Diabetes Self-Management Program

Jane Mahoney, MD, Executive Director, Wisconsin Institute for Health Aging

Professor of Medicine, UW School of Medicine and Public Health

Betsy Abramson, WIHA Deputy Director

Larry Epstein, DSMP Leader

Helping older people live healthier lives through evidence-based prevention programs.

Aging Research

•CAARN: Community-Academic Aging Research Network creates a bridge between university and community groups to do research in healthy aging

•CAARN provides training programs, networking opportunities, and resources to facilitate aging research

WIHA’s Evidence-Based Programs

•Living Well with Chronic Conditions: A self-management workshop for people with one or more chronic health problems•Stepping On: A falls prevention self-management workshop •Sure Step: one-on-one falls prevention assessment in the home for people with cognitive impairments•Healthy Living with Diabetes: self-management workshop for people with type 2 diabetes•Powerful Tools for Caregivers: A self-management workshop for caregivers

Diabetes in the U.S. and Wisconsin

•Annual U.S. cost exceeds $5 billion; Wisconsin 2009 data: $4.07 billion direct; $2.7 billion indirect•By 2050, will be 40 million people with type 2 diabetes•Wis: 475,000 adults with diabetes; 1.45 million adults with pre-diabetes•Surgeon General’s report 2009: growing need for community-based service programs to complement clinic based ones.

Goal of Self-Management Programs

•Increase self-confidence to manage health and chronic disease•Prove efficacious for all races•Prove efficacious in multiple cultures, including Hispanic Americans

Stanford Diabetes Self-Management Program

•Modeled after effective Chronic Disease Self-Management Program•Specifically for adults with type 2 diabetes•2-1/2 hour sessions, 1/week, for 6 weeks•Community setting•2 leaders – one or both are non-professionals with diabetes•Group size: 12-16

Topics•Healthy Eating •Sharing/Problem-Solving•Action Planning•Exercise for strength and endurance•Preventing Hypoglycemia•Monitoring glucose•Stress/Depression•Appropriate use of Medications•Preventing Complications•Working more effectively with health care providers

Process•Weekly action plans•Brainstorming•Share experiences•Help solve problems in creating or carrying out self-management plansKeys to Success•Highly participative•Mutual support and success builds self-confidence

Benefits•Designed to enhance regular treatment and diabetes education•Complements CDEs – increases referrals to them•Can help with other chronic diseases

Research•Focus groups with diabetes educators and with Latinos with diabetes•Developed program to be similar to other self-management programs•Randomized trial: 198 usual care wait list; 219 Spanish Diabetes Self-Management program•Participants followed for 6 months•Mean age 53; 7.5 years education; 62% women

Results of randomized trialCompared to wait list control, diabetes self-management program group had:•Lower HbA1C•Less health distress•Fewer hypo and hyperglycemia symptoms•Better self-efficacy to manage disease

Pre-Post results•18 months after the workshop, compared to baseline, diabetes self-management group had:•Lower HbA1C•Decreased health distress•Better self-reported health•Fewer hypo/hyperglycemia symptoms•Improved self-efficacy to manage disease•Improved communication with provider•Fewer ER visits in past 6 months

Summary

Diabetes self-management program:•Theory-based to change behavior•Improves self-efficacy to manage disease and decreases health distress•Proven to decrease HbA1c and hypo/hyperglycemia symptoms•Results appear sustained out to 18 months•Has established training program and track record with implementation•Supplements patients’ clinical care and diabetes education

Program accepted by WIHA Board•Consistent with other programs•Excellent results•Health care partnership potential•High incidence of diabetes in minorities and low-income•Existing Living Well leaders easily cross-trained•Partnership with Network Health’s Master Trainers•Potential for funding•Potential for reimbursement

Began in 2013•“Healthy Living with Diabetes” Selected five pilot counties that:

• Had strong LW Leaders• Committed to conducting workshops

between March and June 2013• Strong health care partnerships

•Brown, Iron, Milwaukee, St. Croix and Waukesha counties•Held cross-training March 2013•Network Health provided Master Trainers•24 Leaders cross-trained

Partnership with health care systems?

•Yes!•2/3: CDEs helped plan or deliver workshop•Over 75% health systems provided facility, snacks and/or staff

Health systems involved because:

•Recognize that the program is complementary, not competition•Proven product•Incidence and prevalence of diabetes

Workshops and Participants•12 held in: Milwaukee, Waukesha, Outagamie, Brown, Calumet, Winnebago and MichiganU.P.•107 participants, 86 completers,•Gender: 74 women, 33 men•Race: 73 white, 15 African American, 2 Latinos•Ages: Ranged from 22-92

˂ 35: 3, 45-54: 9, 55-64: 15, 65-74: 30, 75-84: 22, 85-95: 7

Top 10 Chronic Diseases•Diabetes: 67•Hypertension: 46•High Cholesterol: 40•Arthritis: 32•Depression/anxiety: 20•Heart Disease; 19•Lung disease; 17•Cancer: 11•Stroke: 7•Pre-diabetes: 7

Motivations for participants:

•Gathering info and knowledge•Financial incentives* (50%)•Newly diagnosed•Frustrated or unclear directions from health care provider

* $35 gift cards for Milwaukee and Waukesha counties

Leader Observations•Participants very engaged, proactive•Referrals from:

• Pharmacists• Community-based programs• County aging and disability resource

centers• Health plan, health provider, health

system, including CDEs • Parish nurse• Health Club• Community events• Posters and newspaper ads

Observations from Larry Epstein•Experienced Living Well leader and Master Trainer•Experienced Healthy Living with Diabetes leader•Type 2 diabetic•Volunteer with Brown County ADRC•HLWD pilot – Importance, Participants and Observations

Next Steps•More leaders in 5 counties•New counties – still pilot 2013•Both cross-training and initial 2013•Any “ready” county in 2014•Master Trainers•More health care partnerships•Reimbursement: Medicaid, Medicare, private plans?

Next Steps for WIHA•More leaders in 5 counties•New counties – still pilot 2013•Both cross-training and initial•Any “ready” county in 2014•Master Trainers•More health care partnerships•Reimbursement: Medicaid, Medicare, private plans?

Next Steps with Partners•Recommend participants•Assist with marketing•Host workshops in health care settings, provide healthy snacks•Identify leaders•Partner to develop reimbursement•Provide funding•Other…?

Betsy Abramson, Deputy Director(608) 243-5691Betsy.Abramson@wihealthyaging.org

www.wihealthyaging.org