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Public Health Program: Diabetes Don’t Sugar Coat it

5 months ago

2035 words

Topic:   Diabetes Prevention in NYC 

 

Scope of the Problem

Diabetes mellitus is a metabolic disorder defined as hyperglycemia, when the body in unable to produce sufficient insulin to absorb blood sugar. According to the NIDDKD, there are approximately 30.3 million people living with diabetes in the United States. That is roughly 9.4% of the population. Also, more than 25% of the population remain asymptomatic in its early stage and therefore undiagnosed. Diabetes is the 7th leading cause of death.

Diabetes affects 1 in 4 Americans that are above the age of 65, and most commonly it is presented in adults as type 2 diabetes. The type of diabetes are type 1, type 2, and gestational diabetes. About 5% of Americans living with diabetes have type 1, which typically occurs in children and young adults. Type 2 can be developed at any age, those more likely are adults above the age of 45.  

Diabetes comes with long term risks, leading to serious complications, including failure of organs, such as eyes, kidneys, nerves, heart, blood vessels, amputation of extremities and even early death. The reports from 2015 estimates that total costs in medical bills, lost work and wages due to diabetes and related complications amounted to about $245 billion, which increased from $174 billion in 2010. If numbers rise in this trajectory, 1 in 5 Americans will have diabetes by 2025, and 1 in 3 by 2050.

There are about 2 million people in New York State alone who are diabetics, and about half a million of these individuals are undiagnosed. Diabetes is caused by a number of factors, not only diet and exercise, family medical history plays a factor in developing diabetes. According to Healthy People 2020, minority populations are at higher risk of being affected by type 2 diabetes.  The Latino, Hispanic and African American populations are the most predominant groups that are diagnosed. In 2007, 22 African Americans and 23 Hispanics of 100,000 died due to diabetes related cause. These disparities are evident in the risk to diabetes as there are multiple barriers these individuals face.

There were some interventions placed such as the Behavior Risk Factor Surveillance System. This is used to assess and track the prevalence of diabetes in adults. It is useful such that is a statewide telephone survey tool, however, it does not include those individuals that remain undiagnosed and those who are pre-diabetic. In 2008, the NYSDOH, launched Prevention Agenda toward the Healthiest state to support goals of health care reform establishing prevention strategies to reduce prevalence of diagnosed diabetes however it wasn’t as impactful.

Currently, the most effective way to prevent or delay type 2 diabetes is adopting a healthier lifestyle, which includes diet and exercise, and this is shown to improve overall health in regards to disease. From this information, the Diabetes Prevention Program, a research trial was launched. This demonstrated that lifestyle interventions had a great impact in the onset of the disease, effective in any age and racial backgrounds. Then the National Diabetes Prevention Program was established, which aims to implement a lifestyle change nationwide to prevent or delay type 2 diabetes. However, we need to make sure those who have diabetes are also taken care of as well, by including them in this program we will be instilling valuable lifestyle choices for future generations.

 

 

Planning

For this program, making mostly behavioral changes instead of environmental changes is important, because it is harder to relocate individuals who live in certain socioeconomic related areas. The CDC passed the National Diabetes Prevention program which is a national partnership, emphasizing the community-based interventions, that offer a lifestyle change. First, we will gather individuals that are at high risk for diabetes or those individuals that have diabetes. We will achieve this by providers screening patients and referring them to the CDC recognized programs. Health care providers must be informed and educated about the implications. The National DPP offers in person and online lifestyle change program, which teaches participants about making lifestyle changes, from eating healthier foods, to being physically active daily, and improving coping methods. We can also offer these guidelines and as well as free screening tests for individuals with diabetes and pregnant woman. Offering classes and support groups for those who are currently diabetic, to ensure they have the same knowledge in regards to maintain a healthier lifestyle which includes the physical activities, maintaining their blood sugar levels by visiting their primary care providers and reconciliation with proper medication. This will help to maintain and control their diagnosed diabetes.

Surveys and data collected after 6 months, 12 months, is a good start. This will help to address is the intervention of the lifestyle programs are having a positive impact in the community, and will address any styles that need to be improved.  Small testimonials at the end of the sessions could be could to assess patient compliance and patient satisfaction. Also, making sure the patients are returning to their primary care and being screened will also assess the effect of the program.

            The key stakeholders for this program will be public and private organizations. In a community level, it will start by health care professionals and providers, who due to the health care climate are moving towards quality improvement in providing care. Since many providers are being paid to maintain chronic conditions and not based on the number of visits. With the proper awareness, this program can trickle down into the work sector, garnering attention from employers and business that’s promote health and wellness. This will encourage workers to be healthy and would costs less for employers to have fewer employees that are leaving work because they are sick. The local colleges and university communities would be motivated through education and sharing the valuable knowledge. By offering heathier food options in cafeterias and in vending machines, we can gain more younger populations and promote healthier eating. Public and private insurers that value healthier patients who maintain and comply with their doctor’s recommendations. Lastly, federal agencies that are in charge of government spending will find this program more cost effective in the long run.

These programs will be publicly and privately funded, through national and state health funds and even through tax revenues.  Many of the monies allocated for diabetes research can be utilized here. NY is a thriving state and can raise money to fund for research/prevention programs of this nature. The program will be feasible in the long run because many of its provisions are long lasting if implemented correctly. According to CDC, research shows that a structured lifestyle intervention can cut the risk of type 2 diabetes in half. By raising awareness about diabetes/prediabetes/gestational diabetes, sharing valuable information about the intervention programs, encouraging voluntary membership for lifestyle changes, and promote the NDPP as a health benefit, can be very impactful.

 

Development & Dissemination of the Interventions

 

The goal is for Americans that are at high risk, to have access to affordable, high quality, lifestyle change programs which reduces their risk by delaying/eliminating the onset of developing type 2 diabetes and thus improving their health status. Also, we hope to encourage these lifestyle changes in those affected by diabetes and in pregnant woman, to ensure these behaviors become second nature and can be passed on in future generations. By implementing these programs, that utilize life coaches and encourage screening tests, it is a better way to lower the prevalence and future incidence rates of diabetes that is plaguing NY.

 

The CDC runs the National DPP which specific guidelines as described below. This can also cater to patients that are already diabetic, encouraging their participation can help them maintain and control their disease.

  1. CDC-approved curriculum.
  2. Offer lifestyle program within 6 months of approval of CDC
  3. Deliver program for at least 1 year, 16 sessions within first 6 months, and 6 sessions in the last 6 months
  4. Submit data on participants progress—including stats such as weight loss, physician activity, and attendance—every 12 months
  5. Trained lifestyle coach’s, who helps build participants skills and confidence
  6. Individuals designated as diabetes prevention program coordinator
  7. Require 50% of participants within prediabetes, verified by blood test or gestational

The first step is to raise awareness. For those that are undiagnosed or at high risk of developing diabetes, the best people to target this population is health educators at schools and primary care providers. Health educators have developed relations with children, teens, young adults, and thus exposing these age groups early on about the risks of diabetes, can encourage change in lifestyle. Also, primary care providers, are key components to promoting awareness about lifestyle changes. These simple interventions in regards to discussion and screening patients regarding their development of diabetes, whether that is through a blood test, or assessing patient’s biometrics to determine their risk, or family history as a risk factor, will not require a great deal of money. It is the proper implementation and time management that will allow for these parameters to be covered. As mentioned above, once the awareness phase is achieved, offering intervention programs for these individuals to join for little to no cost. This incentive can bring a lot of voluntary patients. Many of the programs can be held at local community centers, churches after hours, or schools after school, and local parks. The sessions can be once a week or twice a month, depends on the facility, depends on the accessibility and schedule of the patients. Those that are online have more freedom, as they able to cater to their personalized scheduled. Both options help individuals in the same measures. The programs would consist of a healthy lifestyle coach that would also possess knowledge about diabetes prevention. The coach will offer valuable lessons in terms of making healthy choices for meals, what types of physical activities/exercises to incorporate in daily routines, ways to stay motivated/lose weight/keep it off, and building confidence. All of these simple interventions can help patients, encouraging them to take control of their life and their health.

 

Evaluation & Maintenance

To evaluate the impact of the prevention program we would conduct studies to assess the number of pre-diabetics before and after the program, most likely in a 6 month and 12 month frame. This data would be completed after a checkup, in a primary care office or in a laboratory facility, its often done through a blood draw to determine patients insulin levels, or determined by their biometrics. We would also assess the groups of individuals with diabetes and make sure they have maintained their blood sugar levels and even so if they have lost weight in the program, to reduce their risk of complications. This can be done in a similar setting. Along with the study of the reduced prevalence and incidence rates, we can survey the patients, and instructors, to determine their satisfaction and get their opinions about the program.  Some survey questions can be:

  1. What is diabetes?
  2. What are some related risk factors?
  3. Do you have any
  4. Are you overweight? (show table with chart)
  5. Are you above the age of 45?
  6. Are you above
  7. Are you (certain minority) group?
  8. Have you ever been tested?
  9. Do any of your family or
  10. Have you lost weight?
  11. Were you able to access the intervention programs?

 

If the intervention is unsuccessful, something went wrong. A more detailed look in the program and the outcome of the individuals would need to be assessed, such that proper modifications can be made.  The intervention program wouldn’t need to be overhauled but reorganized, addressing. the weak points and altering to satisfy the patients needs. However, for the most part, more efforts in providing patients with the knowledge about the intervention programs that are a health benefit should be increased. Continued counseling by providers to assess patients need for intervention. This is the most crucial step to determining patients level of risk and offering this intervention as a solution to prevent the development of diabetes.

 

 

References

https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes      

https://www.medicalnewstoday.com/articles/278140.php

https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes

http://www.qtacny.org/programs/national-diabetes-prevention-program/

https://www.cdc.gov/diabetes/prevention/lifestyle-program/experience/index.html

http://www.diabetes.org/in-my-community/local-offices/new-york-new-york/?referrer=https://www.google.com/

http://www1.nyc.gov/site/doh/health/health-topics/diabetes.page

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984379/

http://journal.diabetes.org/clinicaldiabetes/v18n22000/pg69.htm

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