Healthy People 2020

Diabetes

Mickelder Kercy

Teachers College, Columbia University

Author note

This presentation was prepared for HBSS 4100, taught by

Professor John Allegrante and Adjunct Professor Ray Marks

•Diabetes Overview

•Prediabetes Epidemiology

•Healthy People 2020 goals

•Prediabetes Objectives

• Implications for Public Health Practice

•Challenges and Recommendations

• References

Healthy People 2020 • Goals: Reduce the disease and economic burden of diabetes mellitus (DM), and improve the quality of life

for all persons who are at risk for DM

• Overview: Why is Preventing Diabetes in Prediabetic Adults important ?

• Reduce the number of people newly diagnosed with diabetes.

• Avoid life expectancy to decrease by 15 years.

• Lower the risk of heart disease (2 to 4 times higher in diabetics).

• Decrease the risks of kidney failure, lower limb amputations, and adult-onset blindness.

• Reduce the costs of medical care ($174 billion in 2007), disability, and premature death.

• 25 percent of all adult patients with type 2 diabetes are in the minority groups.

• Emerging evidences (prevent cognitive impairment, incontinence, fracture risk; and cancer risk and

prognosis).

• The Diabetes Prevention Program, endorsed by the American Diabetes Guidelines (ADA) (2014), lowers the

risk for type 2 diabetes by 58%:

• Losing 7% of your body weight (or 14 pounds if you weigh 200 pounds).

• Exercising moderately (e.g., brisk walking) 30 minutes a day (at least 10 minutes at a time), 5 days a week.

• Choosing a diet with plenty of fresh vegetables, whole grains, fruits, low-fat dairy products, lean meats.

Additional Recommendations include: Exercising vigorously (such as running or jogging) 15 minutes a day,

five days a week as a time-efficient alternative; and stress reduction and coping skills (Gonzalez,

Goeppinger, & Lorig, 1990, pp. 135-138; U.S. Department of Health and Human Services, 2008, p. 22).

Prediabetes Objectives • 2 objectives (D-1 & D-16) and 4 Sub-Objectives (D-16.1 to D-16.3)

• Highlight of these Objectives and Sub-Objectives

• Prevent or delay the onset of type 2 diabetes in high-risk individuals by promoting lifestyle changes in all

racial and ethnic groups.

D-1 Reduce the annual number of new cases of diagnosed diabetes in the population

• Baseline: 8.0 new cases of diabetes per 1,000 population aged 18 to 84 years in 2008.

• Target: 7.2 new cases per 1,000 population aged 18 to 84 years.

• Target Setting-Method: 10 percent improvement.

• Data Sources: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS.

D-16 Increase prevention behaviors in persons at high risk for diabetes with prediabetes

• D-16.1 Increase the proportion of persons at high risk for diabetes with prediabetes who report increasing

their levels of physical activity

• Baseline: 44.6 percent of adults (18 years and older) reported increasing their physical activity levels in 2008.

• Target: 49.1 percent.

• Target Setting-Method: 10 percent improvement.

• Data Sources: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS.

• D-16.2 Increase the proportion of persons at high risk for diabetes with prediabetes who report trying to

lose weight

• Baseline: 50.0 percent of adults (18 years and older) reported controlling or trying to lose weight in 2008.

• Target: 55.0 percent.

• Target Setting-Method: 10 percent improvement.

• Data Sources: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS.

• D-16.3 Increase the proportion of persons at high risk for diabetes with prediabetes who report reducing the

amount of fat or calories in their diet

• Baseline: 48.5 percent of adults (18 years and older) reported reducing fat or calories in their diet in 2008.

• Target: 53.4 percent.

• Target Setting-Method: 10 percent improvement.

• Data Sources: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS.

Implications for Public Health Practice

• As prescribed in Healthy People 2020, 10% more individuals among the 86 million people with prediabetes need to

increase their self-efficacy for physical activity, weight loss and adequate nutritional intake, which can be accomplished

by using the principles of social cognitive theory, helping them live a lifestyle to better handle stress, and fostering

social support for these individuals (Bandura, 2004, pp. 144-145; Winett et al., 2014 ; Gonzalez, Goeppinger, & Lorig,

1990, pp. 135-141).

• In the role of a public health professional, contributing to the success of Healthy People 2020 will require the

application of these health behavior theories in the socio-environmental context of the people with prediabetes,

especially the minority groups of African descent (Baruth et al., 2013, pp. 716-718; Caldwell & Takahashi, 2014, pp. 410-

411; Harmon, Blake, Thrasher, & Hébert, 2014, p. 222; Odulana et al., 2013, pp. 130-131; Wilcox et al., 2013, pp. 127-129).

• The accomplishment of the prediabetes objectives and sub-objectives are feasible based on the socio ecological

approach evidenced by research and currently applied with the concerted efforts of many stakeholders at the federal,

state and local levels, as illustrated by the National Diabetes Prevention Program, the ongoing creation of access to

healthier and more affordable food from local farmers by the United States Department of Agriculture, Treasury , and

Health and Human Services, and the State Indicator Report on Physical Activity (Centers for Disease Control and

Prevention, 2014a; United States Department of Agriculture, 2014; CDC, 2014b).

• Challenge: Create or enhance access to safe places for physical activity (e.g., Walking and biking)

in all states

• Recommendation: Support some form of complete “street and community-scale design policy” in

all states (currently available in 27 states) (CDC, 2014b, p. 19).

• Challenge: Increase the intake of certain nutrient-rich foods, including fruits and vegetables and

whole grains in all adults with prediabetes

• Recommendation: Increase the number of states (currently 27 states) that have state-level policies

that incentivize food retail outlets to provide foods that are encouraged by the Dietary Guidelines

for Americans (CDC, 2013, p. 2).

Reduce the percentage of census tracts (30.3%) that do not provide access to

healthier food as reported in 2011 (Grimm, Moore, & Scanlon, 2013, p. 22).

• Challenge: No consensus exists concerning the best anti -diabetic diet • Recommendation: The Mediterranean diet can decrease by 23% the likelihood of developing

diabetes type 2 (Koloverou, Esposito, Giugliano & Panagiotakos, 2014, p. 907). This diet may be

“adjusted to reflect local food availability as well as individual’s preferences” (pp. 909-910). A

recent meta-analysis challenged the current American dietary guidelines limiting the intake of

organically saturated fat even in moderation (O’ Sullivan, Hafekost, Mitrou, & Lawrence, 2013,

pp. 37-40).

Challenges and Recommendations

• Challenge: Increase the number of adults with prediabetes in all ethnic groups who initiate and

sustain effective lifestyle changes

• Recommendation: Implement the National Diabetes Prevention Program in more community health

centers, hospitals, and organizations to offer lifestyle classes tailored to the socio-cultural and

behavioral needs of the people served in the communities.

Faith-based interventions may have the greatest potential to promote both

moderately vigorous physical activity and healthy eating in ethnic minority communities, especially

in churches of African descents, even when accounting for racial or ethnic discrimination (Baruth et

al., 2013, pp. 716-718; Caldwell & Takahashi, 2014, pp. 410-411; Harmon, Blake, Thrasher, & Hébert,

2014, p. 222; Odulana et al., 2013, pp. 130-131; Wilcox et al., 2013, pp. 127-129).

• Challenge: Reduce the percentage of all adults with prediabetes in all ethnic groups

• Recommendation: Intensify the screening of individuals who are at high risk of prediabetes.

• Challenge: Limited access to health interventions in rural and remote regions that contribute to

health disparities

• Recommendation: Increase the awareness and knowledge of the seriousness of diabetes type 2,

its ecological factors, and the effective strategies for preventing it using mobile technologies.

(Stuckey, Shapiro, Gill, & Petrella, 2013, pp. 8-9).

Bandura, A. (2004). Health promotion by social cognitive means. Health Education and Behavior, 31(2), 143-164.

doi: 10.1177/1090198104263660

Baruth, M., Wilcox, S., Saunders, R. P., Hooker, S. P., Hussey, J. R., & Blair, S. N. (2013). Perceived environmental

church support and physical activity among black church members. Health Education & Behavior,

40(6), 712-720. doi: 10.1177/1090198113477110

Caldwell, J. T., & Takahashi, L. M. (2014). Does attending worship mitigate racial/ethnic discrimination in

influencing health behaviors? Results from an analysis of the California Health Interview Survey.

Health Education & Behavior, 41(4), 406-413. doi: 1090198114529127

Centers for Disease Control and Prevention. (2008). Road to health activities guide. Atlanta: U.S. Department of

Health and Human Services, Centers for Disease Control and Prevention; 2008. Figure 1. Retrieved

from http://www.cdc.gov/diabetes/ndep/pdfs/5-road-to-health-toolkit-activities-guide-508.pdf

Centers for Disease Control and Prevention. (2008). Road to health activities guide. Atlanta: U.S. Department of

Health and Human Services, Centers for Disease Control and Prevention; 2008. Figure 2. Retrieved

from http://www.cdc.gov/diabetes/ndep/pdfs/5-road-to-health-toolkit-activities-guide-508.pdf

Centers for Disease Control and Prevention. (2013). State indicator report on fruits and vegetables, 1-16. Retrieved

from http://www.cdc.gov/nutrition/downloads/State-Indicator-Report-Fruits-Vegetables-2013.pdf

Centers for Disease Control and Prevention (CDC). (2014a, March). National diabetes prevention program.

Retrieved from http://www.cdc.gov/diabetes/prevention/about.htm

References

Centers for Disease Control and Prevention. (2014b, July). State indicator report on physical activity, 2014, 1 -28.

Retrieved from http://www.cdc.gov/physicalactivity/downloads/pa_state_indicator_report_2014.pdf

Gonzalez, V. M., Goeppinger, J., & Lorig, K. (1990). Four psychosocial theories and their application to patient

education and clinical practice. Arthritis Care and Research, 3(3), 132-143. doi: 10.1002/art.1790030305

Grimm, K. A., Moore, L. V., & Scanlon, K. S. (2013). Access to healthier food retailers—United States, 2011. CDC

health disparities and inequalities report—United States, 62(3), 20-26. Retrieved from

http://www.cdc.gov/mmwr/pdf/other/su6203.pdf

Harmon, B. E., Blake, C. E., Thrasher, J. F., & Hébert, J. R. (2014). An evaluation of diet and physical activity

messaging in African American churches. Health Education & Behavior, 41(2), 216-224.

doi: 10.1177/1090198113507449

Koloverou, E., Esposito, K., Giugliano, D., & Panagiotakos, D. (2014). The effect of Mediterranean diet on the

development of type 2 diabetes mellitus: A meta-analysis of 10 prospective studies and 136,846

participants. Metabolism, 63(7), 903-911. doi: 10.1016/j.metabol.2014.04.010

Odulana, A. A., Kim, M. M., Isler, M. R., Green, M. A., Taylor, Y. J., Howard, D. L., ... Corbie-Smith, G. (2013).

Examining characteristics of congregation members willing to attend health promotion in African

American churches. Health Promotion Practice, 15(1), 125-133. doi: 10.1177/1524839913480799

O’Sullivan, T. A., Hafekost, K., Mitrou, F., & Lawrence, D. (2013). Food sources of saturated fat and the association

with mortality: A meta-analysis. American Journal of Public Health, 103(9), 31-42.

doi: 10.2105/AJPH.2013.301492

Stuckey, M. I., Shapiro, S., Gill, D. P., & Petrella, R. J. (2013). A lifestyle intervention supported by mobile health

technologies to improve the cardiometabolic risk profile of individuals at risk for cardiovascular

disease and type 2 diabetes: Study rationale and protocol. BMC Public Health, 13(1), 1051.

doi: 10.1186/ 1471-2458-13-1051

United States Department of Agriculture (USDA). (2014). Agriculture marketing service. Creating access to

healthy and affordable food. Retrieved from http://apps.ams.usda.gov/fooddeserts/

U.S. Department of Health and Human Services. (2008). 2008 physical activity guidelines for Americans, 1-76.

Retrieved from http://www.health.gov/PAGuidelines/pdf/paguide.pdf

U.S. Department of Health and Human Services. (2013). Diabetes Prevention Program (DPP). The National

Diabetes Information Clearinghouse (NDIC). Retrieved from

http://diabetes.niddk.nih.gov/dm/pubs/prevention program/

U.S. Department of Health and Human Services, Healthy People 2020. (2014, October). Diabetes. Retrieved

from http://www.healthypeople.gov/2020/topics-objectives/topic/diabetes

Wilcox, S., Parrott, A., Baruth, M., Laken, M., Condrasky, M., Saunders, R., „ Zimmerman, L. (2013). The

faith, activity, and nutrition program: A randomized controlled trial in African-American churches.

American Journal of Preventive Medicine, 44(2), 122-131. doi: 10.1016/j.amepre.2012.09.062

Figure 1. Adapted from CDC (2008) Figure 2. Adapted From CDC (2008)

"Effective behavior change therefore requires that we do our best as individuals, but also that we

work together with one another to create more healthful and supportive social environments.”

-S. Leonard Syme