U.S. Adults Who Were Obese

or Who Had Diagnosed Diabetes

Obesity (BMI ≥30 kg/m2)

Diabetes

1994

1994

2000

2000

No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%

No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at

http://www.cdc.gov/diabetes/statistics

2009

2009

Diabetes means:

• 2 x the risk of high blood pressure

• 2 to 4 x the risk of heart disease

• 2 to 4 x the risk of stroke

• #1 cause of adult blindness • #1 cause of kidney failure• Causes more than 60% of non-

traumatic lower-limb amputations each year

NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2010.

Estimated Cost of

Diabetes in U.S. (ADA 2007)

• Total: $174 billion

• Indirect costs include increased absenteeism ($2.6 billion) and reduced productivity while at work ($20.0 billion) for the employed population

• Reduced productivity for those not in the labor force ($0.8 billion)

• Unemployment from disease-related disability ($7.9 billion)

• Lost productive capacity due to early mortality ($26.9 billion)

Opportunity knocks to open the

doors between business and

community health

Crossing the Great Divide: Business and

Communities Come Together to Promote

Health

Why pick diabetes for a health

promotion intervention at a

business?• Effective interventions

promote multiple good outcomes

• Loss of productivity due to uncontrolled diabetes may be improved with better glucose control

• Improve quality of life for employees

• Many employees (both current and future) have or may be at risk for developing diabetes

• Unique opportunity

for education

• Less time away

from work

• Improves

employer-

employee relations

and shows

employer cares

about employees

The health of a community

impacts the economic health of

its businesses

and

Corporations are able to play a

unique role in the development of

a community’s health and

continued vitality

NBGH Kellogg paper

Where is the community partner?

Do Any Interventions Work?• Bottom Line: Does better glucose control

translate to better outcomes or better health in the individual?

• Yes!

• For every 1% drop in A1c the risk of microvascular complications (eye, kidney, and nerve damage) can be reduced by up to 40%.

• http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.p

Why Control Diabetes?

• Better control translates into fewer

complications in eyes and kidneys

• Fewer complications translate into fewer

days lost to absenteeism and

disability, and future savings on health

care expenditures

• Fewer accommodations needed

So what are some resources

and how can we use them?

National Diabetes Education

Program• CDC and NIH program formed after evidence

showed that better glucose control translated into fewer complications

• Public and private partnerships to improve diabetes treatment and outcomes

• Increased public awareness of the seriousness of diabetes, its risk factors, and strategies for preventing diabetic complications

• NDEP translates the latest science and spreads the word that diabetes is serious, common, and costly, yet controllable and, for type 2, preventable

www.yourdiabetesinfo.orgwww.ndep.nih.gov

What is the NDEP? A Science-based

Program

• Goal - prevent or delay the onset of diabetes

and reduce the illness and premature death

caused by diabetes and its complications

• Strategies based on:

– Clinical trials, epidemiologic studies, evaluation of

community interventions

– Communication, education, and behavioral

science

National Diabetes

Education Program

Awareness

CampaignsSpecial

Populations

Community

Interventions

Partnership

Network

Health

Systems

A joint initiative of CDC and

NIH

What is the NDEP? Education and Communication

• Two major tracks – prevention and control

• Theory- and science-based, audience-tested and tailored messages, materials, tools and campaigns

• Diversity of audiences– People with and at risk for diabetes and their families

– Health care providers

– Lay workers

– Businesses/worksites

National Diabetes

Education Program

• Stakeholder Groups– 4 ethnic minority – AAAA, AAPI, AIAN, H/L– 2 health care provider – HCP, PPOD– 2 age group – children/adolescent, older adults– 1 business– 1 evaluation

• Materials for health care providers, for people who have diabetes and the people who care for them

• Materials have been focus group tested by diverse audiences

• Materials in multiple languages• NO COPYRGHT /Can be co-branded

• www.yourdiabetesinfo.org• www.ndep.nih.gov

NDEP Resources

• Culturally-appropriate, pretested, copyright-free messages and materials in a variety of formats for a wide variety of audiences (public to professional)

• Community capacity-building tools

• Partnership experience and networks

• Knowledge of diversity of cultures – ethnic minority, health professional, business

NDEP Campaign Materials: Control &

Prevention

Different types of materials• Print

• Downloads

• Podcasts

• Videos

• Promotion resources

• Behavior change resources

• PP Presentations such as: Diabetes:

the numbers, and Science of control

Materials for Consumers

Content

• Healthy eating/ how to eat out/tasty

recipes

• Take care of your feet/Be smart about

your heart

• Team care

• Tips to stay healthy

• Know your numbers

4 Steps to control your

diabetes brochure

• Also available in these languages:

• Bengali, Cambodian, Chinese, Gujarati,

Haitian Creole (and CD), Hindi, Hmong,

Japanese, Korean, Laotian, Samoan,

Spanish, Tagalog, Thai, Tongan, Urdu,

Vietnamese

Materials for Professionals and

Lay Workers

NDEP Websites

What is the NDEP? Continuously Improving

• How do we increase reach and impact?

– New channels and formats

– Marketing approach

• How can we make partnerships more

strategic and effective?

• How can we contribute to behavior change

and health outcomes?

NDEP Business Health Strategy

Stakeholder Group: Who are we?

• CDC and NIH• Large and small businesses: GE, GM, Land’s

End• Unions• Occupational health professionals• Public health agencies state Diabetes

Prevention and Control Programs)• Managed care groups• National associations representing

employers, business coalitions and health care insurers

NDEP Business Health Strategy

Partners

• To increase awareness of the benefits of quality diabetes care among employers, benefits managers and managed care decision makers

• To provide employers, health plans and employees with tools and information for incorporating diabetes education programs into the workplace

• To promote the value of investing in prevention

www.diabetesatwork.org

Content• General Diabetes Education :

• Nutrition, Weight Control, and Physical Activity

• Lunch and Learn topics

• Lesson Plans (English and Spanish)

• Fact Sheets (English and Spanish)

• Guide to choosing a health plan, developed with

AAHP

• Supervisor’s guide

• NO COPYRIGHT!

Words of Wisdom

• Can’t transform everything at once

• Use the web sites to print out forms

and “recipes”

• Don’t re-invent the wheel

• Learn from others

Other DAW Projects

GE Project: What Did We Do?• Identify a population at high risk for

developing diabetes and other cardiovascular

risk factors by doing serial cardiovascular risk

assessments (CRA) at the worksite

• Combine public and private expertise (GE+

NBGH+ CDC) to develop interventions to

decrease the risks

• Content: www.diabetesatwork.orgresources/ educational materials

• GE adapted CDC diabetes at work materials and developed some its own

Customer Satisfaction Results

• “I have participated for three years. It is very helpful to see the progress on a consistent basis. This program definitely helps understand the health risks and management, and provides encouragement, support and guidance for healthy life style.”

GE Much

Better

GE Little

Better

About

Same

MD Little

Better

MD Much

Better

Blank or

NA

Treats me with respect 33% 16% 49% 0% 0% 2%Accurately measures

my blood pressure 23% 7% 67% 0% 0% 2%Clearly explains my

risks 47% 23% 21% 5% 0% 5%Clearly explains how I

can reduce my risks 51% 14% 26% 5% 0% 5%

Trane Wellness Program: A Public

Private Partnership

• It started in a supermarket.

• Medical providers (occ med professionals,

docs, nurses, wellness coordinators)

• Sources of expertise: Public health, NDEP

(CDC/NIH), state DPCP (Diabetes Control

and Prevention Program), University of

Kentucky, Local Health Department

• Community groups, AHA, ADA

American Standard/Trane

• Makers of the necessities of life

• Partnership between health department

and private company

• On site training of all shifts

• Plan: Spread to other plants in the US

• Used basic fact sheets from DAW

• 2 messages: Better diabetes control and

Primary prevention

Wheel of Diabetes Fortune:

American Standard/Trane

Comments from “what would keep you from

attending classes”

• If my boss won’t let me come

• If unpaid time

• Getting fired

• Going on strike

• Death

• Wild Horses

Evaluations and comments

Lessons learned

• Work with existing programs: True

collaboration, not competition)

• Include many community and health

organizations

• Include health plan

• Consistency

• Support from the top

What is NDEP Doing in Primary Prevention?

• Messages and materials

– Dissemination

– Evaluation

• Tools for community-based prevention activities

• Adaptation for businesses

• Communication support to DDT’s primary

prevention initiative

Diabetes Prevention: Small Steps. Big

Rewards!

• Based on the science of The Diabetes Prevention Program (DPP)

• Prevent type 2 diabetes in people with pre-diabetes

• Modest lifestyle changes

• Lose 5-7% of body weight, 10-15 lbs in a 200 lb person

• Walk 30 minutes/5 days/ week

• Game Plan Tool kit: strategies to motivate patients to change lifestyle

• The DPP Research Group. Diabetes Care. 1999;22:623

www.yourdiabetesinfo.org

Summary of DPP Lifestyle

Program Treating 100 high risk adults (age 50) for 3 years…

• Prevents 15 new cases of type 2 diabetes1

• Prevents 162 missed work days2

• Avoids the need for BP/Chol pills in 11 people3

• Adds the equivalent of 20 perfect years of health4

• Avoids $91,400 in healthcare costs5

• 1 DPP Research Group. N Engl J Med. 2002 Feb 7;346(6):393-403

• 2 DPP Research Group. Diabetes Care. 2003 Sep;26(9):2693-4

• 3 Ratner, et al. 2005 Diabetes Care 28 (4), pp. 888-894

• 4 Herman, et al. 2005 Ann Intern Med 142 (5), pp. 323-32

• 5 Ackermann, et al. 2008 Am J Prev Med 35 (4), pp. 357-363; estimates scaled to 2008 $US

Small Steps, Big Rewards patient

kitReproducible handouts

• Overview of GAMEPLAN and tools

• Am I At Risk? 2 pager plus “at risk” height/weight charts

• Food and Activity Tracker (8 ½ x 11 version of DPP pocket tracker)

• Walking…A Step in the Right Direction guide for initiating a walking program

• Fat and calorie counter

The Road to Health/El Camino

Hacia La Buena Salud CHW Primary

prevention toolkit

The Road to Health (RTH) Toolkit/ El camino hacia la buena salud

Toolkit : A Toolkit on Primary Prevention of Type 2 Diabetes for

Community Health Workers (CHWs)/Promotores

• The Road to Health Toolkit was developed based on the findings from the Diabetes Prevention Program (DPP) study and focus groups with African American and Hispanic/Latino Community Health Workers.

• Focus groups with CHWs from urban and rural African American and Hispanic/Latino communities:– Diabetes testing, management, and prevention

strategies– Barriers, opportunities, perceptions – Focus on primary prevention– Tools needed– Training video

News You Can Use• November is National Diabetes

Awareness Month

National Diabetes Prevention Program

Goal:

Systematically scale the translated model of the Diabetes Prevention Program (DPP) for high risk persons in collaboration with community-based organizations that have necessary infrastructure, health payers, health care professionals, public health, academia, and others to reduce the incidence of type 2 diabetes in the United States.

NATIONAL DIABETES PREVENTION

PROGRAM

Health

Marketing:

Support

Program Uptake

Increase

referrals

to and use of

the prevention

program

Training:

Increase

Workforce

Train the

workforce that

can implement

the program

cost effectively

Recognition

Program:

Quality

Implement a

recognition

program that will:

• Assure quality

• Lead to

reimbursement

• Allow CDC to

develop a

program registry

Intervention

Sites: Deliver

Program

Develop

intervention

sites that will

build

infrastructure

and provide the

program

C o m p o n e nt s

Interventions Cost per year

Intensive Lifestyle (DPP) $1,500 / $700*

Group Lifestyle (DPP) $300 – 450*

Group Lifestyle at YMCA $240**

Note: For DPP, $1500 for the first year and $700 for years after the first year

Sources: * Herman , Brandle , Zhang, et al. Diabetes Care. 2003 Jan;26(1):238-9.

**Ackermann, et al. Am J Prev Med. 2008 Oct;35(4):357-63

Per capita costs of the lifestyle

intervention program (US$)

National Diabetes Prevention Program

• Training = CDC contracted with Emory University

to establish the Diabetes Training and Technical

Assistance Center (DTTAC) and developed

Master Trainer curriculum and unified Lifestyle

Coach curriculum – www.dttac.org.

• Recognition Program = CDC and partners

developed the standards for program recognition

• For more information:

http://www.cdc.gov/diabetes/prevention/

The Comprehensive Workplace Health

Program to Address Physical Activity,

Nutrition, and Tobacco Use in the Workplace

will establish and evaluate comprehensive

workplace health programs to improve the

health of workers and their families.

National Healthy Worksite

Program.

Source: Solicitation #: 2011-N-13420

3

• Reduce the risk of chronic disease among

employees through science-based workplace

health interventions and promising practices.

• Promote sustainable and replicable workplace

health activities such as establishing a worksite

health committee, having senior leadership

support, and forming community partnerships

and health coalitions.

• Promote peer-to-peer business mentoring.

Program Goals

4

National Healthy Worksite Program

Regions

Region 1 Region 7Region 2 Region 4Region 3 Region 5 Region 6

Local Program Sites

5

Community

Level

Employer

Technical Assistance

• Quarterly Training

• Peer to peer mentoring/key program findings

• Participation in community partnerships

• Subject matter expertise on worksite wellness

• Webinars and distance-based learning

• Resources and tools will be available through

program website

http://www.cdc.gov/NationalHealthyWorksite

Non-participating Employer Resources

33

• Program website

www.cdc.gov/nhwp

or

www.cdc.gov/NationalHealthyWorksite

• Program mailbox

NationalHealthyWork@cdc.gov

• Responses to frequently asked questions will be posted to the National Healthy Worksite Program website. The website will be updated regularly.

How to Stay Connected

34

How do I get NDEP materials?

All NDEP materials are

copyright-free.

Download from

www.yourdiabetesinfo.org

Visit all of the NDEP

Web sites:www.ndep.nih.gov

www.betterdiabetescare.nih.gov

www.cdc.gov/diabetes/ndep

www.diabetesatwork.org