A joint initiative of NIH & CDC Building the “Medical Home” Without Walls: A New Team Approach to Managing Diabetes with Pharmacists, Podiatrists, Optometrists

A joint initiative of NIH & CDC

Building the “Medical Home” Without Walls: A New Team Approach to Managing

Diabeteswith Pharmacists, Podiatrists,

Optometrists and Dental Professionals

W. Lee Ball, Jr., OD, FAAO

Javier Lafontaine, DPM, MS

Tom Oates, DMD

Phil Rogers, DPH


Presenter Disclosures

(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

W. Lee Ball, OD, FAAO

No relationships to disclose


The National Committee for Quality Assurance

• The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physician, and when appropriate, the patient’s family.


Patient-Centered Medical Home

• Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.


Patient-Centered Medical Home

• A primary care practitioner is a partner in care, a coach, an advisor and the person who assumes overall responsibility for coordinating care among all heath service providers, always focusing on the best interests and personal preferences of the patient.


Coordination of Care

• Coordination of care presents many challenges when delivered by multiple providers in a variety of settings. This coordination helps ensure adherence to the intended treatment plan and identify drug and disease management problems in a timely manner.


Team Approach

• A multidisciplinary team approach is critical to success in diabetes care and complications prevention.

• Pharmacist, podiatrist, optometrist and dental care (PPOD) professionals are often a primary point of care for people with type 2 diabetes. These professionals play an important role in ensuring that diabetes care is continuous and patient centered.


Team Approach

• The purpose of this lecture is to encourage primary care physicians to establish a multidisciplinary team of healthcare providers to treat diabetes.

• The goals of Working Together to Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists, and Dental Professionals is to reinforce consistent diabetes messages across the PPOD and all medical providers.


Pharmacists as Part of the Diabetes Care TeamPhilip Rodgers, PharmD, BCPS, CDE, CPP, FCCP

Clinical Associate Professor, UNC Eshelman School of Pharmacy

Clinical Pharmacist, Duke University Hospital

Disclosures:

I am a pharmacist and am a member of NDEP


Q&AQ&A

• How can I as an eye-care professional utilize a How can I as an eye-care professional utilize a pharmacist for a diabetes patient?pharmacist for a diabetes patient?A.A. Pharmacists are not involved in diabetes care.Pharmacists are not involved in diabetes care.

B.B. Pharmacists counsel patients about their diabetes Pharmacists counsel patients about their diabetes medications.medications.

C.C. Pharmacists can provide input on adherence to Pharmacists can provide input on adherence to diabetes and ophthalmologic medications.diabetes and ophthalmologic medications.

D.D. Pharmacists can provide input on special devices for Pharmacists can provide input on special devices for low-vision patients with diabeteslow-vision patients with diabetes

E.E. B, C, and D above.B, C, and D above.


The Diabetes TeamThe Diabetes Team

Individual with Diabetes

Individual with Diabetes

Primary Care PhysicianPrimary Care PhysicianPrimary Care PhysicianPrimary Care PhysicianEndocrinologist/DiabetologistEndocrinologist/DiabetologistEndocrinologist/DiabetologistEndocrinologist/Diabetologist

OthersOthersOthersOthers

PharmacistPharmacistPharmacistPharmacistRN/NP/PARN/NP/PARN/NP/PARN/NP/PA

Certified Diabetes Certified Diabetes EducatorEducator

Certified Diabetes Certified Diabetes EducatorEducatorDietitianDietitianDietitianDietitian

PodiatristPodiatristPodiatristPodiatrist

OphthalmologistOphthalmologistOptometristOptometrist

OphthalmologistOphthalmologistOptometristOptometrist

Adapted from http://www.betterdiabetescare.nih.gov/NEEDSbestpracticemodel.htm. Accessed October 3, 2006, and Diabetes Care. 2006;29(suppl 1):S4-S42.

http://www.betterdiabetescare.nih.gov/NEEDSbestpracticemodel.htm


What does it take to be a Pharmacist?What does it take to be a Pharmacist?

• 2 years pre-pharmacy college work2 years pre-pharmacy college work– >60% have a prior 4 year degree completed>60% have a prior 4 year degree completed

• 4 years of professional school4 years of professional school– Incl. 40 weeks experiential training (~11 months)Incl. 40 weeks experiential training (~11 months)

• Confer Doctor of Pharmacy (=PharmD)Confer Doctor of Pharmacy (=PharmD)– ““RPh”: Designation of registered pharmacist by RPh”: Designation of registered pharmacist by

state board of pharmacystate board of pharmacy• Residency optional (~30% graduates)Residency optional (~30% graduates)

– 11stst year general, 2 year general, 2ndnd year specialty year specialty– 2 year fellowships2 year fellowships


Pharmacists Role in Diabetes CarePharmacists Role in Diabetes CareCredential Qualifications Activities

Pharmacist (RPh) Pass the boards! General counseling, monitoring

Certificate Programs Varies (class + patient cases) Advanced counseling, monitoring

Certified Disease Management (CDM)

Examination in diabetes by NISPC Advanced counseling, monitoring

Certified Diabetes Educator (CDE)

1000 hours direct patient education + 200-Q exam by NCBDE

Recognition by other HCPs, advanced practice, extensive patient education

Advanced Diabetes Management (BC-ADM)

500 hours direct patient care + 175-Q exam by ANCC

Direct patient care

Collaborative Drug Therapy Management

Residency ± board certification ± various years of experience

Direct patient care, prescriptive authority in NC


Drugs to Treat DiabetesDrugs to Treat DiabetesGlipizide

Glipizide XL

Glyburide

Glyburide, micronized

Glimeperide

Acetohexamide

Chlorpropamide

Tolazamide

Tolbutamide

Repaglinide

Nateglinide

Acarbose

Miglitol

Metformin

Metformin XR

Metformin/Glyburide

Metformin/Glipizide

Pioglitazone

Rosiglitazone

Sitagliptin

Sitagliptin/Metformin

Saxagliptin

Rosiglitazone/Metformin

Rosiglitazone/Glimeperide

Pioglitazone/Metformin

Pioglitazone/Glimeperide

Exenatide

Pramlintide

Regular insulin

NPH insulin

Regular 70/30

Regular 50/50

Insulin Lispro

Lispro 75/25

Lispro 50/50

Insulin Aspart

Aspart 70/30

Insulin Glulisine

Insulin Glargine

Insulin Detemir


Drugs and DiabetesDrugs and Diabetes

• 84.1% of persons with diabetes are on 84.1% of persons with diabetes are on antidiabetic medication(s).antidiabetic medication(s).

• >50% of patients with chronic diseases do >50% of patients with chronic diseases do not take their medications properly.not take their medications properly.

• Patients with diabetes see their pharmacist 7 Patients with diabetes see their pharmacist 7 times more frequently than their physician.times more frequently than their physician.

www.cdc.gov, accessed Aug 2009JAMA 2004;291:335–342

Pharmacotherapy 2008;28421-436

http://www.cdc.gov/


National Diabetes Education Program:National Diabetes Education Program:The PharmacistThe Pharmacist

• Promote pharmacists role in drug therapy Promote pharmacists role in drug therapy managementmanagement

• Recommend that your patients with Recommend that your patients with diabetes talk with their pharmacist about diabetes talk with their pharmacist about how to get the most benefit from how to get the most benefit from medications by individualizing dosage medications by individualizing dosage regimens.regimens.

www.ndep.nih.gov, accessed Aug 2009

http://www.ndep.nih.gov/


American Diabetes AssociationAmerican Diabetes Association

• ““People with diabetes should receive medical care from a physician-People with diabetes should receive medical care from a physician-coordinated team. Such teams may include, but are not limited to, coordinated team. Such teams may include, but are not limited to, physicians, nurse practitioners, physician’s assistants, nurses, dietitians, physicians, nurse practitioners, physician’s assistants, nurses, dietitians, pharmacistspharmacists, and mental health professionals with expertise and a , and mental health professionals with expertise and a special interest in diabetes. It is essential in this collaborative and special interest in diabetes. It is essential in this collaborative and integrated team approach that individuals with diabetes assume an integrated team approach that individuals with diabetes assume an active role in their care.”active role in their care.”

• ““Nurses, Nurses, pharmacistspharmacists, and other nonphysician health care professionals , and other nonphysician health care professionals using detailed algorithms working under the supervision of physicians using detailed algorithms working under the supervision of physicians and/or nurse education calls have also been helpful.”and/or nurse education calls have also been helpful.”

Standards of Medical Care in Diabetes—2009. Diabetes Care 2009;32:s13-61


Various Diabetes Services Various Diabetes Services Provided by PharmacistsProvided by Pharmacists

• CounselingCounseling– OBRA 90OBRA 90

• Drug interaction identification/preventionDrug interaction identification/prevention• Adverse drug reaction detection/preventionAdverse drug reaction detection/prevention• OTC and diabetic supply product selectionOTC and diabetic supply product selection• Medication therapy management (MTM)Medication therapy management (MTM)

– Medicare Part DMedicare Part D• DME servicesDME services• Group classesGroup classes• Health screening at pharmacy or local eventsHealth screening at pharmacy or local events• Collaborative drug therapy managementCollaborative drug therapy management


The Pharmacist’s EvaluationThe Pharmacist’s Evaluation

• Medication reconciliationMedication reconciliation– Resolve issues: omissions, dosing, duplicates, interactions, Resolve issues: omissions, dosing, duplicates, interactions,

ADRs, non-adherence, costADRs, non-adherence, cost• Identify treatment optionsIdentify treatment options

– Untreated indications (eg: complications)Untreated indications (eg: complications)– Optimize dosages, combinations, drug forms, costOptimize dosages, combinations, drug forms, cost– Improve medication adherenceImprove medication adherence

• Achievement of goalsAchievement of goals– Self-monitored blood glucoseSelf-monitored blood glucose– A1c and beyond (BP, LDL)A1c and beyond (BP, LDL)

• ““Standard” drugs applied where appropriate: aspirin, Standard” drugs applied where appropriate: aspirin, statins, ACE inhibitors or angiotensin receptor blockersstatins, ACE inhibitors or angiotensin receptor blockers

• Referral: Eye care, dental care, podiatry, othersReferral: Eye care, dental care, podiatry, others


• Glucose meters for visually-impairedGlucose meters for visually-impaired– Example: Prodigy Voice meterExample: Prodigy Voice meter

• Syringe magnifierSyringe magnifier– Guides needle into bottleGuides needle into bottle– 2 x magnification2 x magnification

• Insulin PensInsulin Pens

The Pharmacist-Optometrist InterfaceThe Pharmacist-Optometrist Interface


The Asheville ProjectThe Asheville Project

• Self-insured city government contracted with 12 Self-insured city government contracted with 12 community pharmacies to provide enhanced education and community pharmacies to provide enhanced education and oversight to employees with diabetes.oversight to employees with diabetes.

• ResultsResults– A1c, LDL improved at every visit, up to 5 years outA1c, LDL improved at every visit, up to 5 years out

• Increased percentage with A1c<7%Increased percentage with A1c<7%

– Total mean direct medical costs decreased by $1200 to $1800 per Total mean direct medical costs decreased by $1200 to $1800 per patient per yearpatient per year

• >$20,000 saved in first year for employer>$20,000 saved in first year for employer

– Decreased sick days, with $18,000 increased productivity.Decreased sick days, with $18,000 increased productivity.

• Beyond Asheville: Diabetes Ten City ChallengeBeyond Asheville: Diabetes Ten City Challenge

J Am Pharm Assoc 2003;43:173-84


Published EvidencePublished Evidence

• Systematic review of 21 well-controlled trialsSystematic review of 21 well-controlled trials• ResultsResults

– Reduced A1c by ≥ 0.5%Reduced A1c by ≥ 0.5%• Strategies with direct intervention by pharmacist resulted in Strategies with direct intervention by pharmacist resulted in

more of a reduction (1%)more of a reduction (1%)

– Reduced SBP up to 18mmHg, DBP up to 17mmHgReduced SBP up to 18mmHg, DBP up to 17mmHg

– Reduced LDL by 11 mg/dLReduced LDL by 11 mg/dL

– Cost to lower A1c ~0.5% was $315/patient (over 7 Cost to lower A1c ~0.5% was $315/patient (over 7 visits).visits).

Pharmacotherapy 2008;28:421-36


Barriers to Pharmacist CareBarriers to Pharmacist Care

• Lack of clinical data communicationLack of clinical data communication– Lab/note info not Lab/note info not received from received from othersothers– Prescription information not Prescription information not sent to sent to othersothers

• Lack of timeLack of time– Prescription volumes, incentivesPrescription volumes, incentives

• Lack of adequate reimbursementLack of adequate reimbursement– MTM: A new hope?MTM: A new hope?

• Lack of adequate training among pharmacistsLack of adequate training among pharmacists


What can you do?What can you do?

• If your patient has apparent poor control of If your patient has apparent poor control of diabetes or complicated medications, refer diabetes or complicated medications, refer him/her to contact their pharmacist.him/her to contact their pharmacist.

• Get to know pharmacists in your area.Get to know pharmacists in your area.– Identify which ones specialize in diabetes careIdentify which ones specialize in diabetes care– Some may hold diabetes classes or consult at local Some may hold diabetes classes or consult at local

clinics.clinics.

• Form a partnership with selected pharmacists to Form a partnership with selected pharmacists to provide specialized services or products.provide specialized services or products.– Expect interaction and intervention with patientsExpect interaction and intervention with patients


Q&AQ&A

• How can I as an eye-care professional utilize a How can I as an eye-care professional utilize a pharmacist for a diabetes patient?pharmacist for a diabetes patient?A.A. Pharmacists are not involved in diabetes care.Pharmacists are not involved in diabetes care.

B.B. Pharmacists counsel patients about their diabetes Pharmacists counsel patients about their diabetes medications.medications.

C.C. Pharmacists can provide input on adherence to Pharmacists can provide input on adherence to diabetes and ophthalmologic medications.diabetes and ophthalmologic medications.

D.D. Pharmacists can provide input on special devices for Pharmacists can provide input on special devices for low-vision patients with diabeteslow-vision patients with diabetes

E.E. B, C, and D above.B, C, and D above.


ConclusionConclusion

• Pharmacists play an important role in the care of your Pharmacists play an important role in the care of your patient with diabetes.patient with diabetes.

• Recommend that your patients with diabetes talk with Recommend that your patients with diabetes talk with their pharmacist about how to get the most benefit their pharmacist about how to get the most benefit from medications by individualizing dosage from medications by individualizing dosage regimens.regimens.

• Evidence demonstrates that pharmacists can improve Evidence demonstrates that pharmacists can improve the care and outcomes of patients with diabetes.the care and outcomes of patients with diabetes.

• Barriers may prevent widespread pharmacist Barriers may prevent widespread pharmacist engagement, but can be overcome locally with a engagement, but can be overcome locally with a collaborative effort.collaborative effort.


Risk Factors

• Foot– Peripheral Neuropathy– Biomechanics– Peripheral Vascular Disease– Prior Ulceration– Prior Amputation


Foot Health and Diabetes

• A comprehensive foot examination for abnormalities, including evaluation of pulses, sensation, foot biomechanics, and nails helps determine the person’s category of risk for developing foot complications. Persons with diabetes who are at high risk have one or more of the following characteristics: loss of protective sensation, absent pedal pulses, foot deformity, history of foot ulcers, or prior amputation.


Eye Health and Diabetes

• Diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year. People with diabetes can maintain optimal vision and healthy eyes by having an annual comprehensive vision examination, including a dilated eye examination, with early intervention if retinopathy is found.


Vision Loss From Diabetes

• Vitreous Hemorrhage• Traction Retinal Detachment• Diabetic Macular Edema


Retinal Signs of HypoxiaRetinal Signs of Hypoxia

• Cotton wool spots

• Venous caliber abnormalities (VCAB)

• Venous tortuosity

• Arteriolar abnormalities

• Intraretinal microvascular abnormalities (IRMA)

• Featureless retina


Other Common Eye Complications in Diabetes

• Fluctuating vision/refractive error

• Cataracts

• Double vision

• Corneal abrasion/ulcers/dry eye

• Glaucoma


Oral Health and Diabetes

• Diabetes can lead to changes in the oral cavity. Of particular concern to dentists and dental hygienists are the effects of diabetes on the health of the gingiva (gums) and periodontal tissues. Poor glycemic control is associated with gingivitis and more severe periodontal diseases. Oral signs and symptoms of diabetes can also include a neurosensory disorder known as burning mouth syndrome, taste disorders, abnormal wound healing, and fungal infections.


Oral Health and Diabetes

• Individuals with diabetes may notice a fruity (acetone) breath, frequent xerostomia (dry mouth), or a change in saliva thickness. Dry mouth can also lead to a marked increase in dental decay.

• Unfortunately, caring for the mouth is often overlooked when trying to control other problems associated with diabetes. Good oral hygiene combined with good glycemic control can prevent many of these problems.



People with diabetes and severe periodontal disease have:

• 6x increased risk of poor glycemic control

• 82% had 1 or more macrovascular complication (CVD, CVA) (vs. 21% w/o periodontal dz)

• Death rate due to CVD 2.3x higher

• Death rate from nephropathy 8.5x


Control of Glucose Matters in Oral Health

• People with poorly controlled diabetes had more periodontal disease than people well controlled

• In a study with Pima Indians, improved periodontal disease correlated with better glucose control

• Effective interventions promote multiple good outcomes


Why Does Diabetes Continue to Command Our Attention?

Because EVERY 24 HOURS there are:• 4,100 new cases of diabetes,• 810 deaths due to diabetes,• 230 amputations,• 120 kidney failures, and• 55 new cases of blindness

Source: NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.


Estimated Cost of Diabetes in the United States

• Direct Medical Cost: $92 billion

• Indirect Cost: $40 billion

• Total Cost: $132 billion

Source: Lewin Group, Inc., for the American Diabetes Association, 2002.




Obesity Trends1990 2001

Diabetes Trends1990 2001

BRFSS, 1990- 2001

A joint initiative of NIH & CDCAfrica Americas Eastern

MediterraneanEurope Southeast

Asia

1995

2000

2025 (projected)

80

0

10

20

30

40

50

Est

imat

ed

Pre

vale

nce

(mill

ion

s)

60

70

WesternPacific

Worldwide Diabetes Prevalence

World Health Organization; 2001.


Countries With Largest Number of People With Diabetes

• India 19 million 57 million• China 16 million 38 million• USA 14 million 22 million• Pakistan 4 million 15 million• Indonesia 5 million 12 million• Mexico 4 million 12 million

1995 2025


Hispanic/Latino Americans and Diabetes

• 2.2 times as likely to have diabetes as non-Hispanic whites

• 9.5 percent (2.5 million) of all Hispanic/Latino Americans have diabetes

• Mexican Americans are 1.7 times as likely to have diabetes as non-Hispanic whites

NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.


African Americans and Diabetes

• 13.3 percent (3.2 million) of all African Americans have diabetes

• African Americans are 1.8 times as likely to have diabetes as non-Hispanic whites




Preventing Diabetes Complications

• Glucose control (micro 40%)• Blood pressure control (CVD/CVA 33-50%;

micro 33%) • Blood lipid control (CVD 20-50%) • Preventive care practices for eyes (50-60%),

kidneys (30-70%), feet (45-85%)



How can we harness our efforts into true

multidisciplinary team care?


Major NDEP campaign messages

• Diabetes is serious, common, costly, yet controllable.

• Control Your Diabetes. For Life.• Be Smart About Your Heart. Control the

ABCs of Diabetes: A1C, Blood Pressure, and Cholesterol

• Diabetes Prevention Program message Small Steps. Big Rewards.


PPOD Goals

Promote the objectives of NDEP by utilizing Pharmacy, Podiatry, Optometry and Dentistry organizations and providers to increase awareness of and access to quality care for persons with diabetes


PPOD Primer Goals• Promote multidisciplinary diabetes care• Section on “What You As A Health Care Provider

Can Do” • Intended as a “cross-training” document, not a

comprehensive guide to sub-specialty care• Educate PPOD providers so they can educate

patients in turn• Sections specific to each discipline:

– Key issues in each PPOD discipline– Referral recommendations– Patient education for self-management


Working Together Key Messages• Recommend routine exams for complication

prevention: oral health, comprehensive foot, dilated eye

• Reinforce self-exams• Recognize danger signs• Pharmacist role in diabetes care team:

medications management, individualized plans, use of glucose meter and other supplies

• Importance of metabolic control (ABCs)



Sample vignettes – Team Care

• A dentist notes that his patient smokes. In addition to telling the patient that smoking can cause oral cancer, he describes the impact tobacco use can have on increasing diabetes complications. He asks the patient to consider quitting as an important step in controlling diabetes and gives him the 1-800-QUITNOW number.


Sample vignettes (continued)

• A 40-year-old woman asks her local pharmacist for advice on reading glasses. She says, “I must be getting older, everything is just blurry.” The pharmacist uncovers a history of diabetes diagnosed the previous year, but that the patient never returned for follow up. The pharmacist advises the woman that her blurred vision may be a sign of diabetes and arranges for the woman to be seen by a primary care provider and eye care provider for follow up.


Agent PrimaryAction

HowSupplied/Storage

TypicalDosage

DurationAction

Side Effects Precautions Comments

Exenatide(Byetta™)

Modulates gastricemptying, glucagonproduction. Increasessatiety, leading todecreased caloricintake. For type2 diabetes

5 mcg/ml prefilled pen10 mcg/ml prefilled penNot in use: refrigerateuntil expiration date.In use: room temperature,discard after 30 days.

5 mcg BID subcutaneousfor 1 month, then 10 mcgBID, injected within 60minutes before morningandevening meal.

Approximately10 hours

Nausea andhypoglycemiamost common;occasional vomiting,diarrhea, jitters,dizziness, headache.

Not for use with type 1diabetes, patients withsevere renal disease orESRD, or severeGI disease

Consider lowering dose of sulfonylureato avoid hypoglycemia when starting.May reduce the rate of absorption oforal medication. Medications requiringthreshold concentrations should betaken 1 hour prior to injection.Approved for use with sulfonylureasand/or metformin.

Pramlintide(Symlin™)

Modulates gastricemptying, glucagonproduction. Increasessatiety, leading todecreased caloricintake.

5 ml vials containing0.6 mg/ml. RequiresU-100 insulin syringefor injectionNot in use: refrigerateuntil expiration date.In use: room temperature,discard after 28 days.

Type 1: 15–60 mcg starting;15 mcg subcutaneous beforemeals of 30 gm or morecarbohydrate.Type 2: 60–120 mcg starting60 mcg subcutaneous.Titrate as directed byprescriber.

Elimination t1/2of 48 minutes

Nausea andhypoglycemia mostcommon. Doses areadjusted based onpresentation of theseside effects. Occasionalvomiting, stomach pain,dizziness, indigestion.

Contraindicated with:hypoglycemic unawareness,gastroparesis. Patient non-adherence.Should never be mixedwith insulin. Insulin doseshould be reduced by 50%when starting.

Requires patient testing of blood sugarsbefore and after meals, frequentphysician followup, and thoroughunderstanding of how to adjust dosesof insulin and Symlin. May reduce therate of absorption of orally administeredmedication. Medications requiringthreshold concentrations should betaken 1 hour prior to injection.

Sitagliptin (JanuviaTM)

DPP-4 inhibitor*DPP-4 inhibitor Prolongs action of (GLP-1) and (GIP), increase insulin synthesis and release, lowers glucagon secretion

25mg, 50mg, 100mg tablets

100 mg po qDModerate renal insufficiency (CrCl <30 mL/min) - 50mg/day

Elimination t1/2 of 12.4 hours

Low incidence of side effectsHeadache, upper respiratory tract infection, nasopharyngitis

Not for use in type 1 diabetes Assessment of renal function is recommended prior to initiation and periodically thereafter.

May be used as monotherapy or with metformin or TZDs.NOT associated with weight loss



PPOD Poster in Spanish


Genetic predisposition

Preclinical state

Normal IGT

DisabilityDeath

Clinical disease

Type 2 DM DisabilityDeath

Complications

Complications

Primary Secondary Tertiaryprevention prevention prevention

Stages in the natural history of Type 2 diabetes


Pre-Diabetes

• At least 54 million U.S. adults age 20 and older have pre-diabetes—which raises their risk for type 2 diabetes and cardiovascular disease



Diabetes Prevention Program (DPP)Lifestyle Intervention

Intensive Lifestyle Modification A comprehensive program with thefollowing specific aims:

• Reduction of fat and calorie intake

• Physical activity at least 150 minutes / wk

• 5-7% loss of body weight

• Reduced risk of diabetes 58%

Worked in all ethnicities, all ages


Diabetes Prevention Program

Among people 60 and older, lifestyle changes reduced the development of diabetes by 71 percent.


PPOD primary prevention brochures include

• Statistics on rising prevalence of diabetes and prediabetes

• Findings of the Diabetes Prevention Program (DPP)

• Risk factors for type 2 diabetes

• Ask – Advise – Assist approach


Case Study



• Includes the challenge: It is estimated that of persons born in 2002, 1 in 3 will develop diabetes in his or her lifetime … unless something changes

• Where to go for further information


How do I get NDEP materials?

All NDEP materials are copyright-free and available by calling toll free

1-800-438-5383 or downloading from

www.ndep.nih.gov


www.ndep.nih.govW. Lee Ball, Jr., OD, FAAO

[email protected]

Dennis Frisch, DPM

[email protected]

Thank You!

Documents

A joint initiative of NIH & CDC Building the “Medical Home” Without Walls: A New Team Approach to Managing Diabetes with Pharmacists, Podiatrists, Optometrists