Diabetes Network Priorities Across the Spectrum of Diabetes

1. Diabetes Network Priorities Across the Spectrum of Diabetes Mary Zornes, RN, BSN, CDE Diabetes Network Leadership Team Member Representing Wenatchee Area Network for Diabetes and Columbia Valley Community Health Introduce yourself, your role on the Leadership Team and the agency/organization or coalition you representIntroduce yourself, your role on the Leadership Team and the agency/organization or coalition you represent

2. Remind them of the SDM reviewed earlier in the day Highlight the area/�stock� they are going to focus on. Re-enforce this stock is the only one in which population flow can return Remind them of the SDM reviewed earlier in the day Highlight the area/�stock� they are going to focus on. Re-enforce this stock is the only one in which population flow can return

3. Session Goals Review the evidence for ways to keep people healthy and prevent prediabetes/diabetes among those at high risk Identify Diabetes Network priorities Report out to the larger group, both today to the Diabetes Network and at the Chronic Disease Summit in the fall (October 5-6) Review the evidence to keep the population in the stock you are discussing Remind the group the purpose of identifying these priorities is to: --refine priorities for the Network --Offer these priorities at the Chronic Disease Summit in the fall (October 5-6)Review the evidence to keep the population in the stock you are discussing Remind the group the purpose of identifying these priorities is to: --refine priorities for the Network --Offer these priorities at the Chronic Disease Summit in the fall (October 5-6)

4. Problem Washington Adults: 25% obese 31% with prediabetes 12% with diagnosed and undiagnosed diabetes Behavioral Risk Factor Surveillance System Washington Adult Health Survey 25% Obesity 12% Diagnosed and undiagnosed diabetes 31% Prediabetes Obesity stats come from BRFSS (Behavioral Risk Factor Surveillance System) and Diabetes and prediabetes stats come from WAHS (Washington Adult Health Survey).� For Diabetes, 10% dx, 2% undx if someone is curious about the breakdown The trend of diabetes is up 75% between 1993-2003, but has held steady since 2003.25% Obesity 12% Diagnosed and undiagnosed diabetes 31% Prediabetes Obesity stats come from BRFSS (Behavioral Risk Factor Surveillance System) and Diabetes and prediabetes stats come from WAHS (Washington Adult Health Survey).� For Diabetes, 10% dx, 2% undx if someone is curious about the breakdown The trend of diabetes is up 75% between 1993-2003, but has held steady since 2003.

5. Evidence Individual Health Physical Activity Nutrition Weight Loss, Maintaining a Healthy Weight Promoting Change to Healthy Behaviors: Addressing Community/Media and Society

6. Evidence: Increase Physical Activity Moderate exercise (150 minutes per week) along with a low-fat, low-calorie diet led to weight loss that ultimately reduced incidence of diabetes (DPP Research Group, 2002). Increased physical activity is important to sustain weight loss (Hamman et al., 2006). Moderate exercise (30 minutes per day) was associated with significant reduction in diabetes risk independent of weight loss (Tuomilehto et al., 2001)

7. Evidence: Eating Nutritiously A Healthy Meal Plan: Emphasize fruits and vegetables, whole grains, and low fat milk products Includes lean meats, poultry, fish, eggs nuts, and beans Is low in saturated fat, trans-fat, cholesterol, sodium, and added sugars USDHHS, USDA Dietary Guidelines for Americans www.healthierus.gov/dietaryguidelines Review population/community based best practices and evidence that keep people in this stock/tub. Consider also those interventions that were not successfulReview population/community based best practices and evidence that keep people in this stock/tub. Consider also those interventions that were not successful

8. Evidence: Weight loss Decreasing Obesity 3 examples of effective interventions to increase physical activity, improve nutrition, and influence behavior change resulting in weight loss: Intensive lifestyle counseling Coaching Motivational interviewing (Adelman & Graybill, 2005; Carino, Coke, & Gulanick, 2004; Christian et al., 2008; DPP Research Group, 2002; Hamman et al. 2006; Lindstrom et al., 2005; Pan et al., 1997) And we know that wt loss decreases the risk for developing diabetes Using a computerized model, decreasing obesity made the largest change in # of people with diabetes, healthy days, preventing complications And we know that wt loss decreases the risk for developing diabetes Using a computerized model, decreasing obesity made the largest change in # of people with diabetes, healthy days, preventing complications

9. Promoting Change to Healthy Behaviors: Increase Knowledge and Awareness Increasing knowledge and raising awareness are necessary steps to influencing behavior change (Prochaska, DiClimente, & Norcross, 1992) Education and media campaigns are some ways to increase knowledge and awareness. EWDN media campaign Tools are available: NDEP, NIDDK, ADA. Network sponsored - EWDN media campaign as an example of efforts to increase knowledge and awareness of diabetes Network sponsored - EWDN media campaign as an example of efforts to increase knowledge and awareness of diabetes

10. Promoting Change to Healthy Behaviors: Evidence: Increase Physical Activity Improved access to facilities for physical activity Access to facilities for physical activity is strongly and consistently associated with levels of physical activity among adults (Humpel et al., 2002; Kruger et al., 2007). Improved built environment In their review of 14 studies, Saelens et al. (2003) found that people tend to walk and cycle more in neighborhoods with higher residential density, land use mixtures (e.g., shopping within walking distance), and connected streets. Review population/community based best practices and evidence that keep people in this stock/tub. Consider also those interventions that were not successfulReview population/community based best practices and evidence that keep people in this stock/tub. Consider also those interventions that were not successful

11. Promoting Change to Healthy Behaviors: Influence Societal Norms Focus health policy on diabetes prevention in those at high-risk through lifestyle interventions to ensure greater impact and cost-effectiveness (Ratner, 2006). Create a supportive environment for behavior change and ongoing reinforcement to maintain changes A program emphasizing family support, communication, and health behaviors has been shown to influence changes in family knowledge, attitude, and behaviors relative to diabetes-related risks (Teufel-Shone et al., 2005). Family and community involvement (Gold et al., 2007, Bull et al., 2006) Home School Work Community Gathering Places

12. Recent Examples for Health Policy and Influencing Societal Norms Moses Lake Healthy Community showed increased fruit/vegetable intake, no increase in obesity Calories posted on menus at chain restaurants in King County California & Washington State indoor/outdoor smoking ban A 12-month worksite diabetes prevention program that provided support to employees with physical activity, dietary education, and behavior change activities showed that 55 percent reduction in IGT after a two-year follow-up (Aldana et al., 2006). Moses Lake received 50K/year from Nutrition, Physical Activity and Obesity Prevention Program (NPAO) for 5 years with goal of increasing access to healthy foods and physical activity opportunities through social and environmental change. Moses Lake received 50K/year from Nutrition, Physical Activity and Obesity Prevention Program (NPAO) for 5 years with goal of increasing access to healthy foods and physical activity opportunities through social and environmental change.

13. Nutrition, Physical Activity and Obesity Prevention Program Statewide Plan outlines evidence based practices Increase access to health-promoting foods Reduce food insecurity in Washington Increase the proportion of mothers who breastfeed their infants and toddlers Increase the number of people who have access to free or low cost recreational opportunities for physical activity Increase the number of physical activity opportunities available to children Increase the number of active community environments in Washington Currently: 3 healthy communities funded by NPAO 9 federal block grants in process to address policy and environmental changes to increase healthy eating or physical activity Some communities such as Snohommish are not funded but are applying healthy community approaches Currently: 3 healthy communities funded by NPAO 9 federal block grants in process to address policy and environmental changes to increase healthy eating or physical activity Some communities such as Snohommish are not funded but are applying healthy community approaches

14. Criteria for Choosing Priorities Priorities need to be: Evidence based Achievable within 2-5 years High level Consider current efforts Biggest Bang for the Buck This is the set of criteria or ground rules for setting/choosing priorities based on the evidence presented. --Needs to be evidence based: ideas are great, but it is really important that we focus on those ideas that have evidence to support their success --Achievable within 2-5 years: consider those priorities where you will see results within the near future --High level: provide enough detail in order to convey the priority but don�t get caught up in the details ---Consider current efforts: are there other efforts that are underway that we can just �piggy-back� on or ones that are too big and broad and need to be refined? --Biggest Bang for the Buck: given limited resources, you might consider priorities that have a high level of impact but require the least amount of effort. This is the set of criteria or ground rules for setting/choosing priorities based on the evidence presented. --Needs to be evidence based: ideas are great, but it is really important that we focus on those ideas that have evidence to support their success --Achievable within 2-5 years: consider those priorities where you will see results within the near future --High level: provide enough detail in order to convey the priority but don�t get caught up in the details ---Consider current efforts: are there other efforts that are underway that we can just �piggy-back� on or ones that are too big and broad and need to be refined? --Biggest Bang for the Buck: given limited resources, you might consider priorities that have a high level of impact but require the least amount of effort.

15. Questions to Answer for Each Priority What is the summary of the evidence? What are the statewide priorities for the Network? How will these inform the work of Regional Coalitions? What priorities align with statewide integration efforts? Can the audience answer these questions? Diabetes Plan: Goal 2 Creating market demand for screening Goal 4 Community Mobilization, regional coalitionsCan the audience answer these questions? Diabetes Plan: Goal 2 Creating market demand for screening Goal 4 Community Mobilization, regional coalitions