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Diabetes Prevention Program Demonstration Project

Diabetes Prevention Program Demonstration Project. Navajo Nation Human Research Review Board Conference November 15 th , 2011 Kristin Graziano, DO, MPH Director, Diabetes Treatment and Prevention Services Tuba City Regional Health Care Corporation. Objectives. Diabetes…why do we care?

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Diabetes Prevention Program Demonstration Project

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  1. Diabetes Prevention Program Demonstration Project Navajo Nation Human Research Review Board Conference November 15th, 2011 Kristin Graziano, DO, MPH Director, Diabetes Treatment and Prevention Services Tuba City Regional Health Care Corporation

  2. Objectives • Diabetes…why do we care? • Discuss the landmark Diabetes Prevention Program study • Results of the 5-year DPP Demonstration Project • Lessons learned

  3. Why We Care • Increasing rates of diabetes • AI/AN diabetes disparities • 2.2 times higher prevalence rates • 3.5 times higher rate of kidney failure • 3 times the risk of cardiovascular disease • Diabetes is now affecting our children and young people • Health care costs: In 2007, $174 billion

  4. Why We Care Impact on individuals, families, and communities

  5. The Questions… Can diabetes be prevented by eating healthier and exercising regularly? And if so, is this as effective as medication?

  6. The Research:Turning the Tide on Diabetes • Diabetes Prevention Program Research Study • 3234 people with prediabetes • 16 lesson curriculum: Lifestyle Intervention • Program goals • 150 minutes exercise per week • 7% loss of body weight in 6 months

  7. Can Diabetes be Delayed or Prevented?The Good News… • YES!!! • The Lifestyle Intervention reduced diabetes by 58% • In participants older than 60 years: 71% • Eating healthier and exercising worked better than a pill • Results published 2002

  8. The Real-Life Questions • Can we take the science and put it into practice to benefit Native Americans across the country? • Will the Lifestyle Balance Intervention help prevent diabetes here in our communities?

  9. The Beginnings… • In 2004,Congress appropriates additional competitive grant dollars for Native Communities to participate in a national Demonstration Project based on the DPP study

  10. Demonstration Project Grantees Across the Country

  11. The DPP Demonstration Project:Translating the Science • Based on the science • Same participant goals • Reduce total fat intake • Exercise 150 minutes/wk • 7% weight loss • Same 16 week curriculum Lifestyle Intervention with some cultural adaptations • Can we achieve similar results? • Group setting taught by para-professionals?

  12. Who Have We Reached? 2,939 Contacts 1006 Labs Completed 207 Consented to Participate 110 Completed Intervention

  13. Results, Outcomes, and Observations: 2-Hour Glucose Tolerance Test

  14. Participation, Program Completion, and Retention • Lifestyle intervention offered to 381 individuals • 207 (54%) signed up • 110 (53%) have completed the intervention

  15. Results, Outcomes, and Observations

  16. Results, Outcomes, and Observations:Physical Activity Change BASELINE AT FOLLOW-UP

  17. Results, Outcomes, and Observations:Clinical Indicators

  18. That All Looks Nice, But… Did you prevent diabetes???

  19. The Answer Is… • Yes ! • 3,396 participants among 36 health care programs serving 80 tribes • Crude incidence of diabetes was 4.0% per yr • Improvements in weight, blood pressure, lipids, and physical activity

  20. “Not everything that can be counted counts, and not everything that counts can be counted.” -Albert Einstein

  21. Participant Voices:Beyond the numbers “My family…they really started taking care of themselves…sometimes we would all go for a walk. Or we would just drive out somewhere and go nature-walking…we never used to do that.”

  22. Participant Voices:Beyond the Numbers “I have more confidence in myself…my self-esteem boosted, my confidence that I have in what I do at work and what I do at home, it boosted…”

  23. “I feel better because I know that I’m doing something for myself to prevent me from having diabetes, prevent me from having heart problems, getting on dialysis…I feel better because the possibility of me developing those problems is always going to be there because its hereditary, but yet I’m doing something…” Participant Voices:Beyond the Numbers

  24. In Summary: Challenges • Ongoing recruitment into program • Retention • Getting to that weight loss goal • Keeping motivated, sustaining change • Maintaining partnerships

  25. In Summary: Successes and Lessons Learned • Diabetes CAN be prevented, in our communities, taught by our staff, in a group setting. • People ARE interested in preventing diabetes • Can be implemented by para-professionals • The curriculum is easily adaptable to be culturally appropriate • Collaboration and integration of clinic-based and community-based services can work. • Partnerships, partnerships, partnerships

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