Diabetes THE APPROACHING TSUNAMI The Ironman Effect 26
Diabetes THE APPROACHING TSUNAMI
The Ironman Effect
26% of Americans above age 65 have type II DM
That means we are creating 2500 diabetics every single day.
Medicare is predicted to become insolvent in 2030.
America’s Growth Spurt
BMI >30 and Diabetes
Diabetes has increased nearly 10 -fold since 1958
Creeping Normalcy
Diabetes and Weight Gain of 11 -16 lbs. doubles the risk of type 2 diabetes Gain of 17 -24 lbs. triples the risk of type 2 diabetes
Costs of Diabetic Meds Metformin - $4/month Januvia - $300/month Farxiga - $460/month Victoza - $600/month Trulicity - $1000/mo. , lowers A 1 c 1 -1. 5% Januvia lowers A 1 c by average of 0. 7% Exercise for 8 weeks lowers A 1 c by 0. 66%
The High Cost of Diabetes
Shadow Pricing On May 30, 2014, the price for a vial of the blockbuster diabetes medication Lantus went up by 16. 1 percent. On the next day, Lantus’s direct competitor, Levemir, also registered a price increase -- of 16. 1 percent. Six months later Lantus was marked up 11. 9 percent, and Levemir matched again exactly. In 13 instances since 2009, prices of Lantus and Levemir have gone up in tandem in the U. S.
“I used to be afraid of failing at something that really mattered to me, but now I'm more afraid of succeeding at things that don't matter. ” ― Bob Goff, Love Does: Discover a Secretly Incredible Life in an Ordinary World
You Are Not Just Treating Diabetes Depression Social isolation Obesity
Exercise ROI Modest exercise can prevent or delay onset of DM by 58% (71% in patients over 60) – NIH/CDC DPP Loss of 5 -7% body weight – 10 lbs. in 200 lb. male, 8 lbs. in 160 lb. female
Gluconomics
Population Statistics Kootenai county 150, 000 Region 1 (5 northern counties) – 220, 000 Idaho – 1. 5 million 8. 4% diabetes Statewide, only 7% Region 1
Idaho Diabetes Statistics Idaho – 1. 5 million 8. 4% diabetes Statewide, only 7% Region 1 126, 000 diabetics (8. 4%) 555, 000 prediabetics (37%)
Region 1 Diabetes Statistics Region 1 – 220, 000 15, 400 diabetics (7%) 81, 400 prediabetics (37%)
Region 1 20 lifestyle coaches 100 patients per coach per year 2000 prediabetics per year Of 2000 participants, 300 -600 cases of diabetes expected (15 -30%) 200 -400 cases prevented (60 -70% reduction) At 81, 400 prediabetics, it would take over 40 years to reach all current atrisk individuals Remaining 80, 000 patients, 12, 000 -24, 000 will become diabetic Classes reduce rate of conversion to DM by 1. 6%
Idaho Statistics 50 lifestyle coaches 100 patients per coach 5000 prediabetics per year Of 5000 participants, 750 -1500 cases of diabetes expected (15 -30%) 500 -1000 cases prevented (60 -70% reduction) At 550, 000 prediabetics, it would take 110 years to reach all current at-risk individuals Remaining 545, 000 patients, 81, 750 -163, 500 will become diabetic Classes reduce rate of conversion to DM by 0. 9%
Population Health
Department of Health and Welfare Clinical services account for a relatively small impact on population health. To improve the health of a broadly defined population, integration of clinical services, public health and community based initiatives is necessary. John Auerbach’s (Associate Director for Policy, Centers for Disease Control and Prevention) method for analyzing the measures of health (adopted by Get Healthy Idaho).
Auerbach’s Buckets Bucket #1 – Traditional Clinical Approaches. Patient construct, one-onone patient interaction. Bucket #2 – Innovative Clinical Care. Patient construct with a narrow population view, e. g. accountable care organization, patient centered medical home. Bucket #3 – Community-wide Health. Community construct, focus is on a broad population (Health District or the state of Idaho). Typically has a policy focus.
YMCA Diabetes Prevention Program Three-year, $12 million grant from the federal Center for Medicare and Medicaid Innovation to make its diabetes-prevention program available to about 10, 000 Medicare patients in 17 communities. $1200 per participant
YMCA’s Effort By The Numbers 11, 714: Participants who attended at least one diabetes-prevention class session. 1, 477: Classes started. 1, 295: Lifestyle coaches trained to teach the CDC's evidence-based curriculum. 569: Diabetes-prevention class locations. 86: Community YMCAs with teachers trained to deliver the program. 35: States where the program is offered. 4. 9%: Average body weight loss achieved by program participants. Source: “YMCA's Diabetes Prevention Program Overview, ” YMCA of the USA, June 17
YMCA’s Effort By The Numbers 1, 295 certified Lifestyle coaches 1, 477 classes 11, 714: Participants who attended at least one session 8 participants per class We would need 9 million DPP classes
Diet and Exercise DM HTN High cholesterol Obesity CAD Sleep apnea Anxiety Depression Social isolation
Kroc Rx
The Doctor Will See You Now
Center for Healthy Living
Pathways to Health We must offer pathways to health. The model will be based on: visits at the health facility group support, and education through shared medical appointments We will bring resources TO the patient rather than asking the patient to travel to the resources.
Evaluation and Management Everyone should be offered diet and exercise. Everyone should have a psychosocial evaluation. It is not enough to recommend these things, they must be provided as part of the health care visit.
What Constitutes an Office Visit? Exercise IS a visit. Diet instruction IS a visit. Behavioral health instruction IS a visit. (goal setting, behavioral activation, CBT, mindfulness solution)
Heritage Health University Ph. D in Health Exercise module Nutrition module Behavioral health module Life Skills module – financial, spiritual, social Medication reduction module
A Different Strategy Collaboration Relationship Think outside your 4 walls Find your largest partner(s) Churches, colleges, community centers Look for champions with passion Surround your patients with healthy role models
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