Diabetes Prevention:Impacting Lives, One Year Later

Sandra Czunas, MPH & Sarah Downs, MPH, CHES | June 6, 2019

SpeakersSandra Czunas, MPHAssociate Health Care AnalystOffice of the State ComptrollerState of Connecticut

Sarah Downs, MPH, CHESProgram Manager, Health ProgramsWellSpark Health

2

Agenda

1. What is Prediabetes and who is at risk?

2. Department of Transportation Pilot Program: April 2018 – June 2019

3. Data Collection and Centers for Disease Control Program Certification

4. The Value of a Health Coach

5. Keys to Program Success

3

What is Prediabetes and how does it impact the U.S. population?

Diabetes: A Growing Costly Concern

Reducing risk of diabetes in the workforce is increasingly important given the growth of adults with diabetes and associated costs for employers.

30.2

Million U.S. adults have diabetes1

2.3x

Higher medical expenses2

$20.4

Billion in absenteeism costs3

Early Detection is Key

1 out of 3Employees has prediabetes1

90%Do not know it

1 Centers for Disease Control and Prevention (CDC) National Diabetes Statistics Report, 20172 American Medical Association, Prediabetes and Diabetes in the Workplace3 The Cost of Diabetes in the U.S.: Economic and Well-Being Impact (Gallup-Sharecare Well-Being Index)4 American Medical Association, Prediabetes and Diabetes in the Workplace

15 – 30% of people with prediabetes will develop type 2

diabetes within 5 years4

5

What is prediabetes?

Puts you at a higher risk for developing type 2 diabetes and

cardiovascular disease

There are no clear symptoms of prediabetes – you may not know you have

it

Blood sugar levels that are higher than normal but not yet high enough to be

diagnosed as diabetes

Common Screening Tests for Prediabetes:

A1C of 5.7% - 6.4%

Fasting blood sugar result of 100 – 125

Score of 5 or more points on the CDC Prediabetes Screening Test

American Diabetes Association, Diagnosing Diabetes and Learning About Prediabetes6

Preventing the Progression

Goals:Lose 5-7% of starting body weight

Exercise on average 150 minutes per weekChoose healthier food options

Education Changing behaviors to fit current lifestyle

Maintaining behavior changes

7

State of ConnecticutDiabetes Prevention Program

Decision to Pilot a Voluntary DPP for CT State Employees

• Labor - Management’s Healthcare Cost Containment Committee, convened by the State Comptroller, weighed in

• DOT drivers with unmanaged diabetes at risk of losing CDL

• Challenges faced by this population

• Long hours

• Frequently changing schedules

• Access to healthy meal choices

• RFP issued and awarded

State of CT, Department of Transportation Diabetes Prevention Program Pilot

9

DOT Population and Prediabetes

434 of the 479 DOT drivers that could have prediabetes may not know it

36.9% of the male population over 18 will be diagnosed with prediabetes

Only 9.4% of those will be aware of their condition

< >20 25 30 35 40 45 50 55 60 65

Average age: 49.4

In the U.S. 1,297 DOT DriversWorking for the State of CT

6%Female

94%Male

Percent of Population with Chronic Conditions – DOT vs. Non-DOT

10

Here’s What We Did

• Focus group with management and DOT employees

• Information sessions with union leaders and at DOT garages

• Determined DOT garage locations for sessions based on sign-ups

• Began onsite sessions at 11 DOT garages• Offered onsite biometric testing for A1c

• Began offering telephonic session make-up opportunities weekly

• 1:1 and group• Offered session review for

maintenance

April – May 2018

June - July2018

Aug 18’– June 2019

• One on one health coaching and ongoing support• Participation in local 5k’s• Hike days at CT trails surrounding DOT sites • Healthy recipe packets for game days & holidays

• Healthy restaurant options – at meal voucher restaurants• Biggest Loser Competition• Walk Around the State competition • Fitness trackers provided

Customization and Enhancements

11

Eat This, Not ThatFast Food Burgers

Eat This Not ThatLarge burger with everything, fries and a sodaValue cheeseburger, small fry and water

Save yourself!Calories: 820Fat: 30gCarbs: 126g

Cholesterol: 40mgSodium: 540mgSugar: 79g

Calories 1340

Total Fat 52g

Total Carbs 189g

Protein 32g

Cholesterol 80mg

Sodium 1370mg

Sugars 86g

Calories 520

Total Fat 22g

Total Carbs 63g

Protein 18g

Cholesterol 40mg

Sodium 830mg

Sugars 7g

12

Outcomes & ResultsData Collection and CDC Requirements

Data CollectionPrior to program start, identify what data elements you will need to collect, how you will collect them and where it will be stored and organized.

• For DPP, the CDC provides data elements that will need to be collected and requirements met to have a successful program

• For all other data elements, review any enhancements you may want and decide what should be tracked through the program to determine success

• Session attendance• Documentation of Weight and Physical Activity• Average body weight loss %• Program eligibility (A1c,Glucose)

• Health coaching sessions• Session delivery method• Behavior diagnostic module administration• Session location

What We Track:

14

6 Month ProgressCDC Standard CDC Data Req. State Status

Attended at least 9 sessions in months 1-6 60% 85.4% In process – achieved to date

# of sessions out of all attended where weights were recorded

80% 100% In process – achieved to date

# of sessions out of all attended where Physical activity was recorded

60% 90.6% In process – achieved to date

Avg % weight loss across all participants 5% 4.6% In process

Participants eligible for program by blood Min 35% 57.3% In process – achieved to date

Participants eligible for program by CDC Risk Test Max 65% 42.7% In process – achieved to date

Note: This data comes directly from the CDC, based on participants (59) that have attended at least 9 sessions and have been in the program for at least 6 months from individual start date to 11/30/2018 15

The Value of a Health Coach

Role of the Health Coach

Build Relationships

Commitment to helping others

Individualized continuum of care

17

Health Coaching Sessions

Examples of common reasons for health coaching sessions for the State DOT program:

• Snow duty

• Motivational regression

• Keeping participants on track

• Emotional barriers

• Nutritional & physical activity information

Health Coaching Delivery Method Count of Received – To date

In Person – 1:1 56

In Person – Group 191

Telephonic – 1:1 541

Telephonic - Group 2

Total 790

18

Incorporating Silver Fern HealthcareA Behavior Diagnostic toolset that helps to achieve positive health outcomes by identifying critical behavior and psychosocial impediments.

Silver Fern helps coaches understand the patient’s self-management story.

Silver Fern Module Number Administered – To date1 – Health Literacy 86

2 – Self Management Behaviors 77

3 – Behavioral Health 80

4 – Physical Pain 83

5 – Poor Sleep 92

Total 418

19

Pilot Program Success

Keys to Program Success Thus FarImpact of Leadership and internal support

• On-going leadership buy-in• Internal champions to promote program• Onsite management• Peer to peer support

Behavioral reinforcement tools• Fitness tracker• Customized healthy recipe cards• Access to 1:1 health coaching• Incentives

Customization for specific workforce• Common trends with the population• Consider shift times and the nature of the populations daily job duties• Location• Typical family life/support• Experience “A day in the life” of your workforce

21

Community Events

West Hartford Mitten Run: December 2, 2018 O’Shenanigans 5K: March 9, 2019

Biggest Loser Competition Awards: April 3, 201922

Testimonials

Thank-you for telling me I can, when my whole life I was told I couldn’t!

If it wasn’t for this program I don’t know if I’d be alive right now, thank-you!

I used to take 12 creams in my coffee every day. After working in this program, I’ve learned just how unhealthy that was. I now drink my coffee black.

This program is bringing me closer to my family. I now have more energy and can play with my kids. The lessons I am learning every week make it feel like I really can maintain this healthy lifestyle.

I can’t believe I’m going to run a 5k this year. A few months ago I was barely getting any exercise at all, but because of this program I now know how important it is. I feel confident I can successfully complete the race knowing the DPP coaches are there for me.

It took me a while to kick it into gear and I appreciate that you didn’t give up on me. I’m so happy that I’ve finally made the commitment to myself and am feeling motivated as a result.

23