Pilot program to prevent diabetes targets lifestyle
WILLMAR -- Halfway through a new four-month, intensive lifestyle-counseling program to reduce their risk of getting type 2 diabetes, the 12 participants have lost a collective 128 pounds.
One person has managed to halve the amount of blood pressure medication he needs. Someone else has started taking walks during the work day.
Most of all, they've benefited from the support of being in a group, said Kara Ellwood, health enhancement coordinator at the Kandiyohi County Area Family YMCA.
"They feel a lot from the group atmosphere. That's what they keep saying over and over," she said. "The support is huge."
The program at the YMCA, which began in February, is part of a state pilot project to examine whether intensive group intervention is effective at preventing or delaying the onset of diabetes among people who have prediabetes.
Willmar is one of three cities -- the others are Rochester and West St. Paul -- selected for the study through the Steps to a Healthier Minnesota initiative.
People with prediabetes have blood glucose levels that are higher than normal but not high enough to qualify as diabetes. Many of them are at elevated risk of developing type 2 diabetes.
This progression doesn't have to be inevitable, however. One of the most widely cited studies, the Diabetes Prevention Program, found that with intensive individual counseling on nutrition and physical activity, people with prediabetes could reduce their three-year risk of developing diabetes by up to 58 percent.
That's the idea behind the Individuals and Communities Acting Now to Prevent Diabetes project, which the YMCA hopes to establish as one of its ongoing community health services.
It's one of the first times there's been any formal effort anywhere to prevent diabetes upstream -- at the prediabetes stage, Ellwood said.
"Minnesota is the only state doing anything with prediabetes," she said.
Local sessions are held at the YMCA once a week for 16 weeks and are led by trained facilitators.
It's a chance for the participants to get good, basic information on food and physical activity but, more importantly, for them to learn how to incorporate this into their daily routine, said Lisa Dawson. Dawson is a fitness instructor at the YMCA and nutrition counselor who is one of the three coaches for the ICAN Prevent Diabetes program.
"We emphasize lifestyle changes," she said. "It's one thing to know what to do. These people have the tools. They just don't know how to use them."
Busy lives, work schedules and a lack of time and energy often lead to less-than-desirable health behaviors, and this can become even more entrenched as people reach middle age, when their risk of type 2 diabetes might begin to climb, Dawson said.
"Habits develop over a lifetime. It's hard to change those behaviors," she said. "It's catching up with them now and they're having to re-evaluate."
"They're realizing this is important," Ellwood agreed.
Gene Kubesh, one of the participants, called it "exactly what I needed to change my lifestyle.
"This includes not only how much you eat, but what you eat," he said. "The encouragement to exercise is also a great help. The group setting creates a lot of synergism that would not be possible by yourself."
Others in the group said they were especially motivated by the need to be accountable.
The chance to connect with other people in the same boat has been one of the most valuable aspects, Dawson said.
"You get down on yourself. The group is really finding that they're not alone," she said. "They affirm that they all are struggling with the same things."
Evaluations at the program's halfway mark suggest that group instruction is indeed an effective -- and low-cost -- way of helping people with prediabetes change their health behaviors.
Two of the participants have already met one of the program goals of losing 7 percent of their body weight, and a few more are close to that goal, Dawson said.
The program also helps participants increase their physical activity by 30 minutes each week, until they reach two and a half hours of activity a week.
Blinded data are being collected and forwarded to the Minnesota Department of Health to help track the program's effectiveness. Participants will be re-evaluated 18 months after completing the program to see whether they maintained their lifestyle changes.
Sustaining long-term change will be one of the challenges, Ellwood and Dawson said. They plan to develop a follow-up program that will allow people to check in every four to six weeks to ensure they stay on track.
A new session of ICAN Prevent Diabetes is slated to start April 25, and already three people are signed up, Ellwood said.
Based on estimates from Family Practice Medical Center and Affiliated Community Medical Centers, at least 1,100 people locally have prediabetes and are candidates for the program, Ellwood said.
"So we know the need is out there," she said. "I think the medical community is starting to realize this program is good."