1. Intermountain Diabetes Prevention Program : Stepping Back to Move Forward Elizabeth Joy, MD, MPH Medical Director, Clinical Outcomes Research Family Medicine & Sports Medicine Salt Lake Clinic LiVe Well Center Kim Brunisholz, MST, PhDc Senior Outcomes Analyst

2. 27 million Americans with DM II 79 million Americans with preDM 25% 20 million will develop DM in 3-5 years

3. Annual cost associated with diabetes: $245 billion/year A person with diabetes costs $8000 more per year than a person without diabetes Preventing diabetes in a 40 – 50 year old person saves $100,000 of lifetime medical expense BURNING PLATFORM

4. Across the Diabetes Continuum…

5. Healthy Lifestyle & Diabetes Prevention Diabetes Prevention Program NEJM 2002 -58% reduction in the incidence of DM in lifestyle group compared to usual care -71% reduction in incidence in participants > 60 yo

6. 10 year Follow-up of the DPP Incidence of diabetes in those randomized to lifestyle intervention reduced by 34% compared to placebo/usual care Incidence of diabetes in those randomized to metformin reduced by 18% compared to usual care Diabetes Care 35:723–730, 2012

7. Why DPP Now? Compelling evidence that DPP works Stunning cost figures related to the care of patients with diabetes Increasing risk with the Select Health Medicare Advantage Plans, and managed care Medicaid Completion of the Intermountain Lifestyle and Weight Management CPM Roll-out of the LiVe Well Program “Helping People Live the Healthiest Lives Possible”

9. Intermountain DPP Identifies patients who are ready to make a lifestyle change Leverages current lifestyle programs Each step includes oversight from “front lines” Minimal footprint on traditional clinical staff

10. DPP Workflow: Role of the Primary Care Provider

11. DPP Workflow: Role of “Team- based Care”

12. 2 Hour Pre-diabetes 101 Class Available in most Intermountain Regions Taught by registered dietitians Helps to dispel myths and guide patients to more definitive interventions aimed at diabetes prevention Provided at no cost to patients of Intermountain Medical Group physicians (regardless of insurance)

13. Evaluation Framework Patient identification Number of patients identified as having prediabetes. Patient participation Number of identified patients invited to participate in the 2-hour Prediabetes class. Implementation Number of providers and clinics enrolling patients in the 2-hour Prediabetes class. Clinical outcomes Percent weight loss, change in weight, HbA1c, fasting blood glucose, blood pressure, BMI, lipids. Healthcare utilization Number of ambulatory care vs. acute care visits.

14. Current State of Affairs Adult patients > 18 yo Patients “at risk” for DM Prediabetic, (unknown) Prediabetic, (known) Based on FPG or HbA1c results Either not seen, not tested, or tested with BMP or CMP, and elevated glucose not detected by query of EDW 4,500 patients 35,000 patients 80,000 patients

15. ADA Screening Recommendations Screen every adult > 45 years of age (regardless of risk factors) with a FPG, or HbA1c every 3 years Adults (> 18 yo) with BMI > 25 kg/m 2, and 1 additional risk factors for diabetes (HTN,, hyperlipidemia, (+) Fhx for type II DM in 1st degree relative, PCOS, h/o gestational diabetes or macrosomic infant) should be screened with FPG or HbA1c every 3 years

18. USPSTF: Screening for Abnormal Glucose and Type 2 Diabetes Mellitus http://www.uspreventiveservicestaskforce.org/P age/Document/RecommendationStatementDr aft/screening-for-abnormal-glucose-and- type-2-diabetes-mellitus

19. Adoption: Program Locations Referring locations: 141 referring Providers 56 referring Clinics Regions Participating : Cache Valley Weber/North Davis North Salt Lake Salt Lake/South Davis Central Salt Lake South Salt Lake Park City/ Heber Valley Utah Valley Southwest Region

22. The Future of Diabetes Prevention Diabetes prevention DOES NOT take place in the doctors office!!!! Diabetes prevention happens where people, “live, learn, work, play, and pray.” This is where we need to be

23. Technology Facilitated DPP Low Tech 2 Hour “Introduction to Diabetes Prevention” class on YouTube Telehealth delivery of 2 hour Intro Class

24. Moderate Tech Patient Advisories in iCentra to prompt physicians to screen patients for pre-diabetes and diabetes FitBit Pilot Project

25. High(er) Tech Text messaging pilot to engage patients in pre- diabetes screening and diabetes prevention Web-based DPP

26. Wants & Needs Screening Integrated clinical decision support that prompts the provider/care team to order a FPG or HbA1c to screen at risk patients for prediabetes Outpatient setting Inpatient setting Educate patients that they should be screened (similar to how patients often coming in saying they want their cholesterol checked) Scalable, affordable and effective approach to diabetes prevention Traditional (face-to-face) DPP for some Web-based DPP for others Build vs. Buy Shared Accountability

27. Thank You Questions & Comments Liz Joy, MD, MPH Liz.Joy@imail.org Kim Brunisholz, MST, PhDc Kim.Brunisholz@imail.org “Helping People Live the Healthiest Lives Possible”