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Program Description and Analysis

Program: Diabetes Prevention Lifestyle Change Programs

Diabetes is a chronic degenerative and metabolic disease with multiorgan associated complications. Its prevalence continues to increase year after year in a dramatic manner. In 2014 the CDC estimated a 9.4% of the population living with diabetes. (CDC 2014). Currently, it is estimated that a total of 30.3 million Americans are diabetics, nonetheless, approximately 7.2 million people with diabetes have not been officially diagnosed with the disease, this means that one out of every 4 patients with diabetes are undiagnosed. From 1958 to 2015 the prevalence of diabetes has increased from 0.94% to 7.4%. (CDC 2017). However, in those people older than 65 years of age, the prevalence is at 25.2%. (ADA 2017). There are 1.5 million cases of diabetes diagnosed each year. These trends, are among the highest of any disease in the US.
All races or ethnic groups are affected by diabetes, however, there are marked differences among races with the African-American, Native Americans and Hispanics, being the more affected. Conversely, these ethnic groups, have less access to healthcare. (Geiss 2014). On top of this very prevalent health problem, there is major underdiagnosing. It is estimated that 7.2 million diabetics, are not diagnosed. Diabetes is a condition that takes years to become a full-blown disease. There is a stage called prediabetes, where the person has been identified with glucose related metabolic abnormalities but has not reached the diagnostic criteria to be called diabetic. This stage, nonetheless, is associated to major health complications. The CDC has estimated that, 34% of the population older than 18 years and 48.3% of those older than 65 are prediabetic. (CDC 2017).
The American Diabetes Association estimated that in 2012 the total costs of diagnosed diabetes were $245 billion. (ADA 2012). Importantly so, diabetes is the leading cause of kidney failure, limb amputations and blindness in our country. (CDC 2011).
With these devastating statistics and the pace with which this disease is affecting the population, is imperative that something is done to decrease its incidence as well as its complications.

Programs:
Given the magnitude and the great impact in health diabetes has, the US government has created numerous initiatives and programs to address this problem. There are Federal, State and local programs, the common goal, is the prevention of this disease.
Examples of these are; the National Diabetes Education Program (NDEP). This is a CDC national program that through the diffusion or media by stakeholder’s partners, are distributed among the population in general with the purpose of educating them about the lifestyle changes needed to prevent diabetes. (CDC 2016). The Chronic Kidney Disease Initiative. This is another CDC program that was created in 2006 to try to provide the public health strategies for promoting kidney health. As mentioned before, the leading cause of kidney failure is diabetes, therefore, this program among other procedures, aims at preventing diabetes.
Another program is the Native Diabetes Wellness Program (NDWP). This program addresses the health inequities so starkly revealed by diabetes in Indian Country and communities. Another program is the Prevent Diabetes STAT, which stand for Screen, Test and Act Today. This is an American Medical Association and CDC conjoint program that is directed to the public, health providers, employers and health insurance companies to try to persuade them to screen for diabetes and act upon the results.
Programs and policies are important to make people and providers aware of this important disease. Policies, can make a major difference. For instance, with the Affordable Care Act Medicaid expansion, the detection and diagnosis, of diabetes was made at an earlier stage in those states that adopted the expansion, as opposed to those that did not. (Kauffman 2015). There are multiple other programs attempting to prevent diabetes. In this case, here, the CDC-Recognized Diabetes Prevention Lifestyle Change Program, also called the National Diabetes Prevention program or NDPP is described and analyzed.
The NDPP is a structured program developed specifically to prevent type 2 diabetes. In can be done in person, or online. It is designed for people at risk to develop diabetes type 2 or that have prediabetes. A trained and certified lifestyle coach leads the program helping people change their eating behaviors, diet, physical activity etc. It is a year-long program that focuses on long term changes and goals. The basis of the program comes from an NIH research study, where structured lifestyle changes cut the risk of developing diabetes by 58%. Further research showed that even 10 years later people that had completed the program were 33% less likely to develop diabetes. (DPPRG 2002). The program invites organizations and clinics that have lifestyle coaches to participate in the program. After submitting an application, the CDC makes sure certain standards are met. The participating organization must track results and share the data with the CDC which becomes the feedback and part of the evaluation process of the program. The participants are taught about nutrition, physical activity, medications, and about lifestyle changes and way to live to prevent diabetes.
Looking at the data mentioned above, it is clear that these kinds of programs are beneficial and that they have the expected results. However, looking at the pace of progression in the prevalence of diabetes it seems that no major indentation has been made against this disease. The question is why? Why, if there are great programs like the NDPP we have not seen a significant decrease or at least a slower pace in the incidence of diabetes. The likely answer is, low participation and low enrollment of patients. We can have an idea of this by entering a zip code in the find-a-program link of the website. For instance, the Zip code 79902 which belongs to the city of El Paso, Texas. Being the 17th largest city in the US turned 2 centers as result. This means that in this large city only 2 centers offer enrollment into this program. Furthermore, a phone called was made to one of the 2 centers to inquiry about the program and the answering person was not aware of what kind of program was inquired about.
With this kind of participation, even a proven successful program is not likely to make the difference.
The stakeholders, mainly the health providers and the population at risk, need to have a more active participation. These very beneficial programs should include an incentive to make participation and involvement more attractive and robust, to the point of making an impact on this very prevalent disease. Having a proven program that has already demonstrated the kind of results it can draw, is not enough if the participation is low.
As it is the case with other chronic diseases, the less educated and the minorities have less access to health programs. These populations also have the higher prevalence therefore, these populations would be the ones drawing a higher benefit at participating in these programs.

References

American Diabetes Association (2017). Statistics About Diabetes, Overall Numbers About Diabetes and Prediabetes. http://www.diabetes.org/diabetes-basics/statistics/. Extracted on March 4, 2018.

Agency for Healthcare Research and Quality (2001). Diabetes Disparities Among Racial and Ethnic Minorities. https://archive.ahrq.gov/research/findings/factsheets/diabetes/diabdisp/diabdisp.pdf. Extracted, March 4, 2018.

Alliance to Reduce Disparities in Diabetes. (2011). About Diabetes Disparities. http://ardd.sph.umich.edu/about_diabetes_disparities.html. Extracted March 4, 2018.
American Diabetes Association. (2012). The cost of Diabetes. http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html?referrer=https://www.google.com/. Extracted March 4, 2018.

Beckles, G. L., Chiu-Fang, C., & Chou, C. (2016). Disparities in the Prevalence of Diagnosed Diabetes – United States, 1999-2002 and 2011-2014. MMWR: Morbidity & Mortality Weekly Report, 65(45), 1265-1269. doi:10.15585/mmwr.mm6545a4

Bo S, Ciccone G, Pearce N, Merletti F, Gentile L, Cassader M, Pagano G. (2007). Prevalence of undiagnosed metabolic syndrome in a population of adult asymptomatic subjects.

Diabetes Res Clin Pract.

 2007 Mar;75(3):362-5. Epub 2006 Aug 22.
https://www.ncbi.nlm.nih.gov/pubmed/16930757. Extracted on March 4, 2018.

Centers for Disease Control and Prevention (2014). National Diabetes Surveillance System. National diabetes statistics report, 2014. Atlanta, GA: US Department of Health and Human Services. http://www.cdc.gov/diabetes/pubs/statsreport14/ national-diabetes-report-web.pdf

Centers for Disease Control and Prevention (2017). National Diabetes Statistics Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Extracted March 4, 2018.

Centers for Disease Control and Prevention. (2011). National Diabetes Fact Sheet, 2011. 
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf
. Extracted March 4, 2018.

Centers for Disease Control and Prevention (2017). Long-Term Trend in Diabetes.
https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf. Extracted March 4, 2018.

Centers for Disease Control and Prevention (2016). National Diabetes Education Program. https://www.cdc.gov/diabetes/ndep/partnership/collaborating-ndep.html. Extracted March 4, 2018.

Diabetes Prevention Program Research Group. (2002). Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. February 7, 2002
N Engl J Med 2002; 346:393-403
DOI: 10.1056/NEJMoa012512

Ford E, Giles W, Dietz W. (2002). Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002; 287: 356–359.

Geiss L, Wang J, Cheng Y, et al. (2014). Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980–2012. JAMA 2014;312:1218–26. http://dx.doi.org/10.1001/ jama.2014.11494

Kaufman H, Chen Z, Fonseca V, McPhaul M. (2015). Surge in newly identified diabetes among Medicaid patients in 2014 within Medicaid expansion states under the Affordable Care Act. Diabetes Care 2015;38:833–837.

Peek, M, Cargill, A, Huang, E. (2007). Diabetes Health Disparities. Human Health Services. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367214/. Extracted February 24, 2018.




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