diabetes - idaho public health districtsidahopublichealthdistricts.org/docs/iadbh...
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Diabetes THE APPROACHING TSUNAMI
The Ironman Effect
26%
of Americans above age 65 have type II DM
That means we are creating 2500 diabetics every
single day.
Medicare is predicted to become insolvent in 2030.
America’s Growth Spurt
BMI >30 and Diabetes
Diabetes has increased nearly 10-fold since 1958
Creeping Normalcy
Diabetes and Weight Gain
Gain of 11-16 lbs. doubles the risk of type 2 diabetes
Gain of 17-24 lbs. triples the risk of type 2 diabetes
Costs of Diabetic Meds
Metformin - $4/month
Januvia - $300/month
Farxiga - $460/month
Victoza - $600/month
Trulicity - $1000/mo., lowers A1c 1-1.5%
Januvia lowers A1c by average of 0.7%
Exercise for 8 weeks lowers A1c by 0.66%
The High Cost of Diabetes
Shadow Pricing
On May 30, 2014, the price for a vial of the blockbuster diabetes
medication Lantus went up by 16.1 percent. On the next day,
Lantus’s direct competitor, Levemir, also registered a price increase
-- of 16.1 percent.
Six months later Lantus was marked up 11.9 percent, and Levemir
matched again exactly.
In 13 instances since 2009, prices of Lantus and Levemir have gone
up in tandem in the U.S.
“I used to be afraid of failing at something that really mattered to me, but now I'm more afraid of succeeding at things that don't matter.” ― Bob Goff, Love Does: Discover a Secretly Incredible Life in an Ordinary World
You Are Not Just Treating Diabetes
Diabetes Depression
Obesity Social
isolation
Exercise ROI
Modest exercise can prevent or delay onset of DM by 58% (71% in
patients over 60) – NIH/CDC DPP
Loss of 5-7% body weight – 10 lbs. in 200 lb. male, 8 lbs. in 160 lb.
female
Gluconomics
Population Statistics
Kootenai county 150,000
Region 1 (5 northern counties) – 220,000
Idaho – 1.5 million
8.4% diabetes Statewide, only 7% Region 1
Idaho Diabetes Statistics
Idaho – 1.5 million
8.4% diabetes Statewide, only 7% Region 1
126,000 diabetics (8.4%)
555,000 prediabetics (37%)
Region 1 Diabetes Statistics
Region 1 – 220,000
15,400 diabetics (7%)
81,400 prediabetics (37%)
Region 1
20 lifestyle coaches
100 patients per coach per year
2000 prediabetics per year
Of 2000 participants, 300-600 cases of diabetes expected (15-30%)
200-400 cases prevented (60-70% reduction)
At 81,400 prediabetics, it would take over 40 years to reach all
current at-risk individuals
Remaining 80,000 patients, 12,000-24,000 will become diabetic
Classes reduce rate of conversion to DM by 1.6%
Idaho Statistics
50 lifestyle coaches
100 patients per coach
5000 prediabetics per year
Of 5000 participants, 750-1500 cases of diabetes expected (15-30%)
500-1000 cases prevented (60-70% reduction)
At 550,000 prediabetics, it would take 110 years to reach all current
at-risk individuals
Remaining 545,000 patients, 81,750-163,500 will become diabetic
Classes reduce rate of conversion to DM by 0.9%
Population Health
Department of Health and Welfare
Clinical services account for a relatively small impact on population
health. To improve the health of a broadly defined population,
integration of clinical services, public health and community based
initiatives is necessary.
John Auerbach’s (Associate Director for Policy, Centers for Disease Control and Prevention) method for analyzing the measures of
health (adopted by Get Healthy Idaho).
Auerbach’s Buckets
Bucket #1 – Traditional Clinical Approaches. Patient construct, one-
on-one patient interaction.
Bucket #2 – Innovative Clinical Care. Patient construct with a
narrow population view, e.g. accountable care organization, patient centered medical home.
Bucket #3 – Community-wide Health. Community construct, focus is on a broad population (Health District or the state of Idaho).
Typically has a policy focus.
YMCA Diabetes Prevention
Program
Three-year, $12 million grant from the federal Center for Medicare
and Medicaid Innovation to make its diabetes-prevention program
available to about 10,000 Medicare patients in 17 communities.
$1200 per participant
YMCA’s Effort By The Numbers
11,714: Participants who attended at least one diabetes-prevention class session.
1,477: Classes started.
1,295: Lifestyle coaches trained to teach the CDC's evidence-based curriculum.
569: Diabetes-prevention class locations.
86: Community YMCAs with teachers trained to deliver the program.
35: States where the program is offered.
4.9%: Average body weight loss achieved by program participants.
Source: “YMCA's Diabetes Prevention Program Overview,” YMCA of the USA, June 17
YMCA’s Effort By The Numbers
1,295 certified Lifestyle coaches
1,477 classes
11,714: Participants who attended at least one session
8 participants per class
We would need 9 million DPP classes
Diet and Exercise
DM
HTN
High cholesterol
Obesity
CAD
Sleep apnea
Anxiety
Depression
Social isolation
Kroc Rx
The Doctor Will See You Now
Pathways to Health
We must offer pathways to health.
The model will be based on:
visits at the health facility
group support, and
education through shared medical appointments
We will bring resources TO the patient rather than asking the patient
to travel to the resources.
Evaluation and Management
Everyone should be offered diet and exercise.
Everyone should have a psychosocial evaluation.
It is not enough to recommend these things, they must be provided
as part of the health care visit.
What Constitutes an Office Visit?
Exercise IS a visit.
Diet instruction IS a visit.
Behavioral health instruction IS a visit.
(goal setting, behavioral activation, CBT, mindfulness solution)
Heritage Health University
PhD in Health
Exercise module
Nutrition module
Behavioral health module
Life Skills module – financial, spiritual, social
Medication reduction module
A Different Strategy
Collaboration
Relationship
Think outside your 4 walls
Find your largest partner(s)
Churches, colleges, community centers
Look for champions with passion
Surround your patients with healthy role models
