• Nurse-Led Peer Facilitated Diabetes Prevention and Early Intervention Program

      Adejumo, Oluremi Abiodun; Bode, Claire (2019-05)
      BACKGROUND: Prediabetes, an antecedent to type 2 diabetes (T2D) - the 7th leading cause of death and disability in the U.S., poses a greater impact on marginalized populations. The risk factors include excessive weight, unhealthy eating habits, sedentary lifestyle, and smoking. Diabetes prevention program (DPP) lifestyle intervention can delay or halt the progressions of prediabetes to T2D. PROBLEM: The formerly homeless men in an inner-city residential employment center on the East Coast of the U.S. exhibited high rates of risk factors for T2D: tobacco use (83%), obesity (54%), pre-hypertension (39%), hypertension (14%), and family history of diabetes (42%). OBJECTIVES: This nurse led DPP project implemented and evaluated a peer facilitation approach for reduction of T2D risks among the formerly homeless men in this employment program. METHODS: Five formerly homeless men who were previously trained as diabetes prevention lifestyle coaches (“peer facilitators”) using the Group Lifestyle Balance curriculum delivered twelve (12) weeks of the DPP core interventions to their peers. Each peer kept weekly logs of dietary and smoking habits, the number of times per day that they replaced sugar-sweetened beverages (SSB) with water, and physical activity. Data analyses of changes in all variables were conducted using self-reported data from the participants’ weekly logs and statistical significance was analyzed using the paired t-tests. RESULTS: All these men (N=15) met the required inclusion criteria of having a score of five (5) or higher on the American Diabetes Association (ADA) risk assessment test (mean=5.53; SD=0.74; range=5-7 of a maximum 11 points) combined with being aged 18 years or older. At baseline, most of these men were smokers (73%) and had a family history of diabetes (73%). Data from the participants’ weekly logs for weeks 1 to 12 showed statistically significant changes in behavioral modifications except for physical activity between weeks 1 and 4 (p=0.5). However, there was a significant increase in the participants’ mean number of days for physical activity from week 1 to week 8 (p=0.007) and week 1 through week 12 (p<0.001). Significant reductions were also observed in participants’ mean weights from weeks 1 to 12 (p<0.001). CONCLUSION: Implementation of a nurse-led, peer-facilitated, diabetes prevention in formerly homeless men significantly reduced their risks for T2D; fostered strong relationships among peers; increased program’s relevance and participants’ attendance, as well as provided enormous opportunities for these facilitators to seek employment in other community-based support programs. As well-informed community leaders, these men can also reach numerous other, often hard-to-reach individuals in their network of family and friends. Thus, commitments from local partners will be extremely valuable for sustainability and future evaluations of this tailored, community-based, quality improvement project.
    • Prediabetes Identification and Diabetes Prevention Program Referral

      Hansen, Shannon C.; Bode, Claire (2019-05)
      Background: Diabetes is a common chronic disease and can lead to comorbidities such as coronary artery disease, stroke, hypertension, peripheral vascular disease, nephropathy, neuropathy, and retinopathy. Prediabetes is an asymptomatic disease that precedes type 2 diabetes and affects 84 million Americans. Participating in a structured diabetes prevention program (DPP) incorporating education on healthy diet, physical activity of at least 150 minutes per week, and weight loss of at least 5-7% can prevent or prolong a diabetes diagnosis. Local Problem: A suburban primary care clinic was inconsistently identifying patients with prediabetes and not referring them to an evidence-based diabetes prevention program. The purpose of this project was to implement and evaluate a quality improvement project incorporating prediabetes identification and referral to a DPP at the primary care clinic. Interventions: At the primary care clinic, adults identified with prediabetes who met inclusion criteria were referred to an evidence-based diabetes prevention program approved by the Center for Disease Control and Prevention (CDC). Criteria included being 18 years of age or older, having lab values in the prediabetes range (HgA1c 5.7-6.4%), and did not have a previous diabetes diagnosis. Medical assistants were educated on the prediabetes identification and referral process for the first two weeks of the project. Implementation began at week three and continued through week 14 with the intention of continuing the program after the project completed. Results: A total of 764 patients were seen in the clinic over a 12-week timeframe. Of the patients who were seen, 335 underwent laboratory analysis of glycated hemoglobin (HbA1c) with 130 of those results between 5.7-6.4%. Considering diabetes prevention program inclusion criteria, 44 patients were removed for having a previous diabetic diagnosis or a BMI < 24 (<22 if Asian). Of the remaining 76 patients, 35 were identified, based on chart review, as having an “elevated HbA1c” or prediabetes. Four of those patients were notified of the DPP and referred to the program. Conclusions: Overall, office staff was willing to learn how to identify prediabetic patients and refer them to a DPP. Patients identified with prediabetes and notified of the DPP were willing to be referred. Limitations of implementation were identified and if altered could improve the volume of patients referred to a DPP. Sustaining the prediabetes identification and referral process at this clinic could help to detect additional patients with prediabetes and help to prevent or prolong a diabetes diagnosis.