Diabetes at Work: Public Domain Resources that You Can Use with Pamela Alweiss

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  • CDC awarded a contract on September 30th under a competitive solicitation titled, “Comprehensive Workplace Health Program to Address Physical Activity, Nutrition, and Tobacco Use in the Workplace.”The program started on October 1st. This is obviously a mouthful for anyone to say so I am glad that as the program rolls out it will be referred to as the National Healthy Worksite Program. CDC will be working with our partners Viridian Health Management who will be responsible for program implementation and the Research Triangle Institute International who will be leading the National evaluation of the program. The NHWP is designed to assist employers in implementing science and practice-based prevention and wellness strategies that will lead to specific, measurable health outcomes to reduce chronic disease rates. For most employers, chronic diseases – such as heart disease, stroke, cancer, obesity, and diabetes – are among the most prevalent, costly, and preventable of all health problems. The National Healthy Worksite Program seeks to maintain good health through prevention, reduce chronic illness and disability, and improve productivity outcomes that contribute to employer’s competitiveness.
  • Given that chronic disease are the leading cost drivers for many employers as well as the nation as a whole, our goal is to provide program activities that are designed to reduce chronic disease risk by initiating changes in lifestyles and sustaining those changes over time. We also will be capturing a lot of process and outcome evaluation information using the RE-AIM framework (developed by Dr. Russ Glasgow) to better understand sustainable and replicable practices so that the efforts of the employers can be continued after the program ends. We also want to document unique challenges for employers particularly the smallest employer participants so further development of best practices can occur. So we will be keenly interested in promoting sustainable and replicable workplace health activitiesLastly we wasn’t to promote peer to peer mentoring among the employer community. We feel the participating employers will definitely have stories to tell and we want to capture and share those as well as empower the participating employers to be role models to others. Through some of the technical assistance provisions, we will also explore opportunities for the employers to learn from the others in the business community who have successful workplace health programs or other experts that know from years of practice how to achieve these goals.
  • Step #1 – divide up the country into some large regions ensuring some geographic spread for employer participantsThe seven regions where local program sites will be established is shown on this map.This designation will allow the program to involve employers across the country with different geographic, cultural, industry sector, and demographic diversity. The specific site locations will represent a city/county so the participating employers are in fairly close proximity to each other. This will enable the program to work closely with employers on site in building their programs, allow for community connections to take place, and enable the participating employers to form bonds with one another and develop a peer learning network in each of the seven groups. So for example, you may have a site in Dekalb County, GA here in the Atlanta metro area where I work. This site represents Region 2 on the map. This site will include up to 15 employers. And among the 15 employers we will have several representing the small employer group of less than 100 employees, several mid size companies of between 101-250 employees and several large employers with between 251 -1000 full time employees. Talk about Rationale for selecting seven localized sitesProgram administration – Employers who represent a single geographic region could be spread out over multiple states and hundreds of miles. A key component of this program is to have a strong onsite presence by contract staff to work intensively with the employer to plan, implement, manage, and evaluate this program. The ability to devote the time necessary to be at the employer’s worksite is limited when employers are spread across wide geographic areas. Adding additional staff to the program was not supported by available resources. o Systems and Laws – Employers representing a single region across multiple jurisdictions could represent multiple systems of healthcare delivery, regulations, and ordinances that add complexity to program delivery. Two key components of the program are biometric assessment (i.e., health screening) and referral for high risk employees (cardiovascular and diabetes). Different jurisdictions have different requirements for screening. For example, some states require a physician to be present or administer biometric screening to employees as part of a workplace health program adding cost, time, and complexity to the program. Having all participating employers in one jurisdiction limits the systematic and regulatory differences to 7 and ensures all employers within a given community are operating under the same environment.o Community Coalitions - sustainability is a key outcome of the program. The program is limited to 2 years and much effort will be placed into building skill, knowledge, and capacity of employers during the program so that they can sustain and expand their programs after the program concludes. Sustainability is greatly enhanced by partnering with community-based organizations to gain access to the necessary skill, knowledge, program, and resources that can enhance workplace health program at the program’s end. The need to build community coalitions of employers and community-based organizations recognizes that most of the participating employers are small employers without the necessary resources to purchase all programs and services needed to sustain their programs in the future. Community coalitions in smaller jurisdictions are better equipped to foster these relationships quickly and identify and share resources most proximal to the participating employers. o Peer mentoring - Employer often turn to their peers and/or competitors for guidance and as a credible source of information. We wanted to incorporate peer to peer mentoring into the program so participating employers can learn from each other as much or more so than what they are gaining from CDC and Viridian. This too addresses the issue of sustainability in that a peer learning community can be formed and maintained after the program ends so employers can continue to grow and share best practices, innovations, and challenges with each other. Having employers in a localized community will allow for in person interactions, regular meetings and forums facilitated by program staff, and identify and share resource more efficiently. o Available resources – The program can only support 100 employers given the scope of work and the ability to execute all the program components with available resources. A group of 10-15 employers was determined to be sufficient to represent a single community so that industry sector diversity and all three company size categories could be included in each community A selected site location is a group of up to 15 employers that are all located within a small, defined geographic area (i.e., city, county) with sufficient community resources available to maintain a sustainable workplace health program when the National Healthy Worksite Program ends.
  • Many opportunities will be made available to non participating employers such as webinars and access to the website whether your company is not eligible to participate or your company is not interested in full participation but wants to be provided information and updates. Resources include – toolkits, case studies, webinars, assessment and evaluation tools, lesson learned captured.
  • Specify that we will post answers to FAQs not all questions.


  • 1. Public domain resources to address the epidemic of diabetes Pamela Allweiss MD, MPH CDC Division of Diabetes Translation pca8@cdc.gov The findings and conclusions of this presentation are those of the presenter and do not necessarily represent views of the Centers for Disease Control and Prevention.
  • 2. 26 millionwith Diabetes79 millionwithPre-Diabetes
  • 3. Epidemic of Diabetes• Diabetes affects almost 26 million Americans (8.3%), one quarter of whom don’t know they have it.• Another 79 million Americans have pre- diabetes, which raises their risk of developing type 2 diabetes, heart disease, and stroke.• About 1.9 million new cases of diabetes were diagnosed in people aged 20 or older in 2010.www.yourdiabetesinfo.org www.DiabetesAtWork.org
  • 4. Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2009 8 25 7 Percentage with Diabetes 20 Number with Diabetes (Millions) Number with DiabetesPercentage with Diabetes 6 5 15 4 10 3 2 5 1 0 0 1958 61 64 67 70 73 76 79 82 85 88 91 94 97 00 03 06 09 Year CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics
  • 5. Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed DiabetesObesity (BMI ≥30 kg/m2) 1994 2000 2009 No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%Diabetes 1994 2000 2009 No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics
  • 6. Diabetes means:• 2 x the risk of high blood pressure• 2 to 4 x the risk of heart disease• 2 to 4 x the risk of stroke• #1 cause of adult blindness• #1 cause of kidney failure• Causes more than 60% of non- traumatic lower-limb amputations each yearNIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2010.
  • 7. Estimated Cost of Diabetes in U.S. (ADA 2007)• Total: $174 billion• Indirect costs include increased absenteeism ($2.6 billion) and reduced productivity while at work ($20.0 billion) for the employed population• Reduced productivity for those not in the labor force ($0.8 billion)• Unemployment from disease-related disability ($7.9 billion)• Lost productive capacity due to early mortality ($26.9 billion)
  • 8. Opportunity knocks to open the doors between business and community health
  • 9. Crossing the Great Divide: Business andCommunities Come Together to Promote Health
  • 10. Why pick diabetes for a health promotion intervention at a business?• Effective interventions promote multiple good • Unique opportunity outcomes for education• Loss of productivity due to uncontrolled diabetes • Less time away may be improved with from work better glucose control• Improve quality of life • Improves for employees• Many employees (both employer- current and future) have employee relations or may be at risk for developing diabetes and shows employer cares about employees
  • 11. The health of a community impacts the economic health of its businesses and Corporations are able to play aunique role in the development of a community’s health and continued vitality NBGH Kellogg paper
  • 12. Where is the community partner?
  • 13. Do Any Interventions Work?• Bottom Line: Does better glucose control translate to better outcomes or better health in the individual?• Yes!• For every 1% drop in A1c the risk of microvascular complications (eye, kidney, and nerve damage) can be reduced by up to 40%.• http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.p
  • 14. Why Control Diabetes?• Better control translates into fewer complications in eyes and kidneys• Fewer complications translate into fewer days lost to absenteeism and disability, and future savings on health care expenditures• Fewer accommodations needed
  • 15. So what are some resourcesand how can we use them?
  • 16. National Diabetes Education Program• CDC and NIH program formed after evidence showed that better glucose control translated into fewer complications• Public and private partnerships to improve diabetes treatment and outcomes• Increased public awareness of the seriousness of diabetes, its risk factors, and strategies for preventing diabetic complications• NDEP translates the latest science and spreads the word that diabetes is serious, common, and costly, yet controllable and, for type 2, preventable www.yourdiabetesinfo.org www.ndep.nih.gov
  • 17. What is the NDEP? A Science-based Program• Goal - prevent or delay the onset of diabetes and reduce the illness and premature death caused by diabetes and its complications• Strategies based on: – Clinical trials, epidemiologic studies, evaluation of community interventions – Communication, education, and behavioral science
  • 18. National Diabetes Education Program Awareness Special Campaigns Populations Partnership NetworkCommunity HealthInterventions Systems A joint initiative of CDC and NIH
  • 19. What is the NDEP? Education and Communication• Two major tracks – prevention and control• Theory- and science-based, audience-tested and tailored messages, materials, tools and campaigns• Diversity of audiences – People with and at risk for diabetes and their families – Health care providers – Lay workers – Businesses/worksites
  • 20. National Diabetes Education Program• Stakeholder Groups – 4 ethnic minority – AAAA, AAPI, AIAN, H/L – 2 health care provider – HCP, PPOD – 2 age group – children/adolescent, older adults – 1 business – 1 evaluation• Materials for health care providers, for people who have diabetes and the people who care for them• Materials have been focus group tested by diverse audiences• Materials in multiple languages• NO COPYRGHT /Can be co-branded• www.yourdiabetesinfo.org• www.ndep.nih.gov
  • 21. NDEP Resources• Culturally-appropriate, pretested, copyright-free messages and materials in a variety of formats for a wide variety of audiences (public to professional)• Community capacity-building tools• Partnership experience and networks• Knowledge of diversity of cultures – ethnic minority, health professional, business
  • 22. NDEP Campaign Materials: Control & Prevention
  • 23. Different types of materials• Print• Downloads• Podcasts• Videos• Promotion resources• Behavior change resources• PP Presentations such as: Diabetes: the numbers, and Science of control
  • 24. Materials for Consumers
  • 25. Content• Healthy eating/ how to eat out/tasty recipes• Take care of your feet/Be smart about your heart• Team care• Tips to stay healthy• Know your numbers
  • 26. 4 Steps to control your diabetes brochure• Also available in these languages:• Bengali, Cambodian, Chinese, Gujarati, Haitian Creole (and CD), Hindi, Hmong, Japanese, Korean, Laotian, Samoan, Spanish, Tagalog, Thai, Tongan, Urdu, Vietnamese
  • 27. Materials for Professionals and Lay Workers
  • 28. NDEP Websites
  • 29. What is the NDEP? Continuously Improving• How do we increase reach and impact? – New channels and formats – Marketing approach• How can we make partnerships more strategic and effective?• How can we contribute to behavior change and health outcomes?
  • 30. NDEP Business Health StrategyStakeholder Group: Who are we?• CDC and NIH• Large and small businesses: GE, GM, Land’s End• Unions• Occupational health professionals• Public health agencies state Diabetes Prevention and Control Programs)• Managed care groups• National associations representing employers, business coalitions and health care insurers
  • 31. NDEP Business Health Strategy Partners• To increase awareness of the benefits of quality diabetes care among employers, benefits managers and managed care decision makers• To provide employers, health plans and employees with tools and information for incorporating diabetes education programs into the workplace• To promote the value of investing in prevention
  • 32. www.diabetesatwork.org Content• General Diabetes Education :• Nutrition, Weight Control, and Physical Activity• Lunch and Learn topics• Lesson Plans (English and Spanish)• Fact Sheets (English and Spanish)• Guide to choosing a health plan, developed with AAHP• Supervisor’s guide• NO COPYRIGHT!
  • 33. Words of Wisdom• Can’t transform everything at once• Use the web sites to print out forms and “recipes”• Don’t re-invent the wheel• Learn from others
  • 34. Other DAW Projects
  • 35. GE Project: What Did We Do?• Identify a population at high risk for developing diabetes and other cardiovascular risk factors by doing serial cardiovascular risk assessments (CRA) at the worksite• Combine public and private expertise (GE+ NBGH+ CDC) to develop interventions to decrease the risks• Content: www.diabetesatwork.org resources/ educational materials• GE adapted CDC diabetes at work materials and developed some its own
  • 36. Customer Satisfaction Results GE Much GE Little About MD Little MD Much Blank or Better Better Same Better Better NA Treats me with respect 33% 16% 49% 0% 0% 2% Accurately measures my blood pressure 23% 7% 67% 0% 0% 2% Clearly explains my risks 47% 23% 21% 5% 0% 5% Clearly explains how I can reduce my risks 51% 14% 26% 5% 0% 5%• “I have participated for three years. It is very helpful to see the progress on a consistent basis. This program definitely helps understand the health risks and management, and provides encouragement, support and guidance for healthy life style.”
  • 37. Trane Wellness Program: A Public Private Partnership• It started in a supermarket.• Medical providers (occ med professionals, docs, nurses, wellness coordinators)• Sources of expertise: Public health, NDEP (CDC/NIH), state DPCP (Diabetes Control and Prevention Program), University of Kentucky, Local Health Department• Community groups, AHA, ADA
  • 38. American Standard/Trane• Makers of the necessities of life• Partnership between health department and private company• On site training of all shifts• Plan: Spread to other plants in the US• Used basic fact sheets from DAW• 2 messages: Better diabetes control and Primary prevention
  • 39. Wheel of Diabetes Fortune:American Standard/Trane
  • 40. Evaluations and commentsComments from “what would keep you from attending classes” • If my boss won’t let me come • If unpaid time • Getting fired • Going on strike • Death • Wild Horses
  • 41. Lessons learned• Work with existing programs: True collaboration, not competition)• Include many community and health organizations• Include health plan• Consistency• Support from the top
  • 42. What is NDEP Doing in Primary Prevention?• Messages and materials – Dissemination – Evaluation• Tools for community-based prevention activities• Adaptation for businesses• Communication support to DDT’s primary prevention initiative
  • 43. Diabetes Prevention: Small Steps. Big Rewards!• Based on the science of The Diabetes Prevention Program (DPP)• Prevent type 2 diabetes in people with pre- diabetes• Modest lifestyle changes• Lose 5-7% of body weight, 10-15 lbs in a 200 lb person• Walk 30 minutes/5 days/ week• Game Plan Tool kit: strategies to motivate patients to change lifestyle• The DPP Research Group. Diabetes Care. 1999;22:623www.yourdiabetesinfo.org
  • 44. Summary of DPP Lifestyle Program Treating 100 high risk adults (age 50) for 3 years… • Prevents 15 new cases of type 2 diabetes1 • Prevents 162 missed work days2 • Avoids the need for BP/Chol pills in 11 people3 • Adds the equivalent of 20 perfect years of health4 • Avoids $91,400 in healthcare costs5• 1 DPP Research Group. N Engl J Med. 2002 Feb 7;346(6):393-403• 2 DPP Research Group. Diabetes Care. 2003 Sep;26(9):2693-4• 3 Ratner, et al. 2005 Diabetes Care 28 (4), pp. 888-894• 4 Herman, et al. 2005 Ann Intern Med 142 (5), pp. 323-32• 5 Ackermann, et al. 2008 Am J Prev Med 35 (4), pp. 357-363; estimates scaled to 2008 $US
  • 45. Small Steps, Big Rewards patient kit Reproducible handouts • Overview of GAMEPLAN and tools • Am I At Risk? 2 pager plus “at risk” height/weight charts • Food and Activity Tracker (8 ½ x 11 version of DPP pocket tracker) • Walking…A Step in the Right Direction guide for initiating a walking program • Fat and calorie counter
  • 46. The Road to Health/El CaminoHacia La Buena Salud CHW Primary prevention toolkit
  • 47. The Road to Health (RTH) Toolkit/ El camino hacia la buena saludToolkit : A Toolkit on Primary Prevention of Type 2 Diabetes for Community Health Workers (CHWs)/Promotores• The Road to Health Toolkit was developed based on the findings from the Diabetes Prevention Program (DPP) study and focus groups with African American and Hispanic/Latino Community Health Workers.• Focus groups with CHWs from urban and rural African American and Hispanic/Latino communities: – Diabetes testing, management, and prevention strategies – Barriers, opportunities, perceptions – Focus on primary prevention – Tools needed – Training video
  • 48. News You Can Use• November is National Diabetes Awareness Month
  • 49. National Diabetes Prevention Program Goal:  Systematically scale the translated model of the Diabetes Prevention Program (DPP) for high risk persons in collaboration with community-based organizations that have necessary infrastructure, health payers, health care professionals, public health, academia, and others to reduce the incidence of type 2 diabetes in the United States.
  • 50. NATIONAL DIABETES PREVENTION PROGRAM Components Training: Recognition Intervention Health Increase Program: Sites: Deliver Marketing: Workforce Quality Program Support Program Uptake Train the Implement a Developworkforce that recognition intervention Increasecan implement program that will: sites that will referrals the program • Assure quality build to and use ofcost effectively • Lead to infrastructure the prevention reimbursement and provide the program • Allow CDC to program develop a program registry
  • 51. Per capita costs of the lifestyleintervention program (US$)Interventions Cost per yearIntensive Lifestyle (DPP) $1,500 / $700*Group Lifestyle (DPP) $300 – 450*Group Lifestyle at YMCA $240**Note: For DPP, $1500 for the first year and $700 for years after the first yearSources: * Herman , Brandle , Zhang, et al. Diabetes Care. 2003 Jan;26(1):238-9. **Ackermann, et al. Am J Prev Med. 2008 Oct;35(4):357-63
  • 52. National Diabetes Prevention Program• Training = CDC contracted with Emory University to establish the Diabetes Training and Technical Assistance Center (DTTAC) and developed Master Trainer curriculum and unified Lifestyle Coach curriculum – www.dttac.org.• Recognition Program = CDC and partners developed the standards for program recognition• For more information: http://www.cdc.gov/diabetes/prevention/
  • 53. National Healthy Worksite Program. The Comprehensive Workplace Health Program to Address Physical Activity, Nutrition, and Tobacco Use in the Workplace will establish and evaluate comprehensive workplace health programs to improve the health of workers and their families.Source: Solicitation #: 2011-N-13420 3
  • 54. Program Goals• Reduce the risk of chronic disease among employees through science-based workplace health interventions and promising practices.• Promote sustainable and replicable workplace health activities such as establishing a worksite health committee, having senior leadership support, and forming community partnerships and health coalitions.• Promote peer-to-peer business mentoring.4
  • 55. Local Program Sites National Healthy Worksite Program Community Regions LevelEmployer Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 75
  • 56. Non-participating Employer Resources Technical Assistance • Quarterly Training • Peer to peer mentoring/key program findings • Participation in community partnerships • Subject matter expertise on worksite wellness • Webinars and distance-based learning • Resources and tools will be available through program website http://www.cdc.gov/NationalHealthyWorksite33
  • 57. How to Stay Connected• Program website www.cdc.gov/nhwp or www.cdc.gov/NationalHealthyWorksite• Program mailbox NationalHealthyWork@cdc.gov• Responses to frequently asked questions will be posted to the National Healthy Worksite Program website. The website will be updated regularly. 34
  • 58. How do I get NDEP materials?All NDEP materials are copyright-free. Download fromwww.yourdiabetesinfo.orgVisit all of the NDEP Web sites:www.ndep.nih.govwww.betterdiabetescare.nih.govwww.cdc.gov/diabetes/ndepwww.diabetesatwork.org