Reaching Patients At Risk for Diabetes

September 5, 2017

UH Clinical Update - September 2017

By Patricia Kellner, MD, Family Medicine

Patricia Kellner, MD

As an established family physician, I see patients with new diagnoses of diabetes (FBS above 125 or Hemoglobin A1C of 6.5 percent) and new diagnoses of pre-diabetes (FBS 100-124 or Hemoglobin A1C of 5.8-6.4 percent) on a weekly basis. As we all know, diabetes is one of the most serious illnesses we deal with, but it’s also one that we as doctors can’t do much to prevent. Talk only goes so far. Preventing diabetes requires lifestyle change. Changing eating habits and activity levels requires intensive behavioral counseling – and we generally don’t have the training or bandwidth to provide that service. Early in 2016, I read about a program run by the YWCA, the Diabetes Prevention Program, and decided to recommend it to my at-risk patients.

The Diabetes Prevention Program is an evidence-based, year-long program that works with people to develop a healthier lifestyle – and reduce their risk of developing diabetes by half. The program initially meets weekly for 90 minutes, then meets less frequently over the course of the next nine months. It works on proven principles of behavior change, including accountability, group support, finding motivation, development of skills, making small behavior changes, and celebrating successes through coaching. The YWCA runs these programs at a variety of places, including many of the YWCA’s in our region, but I discovered there wasn’t a specific time and location I could point my patients to. I knew that the more specific and local the recommendation is, the more likely the patient would be to act on it. I contacted the director of the Diabetes Prevention Program about this, and she said that if I could recruit enough patients, she would run a program in my medical building. I did that, and over the last 12 months about a dozen of my patients participated. My patients who participated have reported healthier eating, more consistent exercising, and thinking that they can sustain the changes they made – AND they are visibly lighter. Patients I’ve seen have in the last few months have said they “kind of” enjoyed the program and appreciated my referral. To my thinking “kind of liked” is not a bad comment from people making significant lifestyle changes that reduce their chance of getting diabetes!

Because of my patients’ success, I have advocated that University Hospitals Health System make this program widely available to our patients, and a proposal is being developed to do just that.

For patients who need a program now, recruiting patients for the Y’s Diabetes prevention Program is simple. The Y supplies brochures and short application forms that can be faxed to them. I keep both in my exam rooms. I’ve found many at-risk patients are interested. The charge this past year for the entire program was $175 (some financial aid is available for qualifying individuals), and starting in 2018, Medicare will cover the program.

More details about the program are available on the CDC’s website, and I’m happy to share more information with anyone interested. Feel free to email me at Patricia.Kellner@uhhospitals.org.

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