Living on the Edge of Diabetes: How to Integrate the Diabetes Prevention Program into a Community Setting

Abstract

It is estimated that 26% of U.S. adults above the age of 20 have impaired fasting glucose.1 This condition, which is a pre-cursor to diabetes, is diagnosed by a fasting plasma glucose level of 100-125 mg/dl.2 The cardiometabolic risk factors for diabetes include dyslipidemia, hypertension, smoking, being overweight (BMI ≥ 25 kg/m2), hypertryglyceridemia, and inactivity.3 Other risk factors are a large waist circumference (women ≥ 35 inches; men ≥ 40 inches), a history of gestational diabetes, and a family history of diabetes. The percentage of Americans who are overweight or obese is 66.3%.4 The increasing number of pre-diabetes diagnoses and rates of overweight and obesity are staggering, causing many health professionals to feel overwhelmed. The Diabetes Prevention Program (DPP) was a landmark study that demonstrated a reduction or delay in the diagnoses of type 2 diabetes in high-risk individuals, which was achieved through lifestyle intervention with a weight loss of 7% of initial body weight combined with an exercise program of at least 150 minutes per week.5 Participants in this study were assisted by a lifestyle coach who provided motivation and support. The purpose of this article is to describe a program created to integrate materials from the DPP into a year-long education course for self-paying individuals. The intent of the course was to delay or prevent type 2 diabetes in a high-risk population in a rural and economically challenged community while keeping the course cost-effective. Since 2005, we have successfully organized a diabetes prevention program in Kalispell, Mont. Kalispell is located in Flathead County in northwest Montana. Flathead County is classified as a rural county with ~ 14.6 people per square mile and a total population of 74,471.6 We have one regional medical center and serve approximately five surrounding counties with outreach …