Diabetes Prevention Challenges for 2015

kramerAs we begin 2015, the Diabetes Prevention Support Center (DPSC) of the University of Pittsburgh remains committed to keeping our “eye on the prize” in preventing or delaying the onset of type 2 diabetes.

By Kaye Kramer, DrPH, MPH, RN

More than 29 million Americans have diabetes, with type 2 diabetes representing about 90-95% of those cases1. In addition, there are an estimated 86 million cases of prediabetes in the US, a condition that increases risk for type 2 diabetes1. Fortunately, results from the landmark Diabetes Prevention Program (DPP) clinical research trial demonstrated that type 2 diabetes can be prevented or delayed by making modest changes in lifestyle; specifically by achieving a 5-7% weight loss and increasing moderate intense physical activity to 150 minutes per week2.

At the time of the DPP main outcomes publication, our team of University of Pittsburgh DPP investigators began exploring the possibilities for translating the successful lifestyle intervention to the community setting. With funding from the Department of Defense, the DPSC focused on taking what made the DPP work so well in clinical research and applying those concepts in the “real world.”

  • The DPP lifestyle intervention materials have been updated and adapted to the effective Group Lifestyle Balance™ program for community implementation3. The program has been successfully delivered in primary care practices, hospitals, worksites, and community centers, adapted for delivery in African American churches, Hispanic populations and the elderly, and is currently being modified and evaluated in those with mental illness and mobility impairment.
  • The DPSC has developed a comprehensive two-day workshop for health providers to prepare them for delivery of the DPP GLB program in a variety of community settings.
  • To date, the DPSC has trained approximately 2,000 health providers across the US and internationally in delivery of the DPP GLB curriculum. There are currently more than 150 ongoing DPP GLB programs.
  • All of the DPP GLB program materials are freely available for non-profit research/educational use in English and Spanish.

In 2012, the DPSC worked with the Centers for Disease Control and Prevention and the YMCA to develop a national diabetes prevention program, which includes a national Diabetes Prevention Recognition Program (DPRP)4. The DPRP is an exciting step toward standardization and evaluation of diabetes prevention program delivery in the community, which will hopefully lead to better coverage of these services. The CDC, YMCA and their partners have also been actively working to train providers and implement the DPP lifestyle intervention across the US, as have many other researchers and clinicians in the community5.

The Challenges of Diabetes Prevention

While it is clear that considerable progress on the diabetes prevention front has been made, there are multiple remaining challenges.

#1: Program Delivery
Although lifestyle coach training is ongoing in several venues across the country, important questions exist regarding the best, most cost-effective ways to train and mobilize an adequate work-force to deliver diabetes prevention in the community. For example, there are currently no standards in place regarding what lifestyle coach training should consist of, how it should be delivered, how often training should occur, or who is qualified to provide training. Those delivering programs also face concerns regarding keeping healthy lifestyle intervention programs up to date with changes in the nutrition and activity world, monitoring debates about healthy lifestyle in the media, and incorporating best practices for at-risk patients.

#2: Program Reception
On the program receiving end, there is currently a flurry of interest in providing healthy lifestyle programs from employers and insurers, but these types of programs are often abbreviated versions of evidence-based programs, short-term, and not well-evaluated. It is also unclear who will pay for healthy intervention programs; at the present time only a limited number of insurers are offering coverage for these services, and many existing programs are provided by hospital and community foundations, self-pay, or other local funding.

#3: Social Influence
There are numerous social influences on health behavior change (e.g. health literacy, economic disparities, social and cultural norms) that pose distinct personal and community challenges. These dissemination issues must be addressed as we move forward by developing alternate program delivery modes, e.g., online programs, phone apps, telephonic coaching, etc., creating and evaluating culturally appropriate modifications to existing curricula, and brain-storming other strategies to allow better reach to underserved populations.

All of these are legitimate and important concerns for diabetes prevention in the community in 2015. At the DPSC we will be following these and other relevant issues and providing our thoughts and perspectives based on our experiences in this area. We hope that you will read our blog and offer your input and reflections on these important topics. We look forward to sharing with you!

As a lifestyle coach, what topics would you like to see covered in this blog? Share your thoughts in the comments section below. For more on lifestyle coaching and diabetes prevention, be sure to subscribe to our blog here.

We look forward to the next Group Lifestyle Balance training workshop in Pittsburgh on February 25 and 26, 2015!  Register here »