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 million
with Diabetes
79 million
with
Pre-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 Diabetes
Percentage 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 Diabetes
Obesity (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
year
NIDDK, 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 and
Communities 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 a
unique 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

16. So what are some resources
and how can we use them?

17. 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

18. 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

19. National Diabetes
Education Program
Awareness Special
Campaigns Populations
Partnership
Network
Community Health
Interventions Systems
A joint initiative of CDC and
NIH

20. 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

21. 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

22. 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

23. NDEP Campaign Materials: Control &
Prevention

24. Different types of materials
• Print
• Downloads
• Podcasts
• Videos
• Promotion resources
• Behavior change resources
• PP Presentations such as: Diabetes:
the numbers, and Science of control

25. Materials for Consumers

26. 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

27. 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

28. Materials for Professionals and
Lay Workers

29. NDEP Websites

30. 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?

31. NDEP Business Health Strategy
Stakeholder 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

32. 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

34. 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!

35. 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

36. Other DAW Projects

37. 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

38. 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.”

39. 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

40. 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

41. Wheel of Diabetes Fortune:
American Standard/Trane

42. Evaluations and comments
Comments 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

43. Lessons learned
• Work with existing programs: True
collaboration, not competition)
• Include many community and health
organizations
• Include health plan
• Consistency
• Support from the top

44. 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

45. 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;22:623
www.yourdiabetesinfo.org

46. 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

47. 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

51. The Road to Health/El Camino
Hacia La Buena Salud CHW Primary
prevention toolkit

52. The Road to Health (RTH) Toolkit/ El camino hacia la buena salud
Toolkit : 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

53. News You Can Use
• November is National Diabetes
Awareness Month

55. 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.

56. NATIONAL DIABETES PREVENTION
PROGRAM
Components
Training: Recognition Intervention Health
Increase Program: Sites: Deliver Marketing:
Workforce Quality Program Support
Program Uptake
Train the Implement a Develop
workforce that recognition intervention Increase
can implement program that will: sites that will referrals
the program • Assure quality build to and use of
cost effectively • Lead to infrastructure the prevention
reimbursement
and provide the program
• Allow CDC to
program
develop a
program registry

57. Per capita costs of the lifestyle
intervention program (US$)
Interventions Cost per year
Intensive 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 year
Sources: * 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

58. 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/

59. 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

60. 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

61. Local Program Sites
National Healthy Worksite Program
Community Regions
Level
Employer
Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7
5

62. 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/NationalHealthyWorksite
33

63. 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

64. How do I get NDEP materials?
All NDEP materials are
copyright-free.
Download from
www.yourdiabetesinfo.org
Visit all of the NDEP
Web sites:
www.ndep.nih.gov
www.betterdiabetescare.nih.gov
www.cdc.gov/diabetes/ndep
www.diabetesatwork.org