Diabetes Prevention and Control Best and Promising Practices

Prevent and Control Diabetes Rick Schwertfeger, M. A. T. Program Manager Steps to a Healthier Austin Program Division of the Medical Director Austin/Travis County Health & Human Services Austin, Texas

The Biggest Impact: REDUCE OBESITY

Prevent and Control Diabetes Increase physical activity throughout a population

Prevent and Control Diabetes Improve nutrition throughout a population

Prevent and Control Diabetes Case Management

Prevent and Control Diabetes Formalized patient education

Prevent and Control Diabetes Clinicians refer high risk individuals to preventive services

Prevent and Control Diabetes Hb. A 1 c = or < 7. 0

Prevent and Control Diabetes Foot Checks: • Self Check: Daily • Clinical at least 1 x / Yr. • Posters in Exam Room

Prevent and Control Diabetes Eye checks at least 1 x / year

Prevent and Control Diabetes Yearly Flu Shot

Prevent and Control Diabetes Define, analyze and intervene on your Community Diabetes System

Prevent and Control Diabetes Local Diabetes Coalition

Steps to a Healthier Austin • • Reduce the burden of Obesity Reduce risk behaviors – Poor nutrition – Lack of physical activity • Overarching Goals 4. Prevent overweight and obesity 6. Improve nutrition 7. Increase physical activity Austin/Travis County Health and Human Services Department

The Data What does our data say?

Baseline: Obesity Rates Disease/behavior Number % 95% CI Overweight 188, 784 34. 8 % 27. 8 – 41. 8 Obese 102, 938 19. 0 % 9. 7 – 28. 3 Overweight/Obesity 291, 722 53. 8 % 46. 7 – 60. 9 Nutrition – 5 or more vegetables and fruit per day 174, 929 30. 5 % 21. 5 – 39. 5 Physical Activity – Any leisure time physical activity 490, 251 85. 6 % 80. 6 – 90. 5 180, 796 - 221, 740 Source: 2003 BRFSS Data Overweight/Obese

Baseline: Obesity Rates Disease/behavior From To Overweight 127, 891 192, 297 Obese 44, 624 130, 192 Overweight/Obesity 214, 839 280, 165 Nutrition – 5 or more vegetables and fruit per day 98, 909 181, 716 Physical Activity – Any leisure time physical activity 370, 793 416, 337 Source: Stratified from the 2003 Travis County BRFSS data.

Baseline: Intervention Area Causes of Death 2000 -2001 Age adjusted mortality rate per 100, 000 Austin/Travis County Health and Human Services Department

Obesity Trends 2004 -2006 Source: BRFSS 2004 -2006 Question: This was calculated from the self-reported height and weight.

Obesity Trends 2004 -2006 Population Obesity Yr 1 2004 Yr 2 2005 Upper 95 CI% Yr 3 2006 Yr 1 2004 Yr 2 2005 Lower 95 CI% Yr 3 2006 Yr 1 2004 Yr 2 2005 Yr 3 2006 55. 0 57. 5 SHA 54. 6 59. 3 62. 8 55. 7 63. 4 67. 7 51. 7 White 47. 0 56. 7 57. 8 51. 1 62. 1 63. 7 43. 0 51. 2 51. 8 African American 74. 1 67. 8 77. 2 80. 6 79. 6 84. 9 66. 3 53. 2 67. 1 Hispanic 59. 1 62. 4 68. 1 64. 0 70. 0 77. 5 54. 2 57. 0 Male 62. 3 65. 4 67. 8 66. 6 71. 5 75. 7 57. 7 58. 8 Female 46. 4 51. 9 57. 1 50. 0 57. 0 62. 4 42. 9 46. 6 51. 6 Texas 63. 0 64. 1 65. 9 38. 7 60. 1 25. 5 US 60. 1 61. 1 Source: BRFSS 2004 -2006 Question: This was calculated from the self-reported height and weight.

% trying to lose weight Source: BRFSS 2005 -2006. Question: Are you now trying to lose weight?

Eating Fewer Calories/Fat to Lose Weight Source: BRFSS 2005 -2006. Question: Are you eating fewer calories or less fat either lose weight or keep from gaining weight?

Fruit and Vegetable Consumption Stages of Change Do you consistently eat 5 servings of fruits and vegetables a day? 95 % CI Lower 95 % CI Upper N Rate (%) 2005 434 29 25 32 Yes, I have been for more than 6 months 2006 500 35 30 40 Yes, I have been for less than 6 months 2005 118 8 6 11 2006 86 6 5 8 2005 334 22 19 26 2006 314 22 18 26 2005 177 12 9 14 2006 186 13 10 17 2005 449 30 26 34 2006 343 24 21 28 No, but I intend to in the next 30 days No, but I intend to in the next 6 months No, and I do not intend to in the next 6 months Year Source: BRFSS 2005 -2006 Question: Do you consistently eat 5 servings of fruits and vegetables a day?

People Who Report Eating 5 or More Fruits and Vegetables Daily Source: BRFSS 2004 -2006

Number of Fruit and Vegetable Servings per Day Source: BRFSS 2004 -2006 Question: Five Fruit and Vegetable Servings per Day Index-DSHS calculated

Leisure Time Physical Activity in the Past Month Source: BRFSS 2004 -2006 Question: During the past month, other than your regular job, did you participate in any physical activities or exercises?

% Using Physical Activity to Lose Weight Source: BRFSS 2005 -2006. Question: Are you using physical activity or exercise to lose weight or to keep from gaining weight?

Recommended Physical Activity Levels Source: BRFSS 2004 -2006 Question: Meets Recommendations for Moderate or Vigorous Physical Activity is a calculated value from multiple questions about level of physical activity.

Percentage of People Meeting Recommended Moderate or Vigorous Physical Activity Levels Source: BRFSS 2004 -2006 Question: Meets Recommendations for Moderate or Vigorous Physical Activity is a calculated value from multiple questions about level of physical activity.

Physical Activity Reported Stages Source: BRFSS 2005 -2006 Question: (Based on a definition of physical activity) Do you exercise regularly according to that definition?

How People are Lowering Their Risk of Health Problems Source: BRFSS 2005

Use of Areas Conducive to Physical Activity Source: BRFSS 2004 -2006

Level of Physical Activity in the Neighborhood Approximately 75% of Neighborhoods are physically active Source: BRFSS 2004 -2006

Step’s Approach Community based physical activity and nutrition approaches

Medical Model • Limited approaches • Medicines – Slow – Lack of effectiveness in the long term • Bariatric Surgery – Costly – Complications – Lifelong medical management

Steps Model • Working through collaborative partnerships to increase outreach capacity • Build capacity of partners to reach target • Work at the systems level • Focus on community actions and community changes • Focus on nutrition and physical activity strategies

Overall Impact Community Capacity Building Community Actions** Community Changes* Overall 1402 878 Asthma 338 251 Diabetes Obesity Blank 353 181 625 86 410 35 Collective Consortium Achievements *A community change is a new program, policy or practice **A community action is an action taken to lead to a new program, policy or practice Source: SHA Online Documentation Surveillance System (ODSS) (9/22/2003 -9/21/2006)

Steps Unique Encounters Total Number of Encounters = 964, 314 Physical Activity Nutrition Diabetes Obesity OVER ALL TOTAL Source: SHA Partner Reports Years 1 -3 141, 395 215, 549 607, 112 258 964, 314 These are unique encounters. Individual persons may have had more than one encounter.

Community Changes per Objective Obesity Yr 1 Yr 2 Yr 3 Total Obj. 1 - Reduce Adult Obesity… 22 49 44 115 Obj. 2 - Increase Daily Consumptions Of Fruits And Vegetables… 4 42 47 93 Obj. 11 - Increase Child And Adolescent Engagement In Physical Activity… 6 26 22 54 Obj. 12 - Increase Child And Adolescent Engagement In School Physical Activity… 5 6 5 16 Obj. 3 - Increase Adult Engagement In Physical Activity… 31 59 65 155 TOTAL 68 182 183 433

Community Actions per Objective Obesity Yr 1 Yr 2 Yr 3 Total Obj. 1 - Reduce Adult Obesity… 30 77 101 208 Obj. 2 - Increase Daily Consumptions Of Fruits And Vegetables… 10 31 71 112 Obj. 11 - Increase Child And Adolescent Engagement In Physical Activity… 13 37 78 128 Obj. 12 - Increase Child And Adolescent Engagement In School Physical Activity… 26 68 19 113 2 2 1 5 26 10 73 109 107 225 343 675 Obj. 13 - Increase The Proportion Of Schools That Offer Physical Education Classes… Obj. 3 - Increase Adult Engagement In Physical Activity… TOTAL

Nutrition Strategies • Community Cooking Classes – Sustainable Food Center • Train the Trainer Model • Individual participants • Improved Early Childhood Nutrition – Family Connections • Health Worker Certification for Child Care Centers • Outreach to new mothers to increase breastfeeding and create awareness of services

Nutrition Strategies • Farmer’s Markets and Farm Stands – WIC sites – Sustainable Food Center • Lone Star Card to wooden tokens – Increased access • Manor’s Farmers Market • School Gardens – Sustainable Food Center and Marathon Kids • Collaborative effort • Targeting schools • Increase availability and awareness

Nutrition Strategies • School Nutrition Improvements – AISD • Vending machine offering changes • Revamped the school cafeteria menu – MISD, DVISD & PISD • • Vending machine offering changes Revamped the school cafeteria menu Adoption of school Wellness Policy AISD is sharing knowledge and tools with other districts

Nutrition Strategies • Soda and Snack Vending Machine Offerings • Fruit Basket Mini Project • Wellness Wednesdays at Schools – Foods of the Month (Vegetable, Fruit, Dairy or Grain and a Food for Thought) • HEB Initiatives – In the works – – Environmental System Changes at 4 locations Suggested change to Meal Deals Suggested changes to Combo Loco Suggested healthy shopping list

Physical Activity Strategies • Increase the Use Underutilized PARD Facilities – Summer Splash Pool Parties approx. 867 – P 3 Initiatives • Expand the Participation of Marathon Kids – – Year 3 SHA Area MK Participants: Year 4 SHA Area MK Participants: Year 3 SHA Area Completed 26 M: Year 4 SHA Area Completed 26 M: 14, 239 15, 897 = +12% 11, 018 12, 026 = + 9%

Physical Activity Strategies • YMCA Swim Safe – 800+ in 1 st year • YMCA Walking Trail • Walk with WIC – Stroller Program – Peer Support Group • Walk Texas Austin Chapter – Supported by an Active Austin Guide • Walk Across Texas – Texas Cooperative Extension Agency Program

Physical Activity Strategies • Texas Round Up – Support of the Texas-wide Governor’s Fitness Initiative • Healthy Built Environment – 6 locations – Walking Trails (new, extensions, & renovations) – Outdoor Fitness Equipment – Mileage Markers

Physical Activity Strategies Model Programs: • Capital Metro • Mayor’s Fitness Council

Capital Metro Success Story! Comprehensive worksite wellness program • • Consultations with dieticians and personal trainers 24 -hour company fitness center (NEW!!!) personalized health assessments Healthy food choices discount in the company’s cafeteria • A myriad of weight and nutritional management programs • Childcare program Since 2003

Capital Metro Success Story! Health Impact • Reduced health care costs Year Cost increase 2005 -06 6% predicted 2004 -05 9. 6% 2005 -06 26. 8% • Employee absenteeism rates decreased more than 44%, from a high of 12. 4% in March 2004 to 6. 9% in June 2006. Participants report: • increased exercise • healthy food consumption • weight loss • better blood pressure management • reduced stress levels • better overall general health

Capital Metro Success Story! Why is this program working? Studies indicate that comprehensive worksite health programs focused on lifestyle behavior change lead to improvements in health behaviors among employees and a return on investment or employers, in terms of improved employee health and saved health care costs.

Mayors Fitness Council Partner Certification

Benefits of Being an MFC Certified Partner General (All Areas) • Add value to the business • Build and protect reputation and license to operate • Reduce perceived company risk ( a better reputation) • Manage stakeholder expectations and regulatory pressure • Build a sustainable business Workplace • Preferred employer, recruit talented people • Broader risk management generating rationalization and cost savings • Improve employee morale • Improve productivity Marketplace • Enhance brand value and customer loyalty • Create competitive edge • Become a preferred supplier or partner • Improve supply chain performance Environment • Improved environmental performance • Resource conservation • Waste reduction • Cost savings Community • Increased access to local resources • Create mutual advantage within the community Austin/Travis County Health and Human Services Department

Mayor’s Fitness Council Partner’s Certification - Next Steps • Contact the Mayor’s Fitness Council and meet with a council member to begin the partnering process • Implement the Austin Fitness Index in your organization. • Work with the MFC Nutrition and Physical Activity teams to implement effective change programs in each area. • The MFC can provide programs, tools, messaging and support. • Commit to health and fitness at both an individual and at the organizational levels. Austin/Travis County Health and Human Services Department

Physical Activity Strategies • In the works… – Safe Routes to School Application – Point of Decision Prompts in COA buildings – COA PE Dept. Walk/Run and Swim Programs – Retrofitting some COA buildings with showers

How Far Have We Come? Data Speaks…

General Obesity Numbers • 467 CCs with Obesity as the General Goal • Total SPs on Obesity: 223 • Total Number of People Served by Obesity SPs: 37, 668 • Total Number of Hours of SPs on Obesity: 3, 872

General Nutrition & Obesity Numbers • 108 CCs on Nutrition • Total SPs on Nutrition: 235 • Total Number of People Served by Nutrition SPs: 109, 056 people • Total Number of Hours of SPs on Nutrition: 6, 329

Community Changes with Objectives in Nutrition & Obesity • 127 CCs with Objective as reduce adult obesity • 108 CCs with Objective as increase fruit and vegetable consumption • 178 CCs with Objective on increasing adult physical activity • 61 CCs with Objective on increasing child and adolescent physical activity • 20 CCs with Objective to increase child and adolescent participation in school physical education

Services Provided with Objectives in Nutrition & Obesity • 223 SPs with Objective to reduce adult obesity • 235 SPs with Objective to increase fruit and vegetable consumption • 269 SPs with Objectives to increase adult physical activity • 87 SPs with Objective to increase child and adolescent physical activity • 28 SPs with Objective to increase child and adolescent participation in school physical education

Nutrition Community Changes by Program • SFC 33 CCs • WIC 3 CCs

Nutrition Services Provided by Program • SFC Farmers' Market SPs served 3, 855 people with 125 hours of services • SFC THK SPs served 35, 191 people with 375 hours of services • Walk with WIC served 414 people with 42 hours of services • WIC nutrition education served 299 people with 10 hours of service • SHA Core Staff presentations on nutrition served 1700 people with 8 hours of service • ACS Worksite Wellness programs on nutrition served 12, 374 people with 42 hours of service • FC reached 46, 283 people with nutrition education with 5, 363 hours of service (thru trainings, expo, and the newborn packets delivered at hospitals) • H&L served 3, 597 people with nutrition programs with 514 hours of service

Steps to a Healthier Austin Thank you! For more information: Visit www. i. Thrive. Austin. org Call (512) 972 -6761