Raising Provider Awareness of Prediabetes and Diabetes Prevention

Submission Date: September 2014

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Kentucky

States/Territories Involved: Kentucky, Minnesota, New York

Funding Source: NACDD

Other Funding:

NACDD funding

Domain Addressed:

Community-Clinical Linkages, Environmental Approaches

Public Health Issue:

• In Kentucky, 233,000 adults have been diagnosed with prediabetes. Without lifestyle changes to improve their health, 15 to 30% of people with prediabetes will develop type 2 diabetes within five years.
• Ninty-six of Kentucky’s 120 counties had rates of diagnosed diabetes at 11.2% or above, ranking them in the top 20% of the nation (2010).
• The Diabetes Prevention Program research study showed that making modest behavior changes helped participants lose 5 – 7% of their body weight and reduced the risk of developing type 2 diabetes by 58% in people with prediabetes.
• Many people with prediabetes do not know they have it and healthcare providers do not always know how to best recognize and treat prediabetes. Raising awareness of prediabetes and the National Diabetes Prevention Program’s (National DPP) evidence-based lifestyle change program among healthcare providers can promote increased identification of individuals with prediabetes and facilitate provider referral to the lifestyle change program.

Project Objectives:

To implement two interventions geared toward raising awareness among healthcare providers and diabetes educators regarding the recognition and treatment of prediabetes.

Program Action:

The Kentucky Diabetes Prevention and Control Program (KY DPCP) worked with the KY Prediabetes/Diabetes Prevention Program steering committee and other partners to develop two prediabetes/National Diabetes Prevention Program (National DPP) toolkits and presentations.

Toolkits: Two toolkits for diabetes educators and healthcare providers were developed and distributed statewide. The purpose of the toolkits was to: 1) increase educator and provider awareness, 2) increase referrals to the lifestyle change program, 3) provide tools to increase community and employer awareness, and 4) encourage educators/providers to consider becoming an evidence-based lifestyle change program provider. The DPCP led the toolkit development with input and assistance from the KY Prediabetes/Diabetes Prevention Program steering committee. Separate toolkits were created for diabetes educators and healthcare providers. Both contained general and KY-specific information on diabetes prevention, the National DPP, and evidence-based lifestyle change program providers. Materials came from the National Diabetes Education Program (NDEP), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the CDC. The diabetes educator toolkit included a CD with a community presentation adapted from the NDEP Road to Health Toolkit, which could be used for public promotion of prediabetes and the National DPP. The CD included enrollment options, if enrollment was applicable for the area. The provider toolkit included an algorithm adapted from the MN DPCP. Diabetes educator toolkits were distributed at educational events and through local health departments, while provider toolkits were distributed through physician visits and the Kentucky Medical Association (KMA) Community and Rural Health Workgroup.
Presentations: The Department for Public Health’s (DPH) Deputy Commissioner of Clinical Affairs became a state champion for diabetes prevention and presented to nearly 600 attendees at three state or regional symposia. Keynote presentations included information about prediabetes, the National DPP, and suggestions for diabetes educator involvement. In addition, four AADE LNG presentations were given to approximately 100 diabetes educators. A community presentation was included in the diabetes educator toolkit

Simultaneously, the DPCP was involved in several other prediabetes awareness initiatives. The DPCP accessed and advertised a healthcare provider CME activity developed by the New Mexico DPCP. To promote the CME, the DPCP mailed over 6,000 flyers. Two prediabetes articles, one for an academic journal and one for a state magazine, were written by expert authors. Furthermore, an episode of the TV show “Connections with Renee Shaw” on KY Educational Television (KET) featured discussion regarding diabetes prevention. The episode aired three times and is available online at: http://www.ket.org/connections/program.fwx?programid=CWRS0910

“It’s all about relationships —- connecting with key organizations and partners to use all available resources to make a difference for our people at risk for diabetes.” -Theresa Renn, KY DPCP

State Health Department Roles

• Developed a prediabetes/prevention community awareness presentation (for public) and KY-specific materials for diabetes educator toolkit
• Facilitated development of a state level “diabetes prevention champion”
• Presented information on prediabetes and the evidence-based lifestyle change program to diabetes educators and the Kentucky Medical Association (KMA)
• Partnered with an expert in academic detailing and a KMA physician member to help develop and promote the provider toolkit
• Distributed toolkits to diabetes educators, physicians, and other health professionals
• Collaborated with the New Mexico (NM) DPCP to utilize their free online prediabetes CME activity for healthcare providers
• Collaborated with the Minnesota (MN) DPCP to utilize their prediabetes algorithm in the provider toolkit

Partners

• Cabinet for Health and Family Services – Secretary’s office
• Department for Public Health – Deputy Commissioner of Clinical Affairs
• Kentucky Prediabetes/Diabetes Prevention Program steering committee
• Kentucky Educational Television – Renee Shaw with University of Kentucky endocrinologist and Louisville YMCA
• Kentucky Medical Association – Community and Rural Health Workgroup
• University of Louisville – endocrinologist and CME director
• Diabetes Prevention and Control Programs – Minnesota and New Mexico
• Local Health Departments (Louisville Metro, Lexington, and Northern Kentucky)
• American Association of Diabetes Educators
• 4 Kentucky Local Networking Groups

Impact/Accomplishments:

• 7 State or regional presentations
  • 204 Organizations where diabetes educators are employed or practice
  • 154 Certified diabetes educators at participating organizations
• 4 Diabetes educator group partners
• 700 Diabetes educator toolkits distributed to diabetes educators/ health professionals
• 100 Physicians received provider toolkits
• 1 television segment completed through KET

Challenges/Lessons Learned:

Factors Supporting Success

• Dedicated Funding: $35,000
• State health department leadership strongly supported the evidence-based lifestyle change program
• Gained DPH senior leadership support (i.e., diabetes prevention champion)
• Used steering committee/local health department expertise to develop toolkit materials and the CD
• Accessed support staff to produce and distribute toolkits
• Ability to leverage work of other DPCPs and not have to “reinvent the wheel”
• Utilized existing relationships with AADE LNGs and local health departments for toolkit distribution

Challenges and Solutions

Challenge: There was limited time to finalize and assemble a large number of toolkits
Solution: Utilized volunteer and support staff to ensure the task was completed on time

Challenge: Publication of the articles was delayed because the expert authors were writing on volunteer time
Solution: Revised the timeline to give authors more time to write

Challenge: Promotion of the CME to Kentucky providers was behind schedule because a process had to be determined with the CME provider to offer this to large numbers of out-of-state participants
Solution: The KY and NM DPCP staff worked with the CME provider to obtain approval and develop a process to offer the CME in KY

Challenge: Distributing the provider toolkit through academic detailing was delayed due to time needed to finalize and print the toolkit
Solutions: Provider toolkits were distributed via limited physician visits in three areas of the state and a KMA member distributed nearly 100 toolkits to local physicians

Next Steps:

• Work to get prediabetes/diabetes prevention information and toolkits online (KY site) to increase access
• Continue to meet with steering committee every other month
• The National DPP will be presented again as a hot topic (with AADE presenting their data) at our annual symposium (~300 attendees)
• Continue to work with all our evidence-based lifestyle change program sites; currently have 17 providers serving 32 counties (we have developed sheets with more specific information which have helped insurance work out reimbursement details, etc.)
• Work with AADE and YMCA to do trainings in KY to expand sites and providers
• Plan to meet with Medicaid MCOs regarding coverage
• Coordinated YMCA (out of Lexington) to offer the evidence-based lifestyle change program within CHFS building where the largest number of state employees work (with Frankfort site working to become their own lifestyle change program site ongoing)

Program Areas:

Diabetes

State Contact Information:

KY
Theresa Renn (Theresa.Renn@ky.gov) and Janice Haile (Janice.Haile@ky.gov)
Kentucky Diabetes Prevention and Control Program
Theresa Renn 502-564-7996 X 4442; Janice Haile 270-686-7747 X 3031
Theresa.Renn@ky.gov

<< Back to All Success Stories