Progress 09/01/09 to 08/31/11
Outputs
OUTPUTS: The Diabetes Detection and Prevention (DDP) Project was developed as a diabetes pre-education program targeting information to a less-educated population that was not regularly accessing health care. Program sessions are delivered in a local community setting by any level of educator: from lay health workers with basic knowledge about diabetes and a positive attitude, to clinicians using the program to supplement a more comprehensive diabetes education program. The DDP project uses point-of-care testing with results immediately provided to participants and their families, so that they have their individual results available during the discussion of the tests. Each of the three modules, On the Road (OTR) to Living Well with Diabetes, On the Road: Eating Well with Diabetes, and On the Road: Keep Moving with Diabetes, emphasizes the importance of instilling the confidence to reach individual goals and to maintain control over their lives and their health. A fourth module, On the Road: Medications will be added this year. The publications were written and assessed at the 4th grade reading level. OTR Living Well booklets have been translated into Spanish, Russian, and Chinese. OTR Eating Well and Keep Moving modules are available in English and Spanish. OTR: Keep Moving module focuses on physical activity. This module uses the 'Keep Moving Keep Healthy!' physical activity DVD with participants during the class. Stretch bands, pedometers, and tape measures are provided, and blood glucose is measured before and after a moderate routine to demonstrate the impact of physical activity on blood glucose levels. The program emphasizes identification of physical activity in our everyday lives and encourages ways to simply increase what is already being done. The video includes a routine performed sitting as well as standing to address individuals with limited mobility or health-related constraints. The Keep Moving module encourages engaging in physical activity with friends and family to increase success. Family members are encouraged to attend classes and participants are urged to form walking groups, and other group activities to sustain their activity beyond the intervention. The video has English, Spanish, and Chinese language options on one disc. OTR has been modified and integrated into the Pennsylvania Dining with Diabetes program and has been successfully rolled out to 48 (72% of 67 counties) counties in the state. This program has been highly successful at attracting and retaining participants with a follow-up rate of 77% over the preceding two years. This project is scheduled to conclude August 31, 2012; a No Cost Extension was granted to Joslin Diabetes Center (JDC) in September 2011 to fund the final 12 months of the project. Our five state sites (Hawaii, New Mexico, Pennsylvania, Washington, West Virginia) are actively seeking funds to continue the project after that date. This will include It is our goal to fully analyze all available project data. A separate, rigorous evaluation of the DDP Project is planned for Pennsylvania between January and June 2012. PARTICIPANTS: Individuals: Richard Jackson, MD (PI), Sarah Imershein, MPH (Program Manager and Analyst), Matthew Berger, MA (Outcomes Analyst). Collaborators: Joslin Diabetes Center, Affiliated with Harvard Medical School. Provides in-kind hours of research, endocrinology, nutrition, and diabetes education expertise, plus professional education and production resources. Partner Organizations: Washington State College of Pharmacy. Collaborating on the On the Road: Medications module. Training and Professional Development: The grant sponsors a 3-day Diabetes Summit that includes professional and patient education covering medical, nursing, nutrition, and diabetes education for professionals and lay persons. The project also provided training and academic mentorship to three public health students during the project period. One was responsible for a large scale review of 12 years of project data to ensure accurate entry and validation. Another was mentored for her biostatistics degree and assisted in the analysis of the correlation of increased physical activity and reduced blood pressure in our New Mexico cohort. A third was a MD/MPH cadidate who was mentored through the IRB process, and implemented a branch of the outreach program in Boston-area African American churches. TARGET AUDIENCES: Target Audience Low income, medically underserved people with diabetes or concerned individuals. Populations at high risk for diabetes or diabetes complications, e.g. minority populations and elder populations. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.
Impacts
State site data indicates that On the Road continues to be effective at increasing participant awareness and confidence in managing diabetes, has beneficial health effects. The program has also been able to consistently show a modest to significant drop in systolic blood pressure. Pennsylvania: Between September 2010 and April 2011, 776 participants took part in 70 Dining with Diabetes classes (44 counties). Nearly three in four participants, (72.4%) returned three months later for follow-up evaluation. At baseline, 63.9% of participants reported diagnosed diabetes. A total of 281 participants with diabetes returned for follow-up. Their mean A1C at baseline was 6.89, well-controlled (American Diabetes Association goal=A1C<7.0), which dropped to 6.87 at follow-up. Participant awareness of the A1C test and its meaning increased significantly from baseline to follow-up (34.8% to 42.9%). Interestingly, there was no difference in mean A1C from baseline to follow-up for those aware of the test at follow-up (6.52 both times), although it was lower than that for those with diagnosed diabetes at baseline. Mean systolic blood pressure (SBP) decreased 4.45 points for all participants with diabetes (n=315, p<.001), while those with pre-hypertension or hypertension (SBP > 130) decreased 9.22 points (n=226, p<0.001). OTR attendance is open to caregivers and loved ones of people with diabetes. Participants who don't have diabetes are often at risk for it, and are an ideal target for early intervention for prevention or delay of onset. There were 280 (36.1%) OTR participants without diagnosed diabetes at baseline whose average A1C was 5.76. Of this population, 28.5% had a high risk baseline A1C above the normal range (A1C≥6.0) and of these, 38.6% also met the current ADA diagnostic guideline of an A1C ≥6.5. This high-risk group was tested at follow-up and showed improvement in both A1C (-0.28, p=.074) and systolic BP (-8.54, p=.011). These were similar outcomes as those achieved by participants with diabetes in the program. Hawaii: Besides OTR classes (n=3, with 9 total participants, 56% follow-up), Hawaii also conducts diabetes risk screenings. Between September 2010 and August 2011, 673 participants were screened across13 sites. Of those screened, 28.5% reported a diagnosis of diabetes or pre-diabetes. Mean A1C for those with pre/diabetes was 6.8, while for other participants the mean was 5.8 (p<.001). A total of 216 participants also had their blood pressure checked. Mean systolic blood pressure was slightly higher among those with pre/diabetes (139.4 vs 137.8; p=.595), with no difference in mean diastolic blood pressure (76.8 vs. 77.0). West Virginia, New Mexico: Since October 2009, there have been 502 OTR participants in West Virginia and 30 in New Mexico. These data are not yet ready for analysis.
Publications
- Jackson RA, Imershein S, Butkus SN, Broughton S, Polonsky W. A1C and Blood Pressure Awareness [abstract]. Diabetes. 2010; 59(supp 1): A600.
- Imershein S, Jackson RA, Butkus SN, Broughton S. Casting a Wider Net: Including Pre-diabetes and Unidentified Diabetes in Diabetes Outreach Programs [abstract]. Diabetes. 2010; 59(supp 1): A274.
- Imershein S, Jackson RA, Butkus SN, Broughton S, Polonsky W. Nudging People Toward Adherence [abstract]. Diabetes. 2010; 59(supp 1): A604.
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