The Grand Plan: Campaign for the Prevention of

DiabetesRichard A. Peckham

Valdosta State University

Pathophysiology

Type 2 diabetes is not a stand alone disease. It is part of a cluster of metabolic derangements known as metabolic syndrome.

Metabolic syndrome is a pro-inflammatory, pro-thrombotic condition characterized by 1) abdominal obesity 2) dyslipidemia, 3) elevated fasting plasma glucose, and 4) high blood pressure

Metabolic Syndrome and the Damage Done

Metabolic syndrome indicates high risk for cardiovascular disease and Type 2 diabetes

Type 2 diabetes emerges as increasing insulin resistance in the tissues which is compensated by high insulin production by the pancreas

Eventually the pancreas can no longer compensate and failure of insulin production occurs

Metabolic Disease and Type 2 Diabetes

In primary care, metabolic syndrome is reversed by focus on patient counseling to lose weight, to choose a healthy, balanced diet including less fat and calories, and to increase physical activity/exercise

This is also the proven regimen for the prevention of Type 2 diabetes in those at high risk – prevention of the metabolic derangement that results in diabetes

Epidemiology

Over the last decade, the prevalence of diabetes in the US and in Georgia has increased alarmingly

CDC Estimates 11.3% of Americans have diabetes, diagnosed or undiagnosed - 25.6 million people - with newly diagnosed cases added at a rate of 8.0 per 1000 annually

In Georgia, it’s much worse with an estimated 14% having diabetes, diagnosed or undiagnosed - over 1 million people - with newly diagnosed cases added at a rate of 9.6 per 1000 annually

Health Consequences Associated with Type 2 Diabetes

Diabetic ketoacidosis, coma, wounds that resist healing, lower limb amputations, increased risk for heart disease, stroke, high blood pressure, periodontal disease, complications of pregnancy, eye problems, blindness, kidney disease and failure, nervous system dysfunctions, paresthesias, neuropathy, erectile dysfunction, and gastroparesis

Georgia, We Have a Problem

In Georgia, hospital admissions for diabetic ketoacidosis nearly doubled from over 3,702 cases in 2000 to 5,997 in 2006

In 2006, among hospital admissions for cardiovascular or renal disease, 30% had diabetes as a comorbidity

In 2006, 66% of lower limb amputations were linked to diabetes

The annual cost of diabetes care was $5 billion in 2006 up from $4 billion in 2002

Georgian Population Subgroups Most Affected

20% of Georgians over age 65 have diabetes

African American men and women, Hispanics, and Native Americans develop diabetes at twice the rate of Caucasians here (GA Dept. of Public Health, 2010)

Ecological Factors Contributing to Health Disparities

Hereditary predisposition to Type 2 diabetesHealth trajectory influenced by factors of

vulnerability, circumstances, and response (Edberg 2007)In a social environment with a history of

prejudice, exclusion, limited opportunities, and poverty, people develop adaptive strategies for survival (living for today) which may not take into account a need for long term strategies for health maintenance contributing to health disparities

Ecological Factors Contributing to Health Disparities, continued

Alternatively, individuals in high risk groups may be aware of the need to adopt healthier habits but may face barriers in the environment such as

No safe place to take physical activityLimited access to sources of healthy foodLack of transportation to available

facilitiesLow health literacy

Ecological Factors Contributing to Health Disparities, continued

No health insuranceLimited options for access to culturally

competent health experts and needed care

Mass Media Campaign

My idea for a prevention intervention is a mass media campaign to raise knowledge and awareness of the preventable nature of Type 2 diabetes, the extent and seriousness of this metabolic disease among Georgia’s ethnic and racial minorities

Culturally relevant messages for maintaining strength and vigor, sticking to a balanced diet, increasing physical activity, taking care of one’s health to be strong for family and community

Messages targeting parents and caregivers to protect children and those in their care from developing type 2 diabetes

Mass Media Campaign

Working with local health care providers who may receive an influx of inquiries will promote continuity

Having organizational communications structures and a preparedness plan to provide information, guidance and support via electronic communications, telephone, mail, and face-to-face contacts

Transtheoretical Model for Type 2 Diabetes Prevention Campaign

•Community resources available to support decision-making

•Support system available to encourage, validate progress

•Expert advice•Mass media campaign

Precontemplation Contemplation

PreparationAction

Target Market for Campaign

High risk groups of southwest GeorgiaMale and femaleOlder AmericansAfrican AmericansHispanicsNative AmericansPeople of lower socioeconomic status, less

educationPeople with less access to health experts

such as people living in rural communities

Learning About the Target Market

Communnity contacts - to learn more about how best to reach these high risk populations and developing culturally appropriate messages

Local hospitals diabetes care departmentCommunity health department staffCommunity service organizations in the

areaMeeting with leaders of civic organizations,

churches, church groups

Mass Media Campaign

Level of Primary Prevention: to prevent a disease from occurring

In the development of Type 2 diabetes, obesity and lack of physical activity are the two biggest factors

Using roadside billboards, radio, television, online media messages, and community events to promote healthy lifestyle choices

The Grand Plan

In accordance with national diabetes prevention program guidelines the campaign will advocate for weight loss of 5 to 7% of body weight, facilitated by reducing fat in the diet and total calories and increasing physical activity to include 150 minutes of exercise a week.

This was found to reduce by 58% the risk of developing diabetes in those at high risk…in 2002.

Outcomes

The desired outcome of the campaign is to decrease newly diagnosed cases of type 2 diabetes in Georgia by 10% annually from 9.6 per 1000 to 8.6 per 1000 and may take several years to achieve

Other measures might include the number of contacts made (e.g., web hits), petitions or pledges signed urging community action, the number of billboards maintained, and so on.

References

Agency for Healthcare Research and Quality (2010). Predicting cardiovascular risk in patients with metabolic syndrome depends on definition used for the syndrome. Research Activities, (361), 12. Retrieved November 25, 2011, from http://www.ahrq.gov/research/sep10/0910RA.pdf

Castro, M., Charles, K., Dunkley, A., Abrams, K., & Khunti, K. (2008). Bayesian mixed treatment comparison meta-analysis of interventions for Metabolic Syndrome. Abstract retrieved November 25, 2011, from http://www.imbi.uni-freiburg.de/OJS/cca/index.php?journal=cca&page=article&op=view&path%5B%5D=7029

Centers for Disease Control and Prevention 20110321 High blood pressure: High blood pressure factsCenters for Disease Control and Prevention (2011, March 21). High blood pressure: High blood pressure facts. Retrieved November 26, 2011, from http://www.cdc.gov/bloodpressure/facts.htm

References

Centers For Disease Control And Prevention 20110429 Division for heart disease and stroke prevention: Cholesterol fact sheetCenters for Disease Control and Prevention (2011, April 29). Division for heart disease and stroke prevention: Cholesterol fact sheet. Retrieved November 26, 2011, from http://www.cdc.gov/dhdsp/data_statistics/fact_sheet/fs_cholesterol.htm

Centers for Disease Control and Prevention 20110516 Overweight and obesity: Causes and consequencesCenters for Disease Control and Prevention (2011, May 16). Overweight and obesity: Causes and consequences. Retrieved November 26, 2011, from http://www.cdc.gov/obesity/causes/index.html

Centers For Disease Control And Prevention 20111108 National diabetes fact sheet, 2011Centers for Disease Control and Prevention (2011, November 8). National diabetes fact sheet, 2011. Retrieved November 26, 2011, from http://www.cdc.gov/diabetes/pubs/factsheet1.htm

References

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2011). Primary care: the art and science of advanced practice nursing (3rd ed.). Philadelphia, PA: F.A. Davis Company.

Edberg, M. (2007). Essentials of health behavior: Social and behavioral theory in public health. Sudbury, MA: Jones & Bartlett Learning.

Georgia Department of Public Health 2010 2009 diabetes surveillance reportGeorgia Department of Public Health (2010). 2009 diabetes surveillance report. Retrieved November 26, 2011, from http://health.state.ga.us/epi/cdiee/diabetes.asp

HealtyPeoplegov 20111121 2020 Topics & objectives: DiabetesHealthyPeople.gov (2011, November 21). 2020 Topics & objectives: Diabetes. Retrieved November 26, 2011, from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=8

References

National Diabetes Information Clearinghouse 200810 Diabetes Prevention ProgramNational Diabetes Information Clearinghouse (2008, October). Diabetes Prevention Program. Retrieved November 26, 2011, from http://diabetes.niddk.nih.gov/dm/pubs/preventionprograms/index.aspx

Porth C M Matfin G 2009 PathophysiologyPorth, C. M., & Matfin, G. (2009). Pathophysiology (8th ed.). China: Wolters Kluwer Health.

United States Census 2010 2010 2010 census interactive population search: GeorgiaUnited States Census 2010 (2010). 2010 census interactive population search: Georgia. Retrieved November 26, 2011, from http://2010.census.gov/2010census/popmap/ipmtext.php?fl=13