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Diabetes Prevention Action Plan Iowa Department of Public Health Protecting and Improving the Health of Iowans

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Page 1: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Diabetes Prevention Action PlanIowa Department of Public Health Protecting and Improving the Health of Iowans

Page 2: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

IntroductionAndrew Minear, MPHDiabetes Primary Prevention Coordinator

Phone: 515-725-2839Email: [email protected]: Iowa Department of Public Health321 E. 12th St.Des Moines, IA 50319

Started in June 2017 Previously with Department of Public Defense

mailto:[email protected]
Page 3: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Overview: Putting the

Pieces Together Recap - Since May NDPP Iowa’s Landscape Action Plan

Page 4: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Diabetes Prevention Summit in May•An engagement meeting of Iowa’s diabetes prevention stakeholders

•This meeting was a way to bring Iowa’s diabetes prevention stakeholders to brainstorm a plan.

•Out of this meeting came the Action Plan.

Page 5: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Diabetes Prevention Summit in May•Draft an Action Plan to prevent type 2 diabetes

• Raise awareness of prediabetes• Support and sustain the NDPP across Iowa

•Collaborators• Iowa Diabetes Prevention Team• Center of Disease Control and Prevention (CDC)• National Association of Chronic Disease Directors (NACDD)

•Participants included representatives from public, private and non-profit sectors from throughout the state.

Page 6: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Diabetes Strategic Plan Iowa Diabetes Prevention Action Plan

Prevent Diabetes from Occurring in Iowans (Primary Prevention) Awareness and Availability

Ensure Detection of Diabetes in Its Earliest States (Detection) Screening, Testing and Referral

Use Data to Drive Population-Based Diabetes Strategies (Data) Availability

Page 7: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

National Diabetes Prevention Program (NDPP)

Page 8: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs
Page 9: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs
Page 10: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs
Page 11: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

https://www.cdc.gov/diabetes/prevention/pdf/ndpp_infographic.pdf

Page 12: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Evidence-Based ProgramDPP Clinical Trial Study Design and Findings

• 3,243 individuals with prediabetes were divided into three groups

https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp/Documents/DPP_508.pdf

Lifestyle Change Metformin Placebo

Received training and coaching on diet, physical

activity and behavior modification

Took 850 mg twice a day, and received information about diet and exercise

with no coaching

Took placebo pills twice a day and received diet and exercise information with

no coaching

Page 13: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Evidence-Based Program

1. https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp/Documents/DPP_508.pdf 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135022/

Lifestyle Change Metformin Placebo

Received training and coaching on diet, physical

activity and behavior modification

Took 850 mg twice a day, and received information about diet and exercise

with no coaching

Took placebo pills twice a day and received diet and exercise information with

no coaching

Participants in the lifestyle change group reduced their risk of developing diabetes by 58% compared to a 31% reduction for the metformin group 1

Only 5% of the lifestyle change group developed diabetes 1

Participants in the lifestyle change group age 60 and older reduced their risk by 71% 1

Lasting Impact of the Lifestyle Change Intervention10 years later, those who participated in the lifestyle change group were still 33% less likely to develop diabetes 2

Page 14: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Structure of the National DPPProgram Goal: Assist participants to making long-term behavior changes to their diet and activity levels as well as improve their problem solving-skills.

Participant Goal: Lose 5 – 7% of body weight

Months 1 – 6 • Weekly sessions with

a minimum of 16

Months 7 – 12• Monthly sessions

with a minimum of 6

During the program participants are coached in a range of healthy behavior core classes

Example CurriculumStrategies for Healthy Eating OutManaging StressEating LessMaking Active ChoicesStaying MotivatedDietary FatsMore Volume, Fewer CaloriesPreventing Relapse

https://www.cdc.gov/diabetes/prevention/pdf/dprp-standards.pdf

Page 15: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Iowa’s Landscape

Page 16: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Prediabetes in Iowa• Approximately 838,611 adults in

Iowa have prediabetes – more than 1 in 3.

• This is concerning because left untreated:

• 15-30% of people with prediabetes will develop type 2 diabetes within 5 years.

Page 17: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Prediabetes in Iowa•Adults reported being told by a healthcare professional they have prediabetes or at high risk for diabetes.• 2013 – 6.2% • 2014 – 7.8%• 2016 – 7.8%

•This data suggests our screening and testing rates have leveled, off and many Iowans are unknowingly living with prediabetes.

BRFSS). (2017). 2013 and 2014 data provided by the Iowa Department of Public Health. IDPH Bureau of Vital Statistics

Page 18: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Prediabetes in Iowa – BRFSS DataTotal – 7.8%

Male – 8.2%

Female – 7.4%

White/Non-Hispanic – 8%

Non-White or Hispanic – 5.8%

18-24 – 1.6%

25-34 – 4.4%

35-44 – 5.8%

45-55 – 9.9%

55-64 – 11%

65-74 – 13.5%

75+ – 11.3%

Less than H.S. – 7.1%

H.S. or G.E.D. – 8.1%

Some Post H.S. – 8.8%

College Graduate – 6.1%

Less than $15,000 – 10.3%

$15,000 -24,999 – 5.3%

$25,000-34,999 – 9.3%

$35,000-49,999 – 9.2%

$50,000-74,999 – 8.9%

$75,000+ – 6.4%

BRFSS. (2017). 2016 data provided by the Iowa Department of Public Health. IDPH Bureau of Vital Statistics.

Page 19: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Healthcare Expenses

Source: CDC. (2014). Presentation for healthcare providers. Retrieved fromhttp://www.cdc.gov/diabetes/prevention/doc/hcp_ppt_presentation.pdf

Less than $15,000 – 10.3%

65-74 – 13.5%

Total – 7.8%

• Diabetes costs on average $13,700 annually. • 2.3 times more than someone with

out diabetes.• The total costs of treating diabetes in the

United States has increased to 245 billion. • That is up 41 percent from the

previous five years.

Page 20: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs
Page 21: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Prediabetes Risk Test - Hedgehogs I Type 2 Diabetes Prevention I Ad Council

Page 22: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Diabetes Prevention Sites in Iowa Early 2015

Page 23: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Current Diabetes Prevention Sites

Page 24: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Current Diabetes Prevention Sites

Page 25: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Iowa Diabetes Prevention Action Plan

Page 26: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Timeline of Implementation•State Engagement Meeting – May 3, 2017

•Draft quick start action plan – June 5, 2017

•Gather input from stakeholders – August 7, 2017

•Identify workgroups and leads – July – October 2017

•Action Plan and Priorities Finalized – October 23, 2017

•Kickoff Action Plan – TODAY!

•Tracking of implementation of Action Plan – Ongoing through December 2020

•Meetings with all workgroups/leads/stakeholders – Ongoing through December 2020

•Evaluation of Action Plan – January 2021

Page 27: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

In the Works•The Pillar Group Meetings will provide for rich conversation and discussion.• Plan for a focused conversation.

•Leavitt Partnership Interview Calls•This plan has been through the ringer, it has just been approved and is posted on the http://idph.iowa.gov/website.•Keep moving forward.

http://idph.iowa.gov/
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Action Plan ObjectiveDecrease the new cases of diabetes among Iowans with prediabetes and those at highest risk, by increasing enrollment and completion of CDC-recognized diabetes prevention programs.

Page 29: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

The Four Pillars

Pillar 1

Pillar 2

Pillar 3

Pillar 4

Protecting and Improving the Health of Iowans

Awareness

Availability

Screening, Testing and Referral

Coverage

Page 30: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar 1Awareness

CDC estimates that 84.1 million (one in three) American adults have prediabetes

Of those 84.1 million, nine out of 10 do not even know they have prediabetes.

Page 31: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar 1 - Awareness

Carol Hibbs – Marshalltown YMCA/YWCAShort Term Priority – By November 2018, increase Iowa adults who are aware they have prediabetes from 7.8 percent to 15 percent.

Long Term Priority – By November 2019, increase Iowa adults who are aware they have prediabetes from 15 percent to 20 percent.

Awareness of prediabetes and the effectiveness of the CDC-recognized diabetes prevention programs.

Page 32: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Action Steps

Page 33: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar Stakeholders

- Cedar County Public Health Department

- Des Moines University

- Drake University: The College of Pharmacy and Health Services

- Hy-Vee: An Employee-Owned Grocery Store

- Iowa Board of Nursing

- Marshalltown YMCA/YWCA

- Palmer College of Chiropractic

- Polk County Health Department

- University of Iowa Hospitals and Clinics

Page 34: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar 2Availability

Iowa has approximately 40 sites

So far in Iowa, all DPPs are in-person

Increased coverage for DPP = increased need for program availability

Page 35: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar 2 - Availability

Andrew Minear– Iowa Department of Public HealthLong Term Priority – By November 2019, create an infrastructure/network of all existing diabetes prevention program (DPP) sites to maximize coordination, availability and participation in DPPs with CDC recognition or pending CDC recognition, with an emphasis on vulnerable populations.

Availability and support of CDC-recognized diabetes prevention programs.

Page 36: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Action Steps

Page 37: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar Stakeholders

- Cerro Gordo Public Health Department

- Grinnell Regional Medical Center

- Hy-Vee: An Employee-Owned Grocery Store

- Iowa Department of Public Health

- Iowa Pharmacy Association

- Marshalltown YMCA/YWCA

- Norm Waitt YMCA: South Sioux City

- Telligen

Page 38: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Website – Input NeededWrite down three things you think the Data Portal / Diabetes Prevention Website NEEDS to have on it.

Page 39: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar 3Screening, Testing and

Referral

Existing and new STR protocols

Recognition means confidence from referring healthcare providers

Page 40: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar 3 – Screening, Testing and Referral

Kady Reese – Iowa Healthcare CollaborativeShort Term Priority – By November 2018, create and pilot specific modifiable templates on screening, testing and referral (STR) for a variety of providers and settings that describe the triggers and processes for STR and follow-up protocols for people with or at-risk prediabetes.

Long Term Priority – By November 2019, identify populations and areas within the state where the new protocols and guidelines can be disseminated and implemented.

Clinical screening, testing and referral to CDC-recognized diabetes prevention programs in the National DPP.

Page 41: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Action Steps

Page 42: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar Stakeholders - Community Health Partners

- Greene County Medical Center

- Hy-Vee: An Employee-Owned Grocery Store

- Iowa Department of Public Health

- Iowa Healthcare Collaborative

- Iowa Pharmacy Association

- Marion County Health Department

- Mary Greeley Hospital

- Midwestern Public Health Training Center

- Palmer College of Chiropractic

- University of Iowa Hospitals and Clinics

Page 43: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar 4Coverage

Prediabetes and type 2 diabetes affect the health and quality of life of millions of United States adults and cost employers and insurers billions of dollars in lost productivity and medical expenses. Coverage to scale the program

Page 44: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar 4 - Coverage

Ami Bolles – TelligenShort Term Priority – By November 2018, develop a matrix of coverage options for the CDC-recognized diabetes prevention programs based on the payer type.

Long Term Priority – By November 2019, implement diabetes prevention program coverage with at least one payer.

Coverage of diabetes prevention programs by employers and insurance plans.

Page 45: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Action Steps

Page 46: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar Stakeholders

- Iowa Department of Public Health

- Iowa Medicaid Enterprise

- Leavitt Partners

- Telligen

Page 47: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Pillar Group MeetingsOver the next few months, we need to regroup and focus our efforts on the presented action steps.These meetings will be held at the Iowa Department of Public Health.We cannot become stagnant in this growing problem.

Page 48: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Help us keep the momentum, pushing forward, as we continue collaborating on our statewide efforts and decreasing the

diabetes type 2 incidence rate.

Page 49: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

CDC National Diabetes Prevention ProgramInterest in having a Diabetes Prevention Program at your work place or providing one to the public? Check this site out below. But always feel free to contact me with any questions.

www.cdc.gov/diabetes/prevention

Questions or slides:[email protected]

515-728-2839

https://www.cdc.gov/diabetes/prevention
mailto:[email protected]
Page 50: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

Questions?

Page 51: Diabetes Prevention Action Plan - mphtc.org · Total – 7.8% • Diabetes costs on average $13,700 annually. • 2.3 times more than someone with out diabetes. • The total costs

DisclaimerThe information provided in this presentation is for informational purposes only and does not constitute legal advice.

The primary purpose of this presentation is to provide information about prediabetes, diabetes prevention programs and the Prevention Action Plan. There is no intent to reflect a view on specific legislation.

Funding for this presentation was made possible (in part) by Cooperative Agreement #5 NU58DP004807-03-00 from the Centers for Disease Control and Prevention. The views expressed in written materials and by the speaker do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.


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