American Journal of Preventive Medicine
Diabetes prevention at the community levelWorking with the YMCA to Implement the Diabetes Prevention Program
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
References (19)
Obesity and diabetes, the built environment, and the “local” food economy in the U.S., 2007
Econ Hum Biol
(2012)- et al.
Translating the Diabetes Prevention Program into the communityThe DEPLOY pilot study
Am J Prev Med
(2008) - et al.
Lifetime risk for diabetes mellitus in the U.S.
JAMA
(2003) - et al.
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
N Engl J Med
(2002) Data from the 2011 national diabetes fact sheet
- et al.
Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program
Diabetes Care
(2003) - et al.
How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program?
Health Aff (Millwood)
(2012) - et al.
Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program
Diabetes Care
(2005) - et al.
An evaluation of cost sharing to finance a diet and physical activity intervention to prevent diabetes
Diabetes Care
(2006)
Cited by (26)
Promoting sustained diabetes management: Identifying challenges and opportunities in developing an alumni peer support component of the YMCA Diabetes Control Program
2022, Patient Education and CounselingCitation Excerpt :Diabetes self-management is greatly shaped by factors outside the healthcare setting or clinical relationship [1,6]. This has spurred the development of community-based or community-liaised DSMES programs, which are often tailored to address local needs [9–11]. One strength of community-based DSMES programs is that they can provide emotional and instrumental social support regarding living with diabetes [12–14].
Eating behaviors and strategies to promote weight loss and maintenance
2020, Present Knowledge in Nutrition: Clinical and Applied Topics in NutritionSystematic Review of Behavioral Weight Management Program MOVE! for Veterans
2018, American Journal of Preventive MedicineFinancial incentives for diabetes prevention in a Medicaid population: Study design and baseline characteristics
2017, Contemporary Clinical TrialsFasting or Nonfasting Lipid Measurements It Depends on the Question
2016, Journal of the American College of CardiologyCitation Excerpt :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.
Design and participant characteristics for a randomized effectiveness trial of an intensive lifestyle intervention to reduce cardiovascular risk in adults with type 2 diabetes: The I-D-HEALTH study
2016, Contemporary Clinical TrialsCitation Excerpt :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).