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

Setting the Stage on Diabetes Prevention & Interventions in Iowa: A Focus on Efforts in the Workplace Dr. Paul Mulhausen, MD, MHS, FACP, Chief Medical Officer and Ami Bolles, Strategic Account Manager

Iowa Statistics 2

Diabetes Statistics in Iowa • 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 3

Iowa vs United States Report Area Total Population with Population with Population Population Diagnosed Diagnosed, with over Age 20 Diabetes Crude Rate 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% Data Source: Center for Disease Control and Prevention, National Center For Chronic Disease Prevention and Health Promotion. 2013. Source geography: County 4

Adults with Diagnosis Diabetes by Gender 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% Percent Males w/Diabetes Percent of Females w/Diabetes Iowa United States 5

Diagnosed Diabetes year over year Iowa vs US Report 2004 2005 2006 2007 2008 2009 2010 2011 Area Iowa 6.51% 6.78% 6.89% 6.96% 7.17% 7.42% 7.68% 8.18% United 7.31% 7.58% 8.04% 8.33% 8.55% 8.72% 8.95% 9.09% States 6

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

A Public Health Crisis – Future Projections Between 2015 and 2025, projections indicate Americans with diabetes will increase by 40% to nearly 50 million! Source: Population Health Management, February 2017 8

A Public Health Crisis $1 IN $5 Over five years the cost of prediabetes increased 74 percent (to $44 billion) health care dollars is spent caring for people with 60 diabetes. 45 The annual health care costs for a person with diagnosed 30 diabetes are 15 2.3x HIGHER 0 2007 2012 than for a person without. Source: American Diabetes Association 9

Diabetes Prevention in the Work Place 10

Fast Facts  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 1 stress.org / 2 cdc.gov 11

The Need for Prevention Studies have shown that individuals who participate in a structured lifestyle change program can cut their risk of developing type 2 diabetes by more than 50%. Source: American Diabetes Association 12

Supporting Prevention Efforts in the Workplace  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 13

Example of a Workplace Diabetes Prevention 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 14

DPP Corporate Program 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 15

Why Companies will Invest in prevention?  Companies typically see a cumulative and net savings over a 3 year period  DPP cost savings calculator – https://ama-roi-calculator.appspot.com/ 16

Diabetes Self Management – A Workplace Solution? 17

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 18

Known Gaps in Chronic Disease Management  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. Health Affairs 2001 19

Self-Management is Key to High Value Chronic Care 20

Persistent Risk Factors for Complications 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 CDC, 2017 21

Guiding Principles for DSME 1. Diabetes education is effective for improving clinical outcomes 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 22

Self Management that Goes Beyond Disease Management  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 23

Barriers to Effective Self Management Interventions  Insurance coverage gaps  Suboptimal clinical service design  Patient characteristics  The disease itself  Patient interactions with diabetes care and education providers.  Socio-environmental context 24

What Next – An Ecological Approach  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. 25

The Ecology of Self Management American Journal of Public Health 2005; Vol 95(9) 26

The workplace as part of the ecology Clinical Therapeutics 2013; 35 (2) 27

Workplace Diabetes Self Management Interventions  Broadening access and appeal to adults with diabetes (or other 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 28

Workplace Solutions for Diabetes Self Management 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. 29

Questions 30