“Jump Starting” your Diabetes Prevention – How Simple Can be Effective

1. “Jump Starting” your Diabetes Prevention – How Simple Can be Effective mmmMarcy MarcyKylMarcyKyle RDN,LD, CDE,FAND MarcyKyle RDN,LD, CDE,FAND RMarcyKyle RDN,LD, CDE,FAND DN,LD, CDE,FAND

2. MarcyKyle RDN,LD, CDE,FAND Speaker Academy House of Delegates Director Pen Bay and Waldo County Diabetes and Nutrition Services Coordinator, DiabetesPreventionProgram and Medicare Diabetes Prevention Program, Maine Health 10

3. Marcy Kyle, RDN, LD, CDE, FAND • No Disclosures

4. Objectives • 1 How the science of food and exercise promotes blood glucose control and weight loss • 2 Carbohydrate consumption at varying times of the day can affect blood glucose control • 3 Learn the basics of “Jump Start” Meal Plan • 4 Learn the basic cooking techniques utilized in “Jump Start” • Keep it simple and contain the cost. • 5 Learn key points of Medicare Diabetes Prevention Program

5. 30 million with Diabetes 84 millionwith Prediabetes Centers for Disease Control and Prevention National Diabetes Statistics Report, 2017

6. National Diabetes Prevention Program

7. National Diabetes Prevention Program at PBMC Over 130 participants have completed the program Pen Bay is a fully recognized by the CDC Since 2014 • “New” for 2018 • Only 100 MDDP programs in the country • First Medicare Preventative Program

8. Take the Lead in the Community! • 140 participants attended the National Diabetes Prevention Program at PBMC over the past 4 years • 5% - 7% weight loss on average • Current class lost over 276 pounds!

9. Curriculum – first 16 sessions

10. Ongoing support

11. Total carbohydrates count • Carbohydrates give energy • But too much carbohydrate can raise blood glucose above the target range

12. Nobel Prize In Physiology Is Awarded To 3 Americans For Work On Circadian Rhythm - 2017

13. Insulin response to meals, activity

14. Average intake of carbohydrates 275 to 300 grams in a 2000 calorie intake Or 60-75 grams per meal and 30 grams at each snack. Carbs make up half of our calories. So for someone that has impaired glucose tolerance Limiting carbs to 45 – 60 grams per meal and 15 – 30 at snack improves blood sugar For weight loss, limit carbohydrates to 15 – 30 grams at breakfast*, 30 - 45 grams at lunch and dinner Perala et al, 2011*

17. Basics of “Jump Start” • 1. Drink 1 cup water before each meal and snack • 2. Do not skip breakfast • 3. Limit starch at Lunch and Dinner • 4. Exercise daily: 20 – 30 minutes • 5. Keep food and activity logs

18. 2. Do not skip breakfast - options • 1 egg, 1 slice toast, 1 tsp butter and 1 orange • NUTRITION FACTS: Serving size: Entire recipe = 1 serving • Calories =270, Total Carb = 30 gm, Fat = 10 gm, Protein = 10 gm • 2 egg omelet made with 2 cups vegies ( i.e. chopped onion, spinach, mushrooms, peppers and tomatoes) and 1 c melon • NUTRITION FACTS: Serving size: Entire recipe = 1 serving • Calories =265, Total Carb = 30 gm, Fat = 10 gm, Protein = 22 gm • ½ c cooked oats, ½ c berries and 3/4 c yogurt • NUTRITION FACTS: Serving size: Entire recipe = 1 serving • Calories =255, Total Carb = 30 gm, Fat = 10 gm, Protein = 11 gm

19. Breakfast – option 1

20. Patricia’s breakfast “Jump Start” your Breakfast Healthy and satisfying way to start the day!

21. 3. Limit starch at Lunch & Dinner • Shrimp stir fry (sauté 3 – 6 ounce shrimp in 1 tsp vegetable oil) and add 2 cups oriental vegetables, flavor with lite soy sauce, 1/3 c rice. • tip: slow down by using chop sticks! • Chicken parmesan (cover and bake at 350 degrees for 30 minutes) • 3 - 6 ounce boneless skinless chicken breast topped with ¼ cup marinara sauce and 1 tablespoon parmesan cheese) serve with 2 cups steamed broccoli flavored with lemon juice. • Rosemary roasted pork tenderloin (bake at 350 degrees for 30 minutes) 3 – 6 ounce pork tenderloin and serve with 2 cups roasted non-starchy vegetables (limit oil to 1 tsp for roasting vegetables). • NUTRITION FACTS: Serving size: Entire recipe = 1 serving • Calories =370, Total Carb = 15 - 30 gm, Fat = 10 gm, Protein = 29-50 gm

25. Microwave

28. Snack ideas • Choose one: • 1 cup plain yogurt topped with 1 cup berries • 1 cup low-fat milk and 1 oz cereal • 1 English Muffin with 2 tsp peanut butter • 6 cups popcorn • 1 cup ice-cream • 1 small dessert • NUTRITION FACTS: Serving size: Entire snack = 1 serving • Calories =150 - 240, Total Carb = 30 gm, Fat = 5 - 10 gm

29. 5. Record food and activity • Apps • Books

30. The 10 Best Free Apps • 1. Lose It • 2. SparkPeople • 3. MyFitnessPal • 4. Fitbit • 5. Weight Watchers • 6. FatSecret • 7. Pact • 8. Cron-O-Meter • 9. Fooducate • 10. HealthyOut

31. Food Diary • Keeping a Food Diary Doubles Weight Loss • Something as simple as just keeping a food diary can double a person’s weight loss according to a study from Kaiser Permanente’s Center for Health Research. The findings come from one of the largest (n=1700) and longest (30 months) running weight loss maintenance trials ever conducted. • American Journal of Preventive Medicine. August 2008

32. Food and activity log

33. 4. Exercise daily: 20 – 30 min. • The “Role” of Exercise or “Move those Muscles” • Benefits: correlates with long term success to maintain a healthy weight. • “Lifestyle” exercise - activity built into day-to-day routine • versus • “Programmed” exercise - traditional regimen like walking or jogging. • Goal: 150 minutes a week

34. Summary of Day • Breakfast • ½ c cooked oats, ½ c berries and 1 c milk • Lunch • Shrimp stir fry and 2 cups vegetables, 2/3 c rice • Dinner • Roasted pork tenderloin with 2 cups vegetables, small dessert and 5 oz wine (optional) • Exercise • 20 – 30 minutes “brisk” walking • Snacks: • 3/4 c yogurt, ½ c berries, 2 T walnuts • Record food and activity • NUTRITION FACTS: Entire day • Calories = 1200 - 1500 Total Carbs = 150 g Protein = 70 - 100 g Fat = 40 - 55 g

35. Screening is covered by Medicare • 1 screening test/year (≥ 11 months since last test) • If 2 or more apply: • ≥ age 65 • Overweight • Family history of diabetes (parents, brothers, sisters) • History of gestational diabetes or delivery of a baby weighing ≥ 9 pounds

36. Which Screening Tests? • Medicare pays for the following 1x/year if screening criteria met: • 82947 Glucose; quantitative, blood (except reagent strip) • 82950 Glucose; post glucose dose (includes glucose) • 82951 Glucose; Tolerance Test (GTT), three specimens (includes glucose) • Orders should use screening diagnosis • code V77.1 with modifier “TS”

37. Beneficiary Eligibility for MDPP • Criteria: • Medicare part B Coverage • BMI of ≥25 (≥23 in Asian populations) • 1 of 3 blood glucose tests results within the last 12 months • Hemoglobin A1c 5.7-6.4% • Fasting plasma glucose of 110-125 mg/dL • 2-hour post glucose of 140-199 mg/dL Not eligible: Previous diagnosis of Type 1 or Type 2 or ESRD • Physician Referrals Not Required!

38. Medicare DPP Benefit Design 22

39. To become a “Supplier” of MDPP • Achieve CDC DPRP Recognition • Programs enroll as a “Supplier” after achieving CDC DPRP Recognition & even if already a Medicare “Provider” for other services • Every lifestyle coach must have an NPI • Complete the screening for high categorical risk defined in: 424.518 (c) and enrollment regulations set forth in 42 CFR part 424 subpart P

40. Medicare Payments for Medicare DPP • Bundled Payment • Payments Tied to Attestation on claims: • Number of core sessions attended Weight loss of 5% or 9% of baseline Payment for maintenance sessions if ≥ 5% weight loss is maintained!

41. Submitting Claims & Getting Paid • MDPPPrograms Will Need to… • Submit claims to Medicare • Standard claim forms and procedures • Final rules will determine frequency and fee schedule for bundled payment • Required Documentation • Crosswalk between beneficiary identifiers for billing & required patient data submission • Maintain records according to laws and best practice • Eligibility requirements • Services provided • HIPAA

42. Why Medicare DPP? • Payer Adoption # of Participants • of DPP with DPP Benefits • Medicare = another payment stream • Self referrals • ↑ enrollment & purchase of other services • ↑ health care provider referrals for other services • Results = Value in system with primary care • Strengthen your brand

43. What Sets us Apart? Similarities Differences NDPP, MDDP, DSMT, and ADA site Registered Dietitian Nutritionists and Registered Nurses Enhanced NDPP Curriculum Grant Funding and MNT reimbursement EMR referral EPIC Data Dashboard • Nationally recognized • NDDP • Health Coaches • NDPP Curriculum • Grant Funding

44. Program Costs

45. Data collection and reporting • Developed a technical support tool • State Innovation Model (SIM)Grant • Maine CDC, Diabetes Unit • Maine NDPP Data Dashboard • Electronic Medical Records • Epic Flowsheets

46. Maintaining Records & Data

47. Get Ready for the Medicare DPP National Diabetes Prevention Program • Become a NDPP Lifestyle Coach • Achieve Master Trainer status to train health coach • Coordinate NDPP for your organization or community Medicare Diabetes Prevention Program • Apply for Your National Provider Identifier (NPI) number • http://www.eatrightpro.org/resources/practice/getting-paid • type “NPI” in the search box

48. Get Ready for the Medicare DPP • Select database system for data collection • Apply and maintain CDC Recognition • Workshops, trainings, join networks that offer services to prepare and support • Promote the Medicare DPP

49. Tips for Success • Lead • Collaborate • Promote the value of the RDN and NDTR in the DPP • Advocate

50. Academy Resources • Placeholder