Diabetes Prevention and Control

1. Diabetes Prevention and Control Best and Promising Practices

2. Prevent and Control Diabetes Rick Schwertfeger, M.A.T. Program Manager Steps to a Healthier Austin Program Division of the Medical Director Austin/Travis County Health & Human Services Austin, Texas

3. The Biggest Impact: REDUCE OBESITY

4. Prevent and Control Diabetes Increase physical activity throughout a population

5. Prevent and Control Diabetes Improve nutrition throughout a population

6. Prevent and Control Diabetes Case Management

7. Prevent and Control Diabetes Formalized patient education

8. Prevent and Control Diabetes Clinicians refer high risk individuals to preventive services

9. Prevent and Control Diabetes HbA1c = or < 7.0

10. Prevent and Control Diabetes Foot Checks: • Self Check: Daily • Clinical at least 1x / Yr. • Posters in Exam Room

11. Prevent and Control Diabetes Eye checks at least 1x / year

12. Prevent and Control Diabetes Yearly Flu Shot

13. Prevent and Control Diabetes Define, analyze and intervene on your Community Diabetes System

14. Prevent and Control Diabetes Local Diabetes Coalition

15. Steps to a Healthier Austin • Reduce the burden of Obesity • Reduce risk behaviors • Poor nutrition • Lack of physical activity • Overarching Goals 4. Prevent overweight and obesity 6. Improve nutrition 7. Increase physical activity Austin/Travis County Health and Human Services Department

16. The Data What does our data say?

17. Baseline: Obesity Rates 180,796 - 221,740 Overweight/Obese Source: 2003 BRFSS Data

18. Baseline: Obesity Rates Source: Stratified from the 2003 Travis County BRFSS data.

19. Baseline: Intervention Area Causes of Death 2000-2001 Age adjusted mortality rate per 100,000 Austin/Travis County Health and Human Services Department

20. Obesity Trends 2004-2006 Source: BRFSS 2004-2006 Question:This was calculated from the self-reported height and weight.

21. Obesity Trends 2004-2006 Source: BRFSS 2004-2006 Question:This was calculated from the self-reported height and weight.

22. Obesity Trends 2004-2006 Source: BRFSS 2004-2006 Question:This was calculated from the self-reported height and weight.

23. % trying to lose weight Source: BRFSS 2005-2006. Question: Are you now trying to lose weight?

24. Eating Fewer Calories/Fat to Lose Weight Source: BRFSS 2005-2006. Question: Are you eating fewer calories or less fat either lose weight or keep from gaining weight?

25. Fruit and Vegetable Consumption Stages of Change Source: BRFSS 2005-2006 Question: Do you consistently eat 5 servings of fruits and vegetables a day?

26. People Who Report Eating 5 or More Fruits and Vegetables Daily Source: BRFSS 2004-2006

27. Number of Fruit and Vegetable Servings per Day Source: BRFSS 2004-2006 Question: Five Fruit and Vegetable Servings per Day Index-DSHS calculated

28. Leisure Time Physical Activity in the Past Month Source: BRFSS 2004-2006 Question: During the past month, other than your regular job, did you participate in any physical activities or exercises?

29. % Using Physical Activity to Lose Weight Source: BRFSS 2005-2006. Question: Are you using physical activity or exercise to lose weight or to keep from gaining weight?

30. Recommended Physical Activity Levels Source: BRFSS 2004-2006 Question: Meets Recommendations for Moderate or Vigorous Physical Activity is a calculated value from multiple questions about level of physical activity.

31. Percentage of People Meeting Recommended Moderate or Vigorous Physical Activity Levels Source: BRFSS 2004-2006 Question: Meets Recommendations for Moderate or Vigorous Physical Activity is a calculated value from multiple questions about level of physical activity.

32. Physical Activity Reported Stages Source: BRFSS 2005-2006 Question: (Based on a definition of physical activity) Do you exercise regularly according to that definition?

33. How People are Lowering Their Risk of Health Problems Source: BRFSS 2005

34. Use of Areas Conducive to Physical Activity Source: BRFSS 2004-2006

35. Level of Physical Activity in the Neighborhood Approximately 75% of Neighborhoods are physically active Source: BRFSS 2004-2006

36. Step’s Approach Community based physical activity and nutrition approaches

37. Medical Model • Limited approaches • Medicines • Slow • Lack of effectiveness in the long term • Bariatric Surgery • Costly • Complications • Lifelong medical management

38. Steps Model • Working through collaborative partnerships to increase outreach capacity • Build capacity of partners to reach target • Work at the systems level • Focus on community actions and community changes • Focus on nutrition and physical activity strategies

39. Overall Impact Collective Consortium Achievements *A community change is a new program, policy or practice **A community action is an action taken to lead to a new program, policy or practice Source: SHA Online Documentation Surveillance System (ODSS) (9/22/2003-9/21/2006)

40. Steps Unique Encounters Total Number of Encounters = 964,314 These are unique encounters. Individual persons may have had more than one encounter. Source: SHA Partner Reports

41. Community Changes per Objective

42. Community Actions per Objective

43. Nutrition Strategies • Community Cooking Classes • Sustainable Food Center • Train the Trainer Model • Individual participants • Improved Early Childhood Nutrition • Family Connections • Health Worker Certification for Child Care Centers • Outreach to new mothers to increase breastfeeding and create awareness of services

44. Nutrition Strategies • Farmer’s Markets and Farm Stands • WIC sites • Sustainable Food Center • Lone Star Card to wooden tokens – Increased access • Manor’s Farmers Market • School Gardens • Sustainable Food Center and Marathon Kids • Collaborative effort • Targeting schools • Increase availability and awareness

45. Nutrition Strategies • School Nutrition Improvements • AISD • Vending machine offering changes • Revamped the school cafeteria menu • MISD, DVISD & PISD • Vending machine offering changes • Revamped the school cafeteria menu • Adoption of school Wellness Policy • AISD is sharing knowledge and tools with other districts

46. Nutrition Strategies • Soda and Snack Vending Machine Offerings • Fruit Basket Mini Project • Wellness Wednesdays at Schools • Foods of the Month (Vegetable, Fruit, Dairy or Grain and a Food for Thought) • HEB Initiatives – In the works • Environmental System Changes at 4 locations • Suggested change to Meal Deals • Suggested changes to Combo Loco • Suggested healthy shopping list

47. Physical Activity Strategies • Increase the Use Underutilized PARD Facilities • Summer Splash Pool Parties approx. 867 • P3 Initiatives • Expand the Participation of Marathon Kids • Year 3 SHA Area MK Participants: 14,239 • Year 4 SHA Area MK Participants: 15,897 = +12% • Year 3 SHA Area Completed 26M: 11,018 • Year 4 SHA Area Completed 26M: 12,026 = + 9%

48. Physical Activity Strategies • YMCA Swim Safe – 800+ in 1st year • YMCA Walking Trail • Walk with WIC • Stroller Program • Peer Support Group • Walk Texas Austin Chapter • Supported by an Active Austin Guide • Walk Across Texas • Texas Cooperative Extension Agency Program

49. Physical Activity Strategies • Texas Round Up • Support of the Texas-wide Governor’s Fitness Initiative • Healthy Built Environment • 6 locations • Walking Trails (new, extensions, & renovations) • Outdoor Fitness Equipment • Mileage Markers

50. Physical Activity Strategies Model Programs: • Capital Metro • Mayor’s Fitness Council