Diabetes prevention at the community level
Working with the YMCA to Implement the Diabetes Prevention Program

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Introduction

Type 2 diabetes is common and burdensome. Its risk factors include unhealthful eating, physical inactivity, and obesity, which spare no segment of the population and threaten the health and economic well-being of the entire U.S. society. If left unchecked, one in three children born today are expected to develop diabetes in their lifetimes.1

The solution is already known, but reversing the decline in healthy lifestyle behaviors and increases in obesity will require profound individual commitment, social will, and environmental change. Although policy solutions hold promise, changes in the social, cultural, and physical environment take time, and these more fundamental solutions may prove insufficient for addressing the imminent risk of diabetes for tens of millions of Americans already living with prediabetes today. Those individuals need programs immediately that provide education, counseling, problem-solving, and ongoing support for more healthful lifestyle behaviors in the midst of an existing environment that makes physical activity and healthy eating difficult and costly.2

Section snippets

The Diabetes Prevention Program

The Diabetes Prevention Program (DPP) is a goal-based, cognitive and behavioral intervention to help individuals at high risk for type 2 diabetes achieve goals for modest weight loss and moderate physical activity.3 With current estimates of about 2 million Americans developing type 2 diabetes annually,4 it is lofty to consider how complete delivery of the DPP to every adult with prediabetes living in the U.S. today might prevent about 1 million new cases (i.e., a bit more than half) of type 2

Health and Economic Case for a National Diabetes Prevention Strategy

Clearly there are benefits for those who receive the DPP, such as avoiding diabetes, fewer medication needs, higher quality of life, and lower chances of developing other chronic diseases.3, 8 Unfortunately, many individuals are unable or unwilling to pay the sizable fee needed to access the DPP. This brings up the question of the DPP's value for other stakeholders and their willingness to pay.

For example, sponsors of health insurance programs, such as employers and governments, may want

Seeking the Right Community Partner to Scale the Diabetes Prevention Program Nationally

Despite the natural inclination of administrators for health plans and public programs to look within the existing healthcare system as a delivery channel for new health services, the capacity to reach tens of millions of American adults with an ongoing, resource-intensive, lifestyle-based prevention program clearly lies outside the walls of most existing clinics and hospitals.11 Although reaching high-risk individuals in communities might require the DPP to be delivered through a variety of

A Successful Community–Academic Research Collaboration with the Y

In 2003, while the NIH and DPP Research Group were looking for possible avenues for disseminating the DPP lifestyle intervention as a research-proven “best practice,” we engaged the Y of Greater Indianapolis to discuss the possibility that a Y-model for the DPP might fit within their own evolving organizational vision of addressing new frontiers in health and wellness. Since then, we have successfully collaborated with the Y in a robust program of ongoing research involving four funded grants

The Future

The challenge for how to maximize success toward preventing type 2 diabetes on a national scale clearly has an “and/also” solution. The debate should not focus on which particular program or policy should be supported but, rather, how a multitude of complementary approaches can improve the overall reach and effectiveness of combined efforts to improve population health. The Y-model for offering the DPP in the community holds much promise to improve health for a reasonable cost, but this will

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    For example, among patients with impaired fasting glucose, the Diabetes Prevention Program found that intensive lifestyle intervention reduced the incidence of diabetes by 58% (28). More recent efforts have focused on the delivery of lifestyle interventions in community settings or via smartphone applications in an effort to make implementation less burdensome and more sustainable (29,30). Therefore, it is important to identify patients with metabolic risk factors so that intensive lifestyle interventions can be emphasized.

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    GLI instructor training and certification consists of a 2.5-day course run by the Northwestern University training core. The training course was based on the Look AHEAD lifestyle intervention but was adapted from our prior training course for a community-based adaption of the Diabetes Prevention Program that has been offered to over 100 “lay” instructors affiliated with a variety of community organizations (including the Y) in several states [21,37,38]. During training, all GLI instructors receive a GLI operations manual, the participant handouts and toolkits of supportive educational materials (e.g. measuring cups, spoons and food labels).

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