Expanding Diabetes Prevention in Los Angeles County
Counties support the majority of America’s 2,800 local health departments in order to protect their residents’ health, safety and quality of life. In fact, over two-thirds of local health departments are county-based and another eight percent serve multiple counties. Local health departments provide a variety of services, including conducting surveillance to detect and monitor emerging infectious diseases like diabetes. In addition, local health departments work with community partners to help prevent the leading causes of death and disability and lower health care costs.
Local public health programs are essential in preventing chronic diseases such as heart disease, cancer and diabetes, which account for 75 percent of all healthcare spending and are responsible for seven of 10 deaths in the U.S. In addition, these diseases cost an additional $1 trillion each year in lost productivity in the workplace, with obesity alone costing an estimated $147 billion per year.
With November being Diabetes Awareness Month, NACo will host a two-part blog series to highlight county involvement in the diabetes epidemic and discuss how other counties can replicate similar programs in your local community. The first county that will be highlighted is Los Angeles County, a member of NACo’s Large Urban County Caucus, with a population over 10 million. Over 81 percent of diabetic Medicare enrollees ages 65–75 in Los Angeles County receive the glycated hemoglobin test, or HbA1c monitoring, which is used to determine how well your diabetes is being controlled. In addition to monitoring diabetes, Los Angeles County has implemented a Diabetes Prevention Program to help its diverse residents, who either have prediabetes or are at risk for developing type 2 diabetes, make healthier lifestyle choices to reduce their chances of becoming diabetic.
What is the National Diabetes Prevention Program? The National Diabetes Prevention Program (National DPP) is an intensive lifestyle change program designed to help participants make long-term changes and see lasting results. It is a one-year program, administered by a trained lifestyle coach who facilitates learning and helps participants eat healthier, reduce stress and get more exercise. Its group-based format creates a supportive environment amongst participants that allows for sharing and encouragement to overcome struggles . The National DPP is designed for people who have prediabetes or are at risk for developing type 2 diabetes, but who do not yet have diabetes. Participation in the program has shown to reduce the risk of developing type 2 diabetes by 58 percent (71 percent for people over 60 years old) .
What is type 2 diabetes and prediabetes? Type 2 diabetes is the most common form of diabetes that occurs when the body does not properly use insulin and can no longer keep blood glucose levels under control. Individuals with type 2 diabetes often manage their condition via lifestyle change, oral medication, insulin and/or a combination thereof. When a person’s blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes, they are considered prediabetic. Prediabetes increases the risk for developing type 2 diabetes and related conditions like heart disease and stroke. Approximately five-10 percent of people with prediabetes develop diabetes each year, and 70% will do so during their lifetime [2,3].
Why prevention? Preventing type 2 diabetes is a major public health priority in the United States. But why is this so important? The answer is in the numbers. According to the Centers for Disease Control and Prevention (CDC), diabetes is the seventh leading cause of death in the United Sates and the number one cause of kidney failure, lower-limb amputations and adult-onset blindness. In the United States there are more than 110 million adults living with diabetes or prediabetes, many of whom do not know they have the condition. This disease is a threat to population health, sparing no segment of society and disproportionately affecting the poor, older adults and racial and ethnic minorities [4,5].
What is being done to prevent diabetes? Since 2014, the Los Angeles Department of Public Health has received funding from the CDC to expand access to and participation in the National DPP. To advance this goal, the Department of Public Health partnered with key stakeholders to launch the Los Angeles Diabetes Prevention Coalition. The Coalition’s mission has been to scale-up the National DPP in the region, increase access and utilization of the program and enhance healthcare reimbursement to cover program costs. Efforts have placed special focus on addressing the needs of low-income populations.
Over the last four years, the Coalition has been instrumental in developing educational and promotional materials to educate both patients and providers about the program; developing guidance tools to improve clinical processes for identifying and referring patients to local National DPP providers; training health care practitioners on screen, test and referral practices for the National DPP; supporting program development efforts of over 20 organizations; and building the case for coverage of the National DPP. This work at the regional level, along with national efforts, has contributed to improving access to and coverage for the National DPP. For example, since 2014 there has been a notable expansion of coverage options by numerous commercial health plans, Medicare and Medi-Cal (California’s Medicaid program).
How can I replicate this work in my county? Collaboration is key to successful diabetes prevention efforts. Having a diverse team of individuals, healthcare providers, health systems and government entities like public health departments allows for a comprehensive, thoughtful approach to improving awareness of diabetes risk, developing community-clinical linkages and increasing access to and coverage of resources like the National DPP. Policy, systems and environmental changes are also essential elements to preventing chronic diseases like diabetes. Local and federal agencies should work together to provide the infrastructure and resources needed for communities to develop and establish sustainable programming. Below are some helpful resources that can help guide diabetes prevention efforts in your jurisdictions.
American Diabetes Association Diabetes Resources for Individuals
American Medical Association Diabetes Prevention Resources for Health Care Professionals
Centers for Disease Control and Prevention - National Diabetes Prevention Program
Los Angeles County Department of Public Health: National Diabetes Prevention Provider Toolkit
Ad Council – Type 2 Diabetes Prevention Campaign
1. Centers for Disease Control and Prevention. Lifestyle Change Program Details. https://www.cdc.gov/diabetes/prevention/lifestyle-program/experience/index.html.
2. Herman WH, Hoerger TJ, Brandle M, et al. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005;142(5):323–332. PMCID 2701392.
3. Selvin E, Steffes MW, Gregg E, Brancati FL, Coresh J. Performance of A1C for the classification and prediction of diabetes. Diabetes Care. 2011;34(1):84–89. PMCID 3005486.
4. Centers for Disease Control and Prevention. [Accessed November 9, 2018]; National Diabetes Statistical Report: Estimates of Diabetes and Its Burden in the United States, 2014. 2014 http://www.cdc.gov/diabetes/pubs/statsreport14.htm.
5. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988–2012. JAMA. 2015;314(10):1021–1029