Diabetes Prevention Program Marcelle Thurston MS, RD, CDE Kelly McCracken RD, CDE Colorado Department of Public Health and Environment

Goals for Today Define the impact of pre-diabetes in Colorado Provide an overview of the Diabetes Prevention Program (DPP) Describe the national infrastructure in place for DPP to be sustainable in individual states Highlight the onsite Diabetes Prevention Program at the Colorado Department of Public Health and Environment List potential roles of business coalitions

Impact of Prediabetes in Colorado

What is Pre-diabetes? A blood sugar level that is higher than normal but not high enough to be classified as diabetes Without lifestyle changes most people with pre-diabetes will develop type 2 diabetes within 6 years Risk is highest in overweight adults over the age of 45, have family history of diabetes or history of gestational diabetes 4

Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

26 million with Diabetes 79 million with Prediabetes

Value of Investing in Prevention Delaying or preventing diabetes impacts:  Presenteeism  Productivity  Staff retention Mitigates higher risk pool:  Avg. medical costs for a person with diabetes are nearly twice those of a person without diabetes  Costs are more than four-fold for a person with diabetes-related complications compared to a person without diabetes

Overview of the Diabetes Prevention Program (DPP)

The Diabetes Prevention Program (DPP) Based on NIH and CDC clinical trials 5% - 7% weight loss & increased physical activity to 150 minutes a week reduced risk of developing type 2 diabetes by 58% 10-year follow up study showed reduced diabetes incidence of 34% in the lifestyle group Translated into 16-week group based program 30

Cardiovascular risk factors also improved with the DPP Blood pressure significantly lowered Cholesterol levels significantly improved At 3 year follow-up the use of meds for both blood pressure and cholesterol were lowered DPP. Diabetes Care 28:888–894, 2005

How DPP differs from other programs Evidence based Low cost Pay for performance model Decreases risk of other obesity related diseases National infrastructure to assure fidelity

The look of DPP 16-week group based classes Led by a skilled facilitator Topics include healthy eating, physical activity, goal setting Offered at YMCA and community based organizations in several counties Can be offered onsite for employees UnitedHealthcare covers DPP in CO for fully- insured members $300-$400 per participant; based on outcomes

Role of Business Coalitions Educate employers about pre-diabetes and Diabetes Prevention Programs in the area DIABETES Support employers in identifying: – % of employees at risk – communication strategies about prediabetes and DPP – community partners Align shared priorities and goals Create tip sheet for how to negotiate with health plans to include the Diabetes Prevention Program

For more information CDC Diabetes Prevention and Recognition Program recognition/index.htm recognition/index.htm Kelly McCracken 303/ Marcelle Thurston 303/