Setting the Stage on Diabetes Prevention & Interventions in - - PowerPoint PPT Presentation

• Dr. Paul Mulhausen, MD, MHS, FACP, Chief Medical Officer

and Ami Bolles, Strategic Account Manager

Setting the Stage on Diabetes Prevention & Interventions in Iowa: A Focus on Efforts in the Workplace

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Iowa Statistics

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• 300,365: The number of Iowans living

with diabetes

• 810,000: The number of Iowans living

with prediabetes

• $2.6 billion: The amount diabetes costs

Iowa each year

Diabetes Statistics in Iowa

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Data Source: Center for Disease Control and Prevention, National Center For Chronic Disease Prevention and Health Promotion. 2013. Source geography: County

Report Area Total Population

• ver Age 20

Population with Diagnosed Diabetes Population with Diagnosed, Crude Rate Population with Diagnosed Diabetes, Age Adjusted Rate Iowa 2,275,131 218,604 9.61 8.53% United States 239,919,508 23,685,417 10 9.19%

Iowa vs United States

5 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% Percent Males w/Diabetes Percent of Females w/Diabetes Iowa United States

Adults with Diagnosis Diabetes by Gender

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Report Area 2004 2005 2006 2007 2008 2009 2010 2011 Iowa 6.51% 6.78% 6.89% 6.96% 7.17% 7.42% 7.68% 8.18% United States 7.31% 7.58% 8.04% 8.33% 8.55% 8.72% 8.95% 9.09%

Diagnosed Diabetes year over year Iowa vs US

7 22.00% 22.50% 23.00% 23.50% 24.00% 24.50% 25.00% 25.50% 26.00% 26.50% 27.00% Medicare beneficiaries w/Diabetes Iowa US

Iowa vs US Medicare Population

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A Public Health Crisis – Future Projections

Source: Population Health Management, February 2017

Between 2015 and 2025, projections indicate Americans with diabetes will increase by

40% to nearly 50 million!

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A Public Health Crisis

Source: American Diabetes Association

$1 IN $5

health care dollars is spent caring for people with diabetes. The annual health care costs for a person with diagnosed diabetes are

2.3x HIGHER

than for a person without. Over five years the cost of prediabetes increased

74 percent (to $44 billion)

15 30 45 60 2007 2012

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Diabetes Prevention in the Work Place

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• Workplace stress leads to unanticipated absenteeism

costing companies $602/worker/year.1

• People who are physically active for about 7 hours a

week have a 40% lower risk of dying than those who are active less than 30 minutes per week.2

• Annual medical costs are $1,429 higher individuals

with a BMI value over 30 than those of at levels under 30.2 Fast Facts

1 stress.org / 2 cdc.gov

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Studies have shown that individuals who participate in a structured lifestyle change program can cut their risk

• f developing type 2 diabetes by more than 50%.

The Need for Prevention

Source: American Diabetes Association

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• Multifaceted employee lifestyle change participation

programs

• Obesity, nutrition, and physical activity programs in the

workplace are critical elements in addressing type 2 diabetes

• Research suggests that the progression from prediabetes to

type 2 diabetes can be prevented or delayed.

• The lifestyle intervention worked equally well for men and

women and all racial/ethnic groups

• The American Diabetes Association recommends that people

with prediabetes should be counseled on lifestyle changes with goals similar to those of the DPP

Supporting Prevention Efforts in the Workplace

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DPP in the workplace

• DPP in the workplace makes it easier for people with prediabetes to

participate in evidence-based, affordable, and high-quality lifestyle change programs to reduce their risk of type 2 diabetes and improve their overall health

• Engagement in the program when offered at workplace and tied to

a wellness program.

• Peer support

Other Ways

• Coaching

Example of a Workplace Diabetes Prevention

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Offered through a partnership of ADA and Telligen

Program features – Year-long structured program (in-person group, online or distance learning) – Facilitation by a trained lifestyle coach – Use of a CDC-approved curriculum – Regular opportunities for direct interaction between the lifestyle coach and participants – An emphasis on behavior modification, managing stress and peer support

DPP Corporate Program

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• Companies typically see a cumulative and net savings over a 3

year period

• DPP cost savings calculator

– https://ama-roi-calculator.appspot.com/

Why Companies will Invest in prevention?

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Diabetes Self Management – A Workplace Solution?

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The Underlying Premise

“Interventions that encourage people to acquire self- management skills are essential in chronic illness care.”

Edward H. Wagner, Brian T. Austin, Connie Davis, Mike Hindmarsh, Judith Schaefer, and Amy Bonomi

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• Half of people known to have high blood pressure do not have

it under control in alignment with clinical guidelines.

• One-third of people with ischemic vascular disease,

appropriate for life-saving aspirin therapy are not taking it.

• Fewer than half of people presenting to a healthcare provider

with depression or anxiety receive appropriate treatment.

• Fewer than half of people with asthma receive care that is

consistent with clinical guidelines.

Known Gaps in Chronic Disease Management

Health Affairs 2001

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Self-Management is Key to High Value Chronic Care

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Among People with Diabetes

• 16% with an A1C over 9.0%
• 60% skip the annual eye exam
• 16% current smokers
• 88% overweight or obese
• 41% physically inactive
• 74% with high blood pressure
• 30% - 40% eligible for a statin not taking one

Persistent Risk Factors for Complications

CDC, 2017

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• 1. Diabetes education is effective for improving clinical
• utcomes and quality of life
• 2. DSME has evolved from didactics to empowerment models
• 3. There is no one ‘best’ education program or approach, but

there are key features to success:

• behavioral and psychosocial strategies improves outcomes;
• culturally and age-appropriate programs improve outcomes;
• group education is effective
• 4. Ongoing support is critical to sustain progress
• 5. Behavioral goal-setting is effective

Guiding Principles for DSME

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• Managing their diabetes mellitus well
• Enabling people to live well with their diabetes.

– Manage as they go about their daily lives – Enhancing their well-being

• Empowering them as partners

Self Management that Goes Beyond Disease Management

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• Insurance coverage gaps
• Suboptimal clinical service design
• Patient characteristics
• The disease itself
• Patient interactions with diabetes care and education

providers.

• Socio-environmental context

Barriers to Effective Self Management Interventions

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• Diabetes self-management needs to move beyond the status

quo programming

• Diabetes self-management needs to be integrated within the

context of a broader ecology of the affected person.

• Diabetes self-management efforts should be delivered by

multiple strategies, including group education, one-on-one counselling, coaching and technology.

• A multi-pronged strategy that works collaboratively, efficiently

and effectively.

What Next – An Ecological Approach

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The Ecology of Self Management

American Journal of Public Health 2005; Vol 95(9)

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The workplace as part of the ecology

Clinical Therapeutics 2013; 35 (2)

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• Broadening access and appeal to adults with diabetes (or
• ther chronic diseases).
• Interventions

– Standardized Diabetes Self Management Education Curricula

• U of Ill Chicago, DEEP Diabetes Education

Empowerment Program (DEEP)

• Stanford, Diabetes Self Management Program

– Health Coaching – Telephonic Support and Technology Interventions

Workplace Diabetes Self Management Interventions

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Summary

• Multiple cultural and logistical barriers impede the potentially

broad impact of diabetes self-management interventions

• Effective diabetes self-management interventions should

include managing well with diabetes in addition to managing diabetes well.

• The ecological model of self-management implies the value of

the workplace as a potential source of key value in diabetes self-management

• A number of diabetes self-management interventions could

be provided as part of workplace health and well-being.

Workplace Solutions for Diabetes Self Management

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Questions