NEW YORK - Taking an "if we build it, they will come" approach, the YMCA is rolling out a diabetes-prevention program at a Y near you. And they need primary care physicians to refer patients to these programs.
The building started last year, when the YMCA of the USA began offering lifestyle training to people with prediabetes, and by February the program had taken root at 116 sites in more than 30 U.S. communities, David G. Marrero, Ph.D., said at the annual American Diabetes Association advanced postgraduate course.
Photo courtesy Indiana University
Dr. David G. Marrero
The premise of the program is that people who lose 7% of their body weight and gradually increase their weekly exercise to 150 minutes can significantly lower their risk for developing frank type 2 diabetes. Candidates for the program must be overweight and either at high risk for diabetes or with a diagnosis of prediabetes.
The course that is offered at YMCAs involves an hour-long session once a week for 16 weeks. Among the session topics are the following:
• Ways to Eat Less Fat and Fewer Calories.
• Being Active: A Way of Life.
• Four Keys to Healthy Eating Out.
• Talk Back to Negative Thoughts.
• The Slippery Slope of Lifestyle Change.
• Ways to Stay Motivated.
In an effort to stay motivated, those enrolled in the course will attend monthly refresher courses for 8 months to discuss areas in which they are having trouble maintaining their new healthful habits, and reviewing the basic strategies presented during the original sessions.
Evidence of the prevention program’s efficacy, when it was offered as one-on-one training, was demonstrated nearly a decade ago by the landmark Diabetes Prevention Program, which recruited more than 3,000 Americans who did not have diabetes but who did have an elevated fasting blood glucose level. The findings showed that in a controlled, randomized study setting, teaching people to exercise more and change their diet to achieve significant weight loss led to a 58% cut in the rate of new diabetes cases during 3 years of follow-up, compared with control participants (N. Engl. J. Med. 2002;346:393-403).
"The DPP showed the efficacy of lifestyle modification, but the issue remained of how to translate this powerful finding to the public," said Dr. Marrero, professor of medicine and director of the Diabetes Translational Research Center at Indiana University in Indianapolis. "The DPP was expensive." By Dr. Marrero’s calculations, the original DPP lifestyle intervention cost nearly $1,500 per person. With about 70 million Americans estimated to have prediabetes, it was clear that adapting the one-on-one program for a group-based program for use at YMCAs was key.
His group reported on the success of a pilot group–based version in 2008 (Am. J. Prev. Med. 2008;35:357-63). Based on this evidence – and with the backing of the Centers for Disease Control and Prevention – the YMCA moved to expand the program nationally.
By the end of 2011, the program is expected to be available at 150 sites operated by about 50 different YMCAs, said Dr. Matt Longjohn, senior director of chronic disease prevention at the YMCA of the USA.
The CDC is supporting the rollout of the program, as mandated by the National Diabetes Prevention Program of the Patient Protection and Affordable Care Act.
For people without coverage, the year-long program costs about $300 per participant, noted Dr. Longjohn, but many Ys offer it at a reduced rate because they also receive support from the CDC. For example, YMCA of Delaware charges Y members $149 for the prevention-training course; nonmembers pay $199 for the program.
UnitedHealthcare has also signed on to cover the cost of program participation for its beneficiaries who are at risk for diabetes.
The 200 lifestyle coaches who have so far been trained to run the programs receive 3 days of instruction. Dr. Marrero emphasized that coach training is standardized so that it is consistent across all YMCAs nationwide.
Dr. Marrero said that the next step is encouraging primary care physicians to broadly screen and identify people who would benefit from a diabetes-prevention intervention. He and his associates recently began a pilot study to assess the benefits of conducting routine diabetes screening in primary care practices. YMCA branches that offer the diabetes prevention classes are promoting the program to local health care providers. People who sign up to take a set of classes are expected to provide some type of documentation that they have prediabetes, Dr. Longjohn said in an interview.
Dr. Marrero said that he had been an advisor to Eli Lilly, a consultant to Sanofi-Aventis and to YMCA of the USA, and a speaker for Taking Control of Your Diabetes. Dr. Longjohn reported having no disclosures.