diabetes prevention and control

Diabetes Prevention and Control

Best and Promising Practices

Prevent and Control Diabetes

Rick Schwertfeger, M.A.T.

Program Manager

Steps to a Healthier Austin Program

Division of the Medical Director

Austin/Travis County Health & Human Services

Austin, Texas

The Biggest Impact:

REDUCE OBESITY


Increase physical activity throughout a population


Improve nutrition throughout a population


Case Management


Formalized patient education


Clinicians refer

high risk individuals

to preventive services


HbA1c = or < 7.0


Foot Checks:• Self Check: Daily

• Clinical at least 1x / Yr.

• Posters in Exam Room


Eye checks at least 1x / year


Yearly Flu Shot


Define, analyze and intervene on your

Community Diabetes System


Local Diabetes Coalition

Steps to a Healthier Austin

• Reduce the burden of Obesity

• Reduce risk behaviors– Poor nutrition– Lack of physical activity

• Overarching Goals4. Prevent overweight and obesity6. Improve nutrition7. Increase physical activity

Austin/Travis County Health and Human Services Department

The Data

What does our data say?

Baseline: Obesity Rates

Disease/behavior Number % 95% CI

Overweight 188,784 34.8 % 27.8 – 41.8

Obese 102,938 19.0 % 9.7 – 28.3

Overweight/Obesity 291,722 53.8 % 46.7 – 60.9

Nutrition – 5 or more vegetables and fruit per day

174,929 30.5 % 21.5 – 39.5

Physical Activity – Any leisure time physical activity

490,251 85.6 % 80.6 – 90.5

Source: 2003 BRFSS Data

180,796 - 221,740 Overweight/Obese

Baseline: Obesity Rates

Disease/behavior From To

Overweight 127,891 192,297

Obese 44,624 130,192

Overweight/Obesity 214,839 280,165

Nutrition – 5 or more vegetables and fruit per day 98,909 181,716

Physical Activity – Any leisure time physical activity 370,793 416,337

Source: Stratified from the 2003 Travis County BRFSS data.


Baseline: Intervention Area Causes of Death

Cause of DeathIntervention

Area

Rest of A/TC

Heart disease 253.6 209.8

Cerobrovascular disease

67.1 63.2

Asthma 1.9 0.9

Diabetes mellitus 34.1 15.2

Hypertension 9.9 7.4

2000-2001 Age adjusted mortality rate per 100,000

Obesity Trends 2004-2006

Weight Status

3

3834

17

92

158

210

40

60

4136

59

3935

37

17

36

63

0

10

20

30

40

50

60

70

80

Perc

en

tag

e

2004

2005

2006

Source: BRFSS 2004-2006Question:This was calculated from the self-reported height and weight.


Overweight or Obese Individuals

63 64 60 6160 59 6357 55

01020304050607080

SHA 200

4

SHA 200

5

SHA 200

6

A/RR20

04

A/RR20

05

TX 200

4

TX 200

5

US 200

4

US 200

5



Population Upper 95 CI% Lower 95 CI%

Obesity Yr 12004

Yr 22005

Yr 32006

Yr 12004

Yr 22005

Yr 32006

Yr 12004

Yr 22005

Yr 32006

SHA 54.6 59.3 62.8 55.7 63.4 67.7 51.7 55.0 57.5

White 47.0 56.7 57.8 51.1 62.1 63.7 43.0 51.2 51.8

African American 74.1 67.8 77.2 80.6 79.6 84.9 66.3 53.2 67.1

Hispanic 59.1 62.4 68.1 64.0 70.0 77.5 54.2 54.2 57.0

Male 62.3 65.4 67.8 66.6 71.5 75.7 57.7 58.8 58.8

Female 46.4 51.9 57.1 50.0 57.0 62.4 42.9 46.6 51.6

Texas 63.0 64.1 65.9 38.7 60.1 25.5

US 60.1 61.1


% trying to lose weight

Trying to Lose Weight

5147

0

10

20

30

40

50

60

2005 2006

Source: BRFSS 2005-2006.Question: Are you now trying to lose weight?

Eating Fewer Calories/Fat to Lose Weight

Eating Fewer Calories or Less Fat

21

35

2519 18

22

38

22

05

101520253035404550

Yes, fewer calories Yes, less fat Yes, fewer caloriesand less fat

No

2005 2006

Source: BRFSS 2005-2006. Question: Are you eating fewer calories or less fat either lose weight or keep from gaining weight?

Fruit and Vegetable Consumption Stages of Change

Do you consistently eat 5 servings of fruits and vegetables a day? Year N Rate (%)

95 % CILower

95 % CIUpper

Yes, I have been for more than 6 months

2005 434 29 25 32

2006 500 35 30 40

Yes, I have been for less than 6 months 2005 118 8 6 11

2006 86 6 5 8

No, but I intend to in the next 30 days 2005 334 22 19 26

2006 314 22 18 26

No, but I intend to in the next 6 months 2005 177 12 9 14

2006 186 13 10 17

No, and I do not intend to in the next 6 months

2005 449 30 26 34

2006 343 24 21 28

Source: BRFSS 2005-2006Question: Do you consistently eat 5 servings of fruits and vegetables a day?

People Who Report Eating 5 or More Fruits and Vegetables Daily

5 or More Fruit and Vegetable Servings per Day

23 2325 25

232322

29

0

5

10

15

20

25

30

35

40

SHA 2004 SHA 2005 SHA 2006 A/RR 2005 TX 2003 TX 2005 US 2003 US 2005

Per

cen

tag

e

Source: BRFSS 2004-2006

Number of Fruit and Vegetable Servings per Day

Fruits and Vegetables Consumed Daily

5 4 4

2732

37

25

3239 38

29 29

0

10

20

30

40

50

Less than 1 perday or never

1 to less than 3times per day

3 to less than 5times per day

5 or more timesper day

2004 2005 2006

Source: BRFSS 2004-2006Question: Five Fruit and Vegetable Servings per Day Index-DSHS calculated

Leisure Time Physical Activity in the Past Month

Leisure Time Physical Activity

73

70

72

79

74.773.9

72.6

77.576.2

64

66

68

70

72

74

76

78

80

SHA2004

SHA2005

SHA2006

A/RR2004

A/RR2005

TX 2004 Tx 2005 US 2004 US 2005

Source: BRFSS 2004-2006Question: During the past month, other than your regular job, did you participate in any physical activities or exercises?

% Using Physical Activity to Lose Weight

Physical Activity or Exercise

7273

62

64

66

68

70

72

74

76

78

2005 2006

Source: BRFSS 2005-2006.Question: Are you using physical activity or exercise to lose weight or to keep from gaining weight?

Recommended Physical Activity Levels

Percentage of Respondents Meeting Physical Activity Recommendations

10

30

60

15

34

51

13

38

50

0

10

20

30

40

50

60

70

Meets Recommendations Some Physical Activity butdoes not meet

recommendations

No Physical Activity

Per

cen

tag

e

SHA 2004 SHA 2005 SHA 2006

Source: BRFSS 2004-2006Question: Meets Recommendations for Moderate or Vigorous Physical Activity is a calculated value from multiple questions about level of physical activity.

Percentage of People Meeting Recommended Moderate or Vigorous Physical Activity Levels

Percentage Meeting Recommendation for Moderate or Vigorous Physical Activity

47 494745485051

60

0

10

20

30

40

50

60

70

SHA 2004 SHA 2005 SHA 2006 A/RR 2005 TX 2003 TX 2005 US 2003 US 2005

Per

cen

tag

e

Source: BRFSS 2004-2006Question: Meets Recommendations for Moderate or Vigorous Physical Activity is a calculated value from multiple questions about level of physical activity.

Physical Activity Reported Stages

Reported Stages for Physical Activity

47

1320

129

54

1217

9 8

0

10

20

30

40

50

60

perc

en

tag

e

2005 2006

Source: BRFSS 2005-2006Question: (Based on a definition of physical activity) Do you exercise regularly according to that definition?

How People are Lowering Their Risk of Health Problems

Source: BRFSS 2005

Lower Risk of Health Problems by:

6873 75

0

10

2030

40

50

6070

80

90

…Eating fewer high fat orhigh cholesterol foods?

…Eating more fruits andvegetables?

…More physically active?

Use of Areas Conducive to Physical Activity


Access to Areas for Physical Activity

57 54

2718

29

18

NA

26

NA

59

27 30

0

10

20

30

40

50

60

70

Walking Trails.Parks,

Playgrounds,Sports Fields

Schools Open forPublic Recreation

Shopping Malls Public Rec Centers

2004 2005 2006

Level of Physical Activity in the Neighborhood


7

21

57

1513

56

26

69

17

60

14

0

10

20

30

40

50

60

70

Very physically active Somewhat physically active Not very physically active Not at all physically active

2004 2005 2006

Approximately75% of Neighborhoods

are physically active

Step’s Approach

Community based physical activity and nutrition approaches

Medical Model

• Limited approaches

• Medicines– Slow– Lack of effectiveness in the long term

• Bariatric Surgery– Costly– Complications– Lifelong medical management

Steps Model

• Working through collaborative partnerships to increase outreach capacity

• Build capacity of partners to reach target

• Work at the systems level

• Focus on community actions and community changes

• Focus on nutrition and physical activity strategies

Overall Impact

*A community change is a new program, policy or practice**A community action is an action taken to lead to a new program, policy or practiceSource: SHA Online Documentation Surveillance System (ODSS) (9/22/2003-9/21/2006)

Community Capacity Building

Community Actions**

Community Changes*

Overall 1402 878

Asthma 338 251

Diabetes 353 181

Obesity 625 410

Blank 86 35

Collective Consortium

Achievements

Steps Unique Encounters

Total Number of Encounters = 964,314

Source: SHA Partner Reports

Years 1-3

Physical Activity 141,395

Nutrition 215,549

Diabetes 607,112

Obesity 258

OVER ALL TOTAL 964,314

These are unique encounters.

Individual persons may have had more than one encounter.

Obesity Yr 1 Yr 2 Yr 3 Total

Obj.1 - Reduce Adult Obesity… 22 49 44 115Obj.2 - Increase Daily Consumptions Of

Fruits And Vegetables… 4 42 47 93Obj.11 - Increase Child And Adolescent

Engagement In Physical Activity… 6 26 22 54Obj.12 - Increase Child And Adolescent

Engagement In School Physical Activity… 5 6 5 16

Obj.3 - Increase Adult Engagement In Physical Activity… 31 59 65 155

TOTAL 68 182 183 433

Community Changes per Objective

Obesity Yr 1 Yr 2 Yr 3 TotalObj.1 - Reduce Adult Obesity… 30 77 101 208Obj.2 - Increase Daily Consumptions Of Fruits And

Vegetables… 10 31 71 112Obj.11 - Increase Child And Adolescent

Engagement In Physical Activity… 13 37 78 128Obj.12 - Increase Child And Adolescent

Engagement In School Physical Activity… 26 68 19 113Obj.13 - Increase The Proportion Of Schools That

Offer Physical Education Classes… 2 2 1 5Obj.3 - Increase Adult Engagement In Physical

Activity… 26 10 73 109

TOTAL 107 225 343 675

Community Actions per Objective

Nutrition Strategies

• Community Cooking Classes– Sustainable Food Center

• Train the Trainer Model• Individual participants

• Improved Early Childhood Nutrition– Family Connections

• Health Worker Certification for Child Care Centers• Outreach to new mothers to increase

breastfeeding and create awareness of services


• Farmer’s Markets and Farm Stands– WIC sites– Sustainable Food Center

• Lone Star Card to wooden tokens – Increased access• Manor’s Farmers Market

• School Gardens– Sustainable Food Center and Marathon Kids

• Collaborative effort• Targeting schools• Increase availability and awareness


• School Nutrition Improvements– AISD

• Vending machine offering changes• Revamped the school cafeteria menu

– MISD, DVISD & PISD• Vending machine offering changes• Revamped the school cafeteria menu• Adoption of school Wellness Policy• AISD is sharing knowledge and tools with other

districts


• Soda and Snack Vending Machine Offerings• Fruit Basket Mini Project• Wellness Wednesdays at Schools

– Foods of the Month (Vegetable, Fruit, Dairy or Grain and a Food for Thought)

• HEB Initiatives – In the works– Environmental System Changes at 4 locations– Suggested change to Meal Deals– Suggested changes to Combo Loco– Suggested healthy shopping list

Physical Activity Strategies

• Increase the Use Underutilized PARD Facilities– Summer Splash Pool Parties approx. 867– P3 Initiatives

• Expand the Participation of Marathon Kids– Year 3 SHA Area MK Participants: 14,239– Year 4 SHA Area MK Participants: 15,897 = +12%– Year 3 SHA Area Completed 26M: 11,018– Year 4 SHA Area Completed 26M: 12,026 = + 9%


• YMCA Swim Safe – 800+ in 1st year• YMCA Walking Trail• Walk with WIC

– Stroller Program– Peer Support Group

• Walk Texas Austin Chapter– Supported by an Active Austin Guide

• Walk Across Texas – Texas Cooperative Extension Agency Program


• Texas Round Up– Support of the Texas-wide Governor’s Fitness

Initiative

• Healthy Built Environment– 6 locations– Walking Trails (new, extensions, &

renovations)– Outdoor Fitness Equipment– Mileage Markers


Model Programs:

• Capital Metro

• Mayor’s Fitness Council

Capital Metro Success Story!

Comprehensive worksite wellness program• Consultations with dieticians and personal trainers• 24-hour company fitness center (NEW!!!)• personalized health assessments• Healthy food choices discount in the company’s

cafeteria• A myriad of weight and nutritional management

programs• Childcare program

Since 2003


Health Impact• Reduced health care costs

• Employee absenteeism rates decreased more than 44%, from a high of 12.4% in March 2004 to 6.9% in June 2006.

Year Cost increase

2005-06 6% predicted

2004-05 9.6%

2005-06 26.8%

Participants report: • increased exercise• healthy food consumption• weight loss• better blood pressure

management• reduced stress levels • better overall general health


Why is this program working?

Studies indicate that comprehensive worksite health programs focused on lifestyle behavior change lead to improvements in health behaviors among employees and a return on investment or employers, in terms of improved employee health and saved health care costs.

Mayors Fitness Council

Partner Certification

Benefits of Being an MFC Certified Partner

General

(All Areas)

• Add value to the business• Build and protect reputation and license to operate• Reduce perceived company risk ( a better reputation)• Manage stakeholder expectations and regulatory pressure• Build a sustainable business

Workplace • Preferred employer, recruit talented people• Broader risk management generating rationalization and cost savings• Improve employee morale• Improve productivity

Marketplace • Enhance brand value and customer loyalty• Create competitive edge• Become a preferred supplier or partner• Improve supply chain performance

Environment • Improved environmental performance• Resource conservation• Waste reduction• Cost savings

Community • Increased access to local resources• Create mutual advantage within the community


Mayor’s Fitness Council Partner’s Certification - Next Steps

• Contact the Mayor’s Fitness Council and meet with a council member to begin the partnering process

• Implement the Austin Fitness Index in your organization.

• Work with the MFC Nutrition and Physical Activity teams to implement effective change programs in each area.

• The MFC can provide programs, tools, messaging and support.

• Commit to health and fitness at both an individual and at the organizational levels.



• In the works…– Safe Routes to School Application– Point of Decision Prompts in COA buildings– COA PE Dept. Walk/Run and Swim Programs– Retrofitting some COA buildings with showers

How Far Have We Come?

Data Speaks…

General Obesity Numbers

• 467 CCs with Obesity as the General Goal

• Total SPs on Obesity: 223

• Total Number of People Served by Obesity SPs: 37,668

• Total Number of Hours of SPs on Obesity: 3,872

General Nutrition & Obesity Numbers

• 108 CCs on Nutrition

• Total SPs on Nutrition: 235

• Total Number of People Served by Nutrition SPs: 109,056 people

• Total Number of Hours of SPs on Nutrition: 6,329

Community Changes with Objectives in Nutrition & Obesity• 127 CCs with Objective as reduce adult obesity• 108 CCs with Objective as increase fruit and

vegetable consumption• 178 CCs with Objective on increasing adult

physical activity• 61 CCs with Objective on increasing child and

adolescent physical activity• 20 CCs with Objective to increase child and

adolescent participation in school physical education

Services Provided with Objectives in Nutrition & Obesity• 223 SPs with Objective to reduce adult obesity• 235 SPs with Objective to increase fruit and

vegetable consumption• 269 SPs with Objectives to increase adult

physical activity• 87 SPs with Objective to increase child and

adolescent physical activity• 28 SPs with Objective to increase child and

adolescent participation in school physical education

Nutrition Community Changes by Program

• SFC 33 CCs

• WIC 3 CCs

Nutrition Services Provided by Program

• SFC Farmers' Market SPs served 3,855 people with 125 hours of services

• SFC THK SPs served 35,191 people with 375 hours of services• Walk with WIC served 414 people with 42 hours of services• WIC nutrition education served 299 people with 10 hours of service• SHA Core Staff presentations on nutrition served 1700 people with

8 hours of service• ACS Worksite Wellness programs on nutrition served 12,374 people

with 42 hours of service• FC reached 46,283 people with nutrition education with 5,363 hours

of service (thru trainings, expo, and the newborn packets delivered at hospitals)

• H&L served 3,597 people with nutrition programs with 514 hours of service

Steps to a Healthier Austin

Thank you!

For more information:

Visit www.iThriveAustin.org

Call (512) 972-6761

http://www.ithriveaustin.org/

diabetes prevention and control

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