C2 DIABETES TRAINING
INGRID ADAMS P H D , R D , L D ,
JOAN MARTIN, B S M S
LDE
Objectives
 Explain how and why diabetes could be a winnable
battle in Kentucky
 Identify what Cooperative Extension has done in the
area of diabetes self-management
 Explain national approaches used by Cooperative
Extension related to diabetes self-management
 State opportunity to teach Diabetes in the Caribbean
and how agents could get involved
What to Expect
 Shared knowledge and experiential learning – I will
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call on you. This is a great opportunity to say hello
and to hear from you
Quick polls
Group discussion- please type in responses
Problem solving and brainstorming
Physical activity
Questions from you?
Do you have anything to add to the
Objectives?
Why We Must Take Action
 In 1995, approximately 3.5% of Kentucky adults
(120,000 adults) had been diagnosed with diabetes
 By 2010, the prevalence rate for diabetes had
increased to 10% or approximately 370,000
adults.
 For 2012, this rate is slightly higher at 10.7% of
Kentucky Adults.
Source: Kentucky Cabinet for Health and Family Services,
2014http://chfs.ky.gov/dph/info/dpqi/cd/generalinfodiabetes.htm
Kentucky --Diabetes Belt
What do you notice about the map and Kentucky?
Write your answers…
Why We Must Take Action
 The problem is further exacerbated by a high
incidence of obesity and physical inactivity
 An estimated 40 percent of all Kentuckians ages 40
to 74 are currently overweight or obese and can be
classified as having pre-diabetes and are likely to
develop diabetes in the future
 Present statistics show Kentucky to have the 6th
highest rate of diabetes in the nation
Source: Source: Kentucky Cabinet for Health and Family Services,
2014http://chfs.ky.gov/dph/info/dpqi/cd/generalinfodiabetes.htm
Why we must take Action?
 Diabetes complications are responsible for 19%
(114,977) of all hospitalizations with a total cost of
2,043,000,000 in medical expenses and loss of
productivity
 The cost and the impact of diabetes on the
population can be reduced through modification of
lifestyle risks, early diagnosis, appropriate health
care, and self-management education
 Recent statistics show Kentuckians falling short in
the area of self-management education
Source: Kentucky Cabinet for Health and Family Services, 2011
Making Diabetes A Winnable
Battle in Kentucky
 “Winnable Battle is a mindset – A strategic attitude
that can be used for all programs.” Dana Pitts
Making Diabetes A Winnable Battle
in Kentucky
 Disability and premature death are not
inevitable consequences of diabetes.
Control the effects of diabetes:
 Physical activity and dietary interventions
 Self-management training
 Ongoing support, and, when necessary
 Medications
Making Diabetes A Winnable Battle
in Kentucky
 Reducing A1c (a measure of blood glucose control)
by one percentage point can reduce the risk of eye,
kidney, and nerve diseases by 40%.
Making Diabetes A Winnable Battle in
Kentucky
Controlling blood pressure can reduce the risk of heart
disease and stroke by 33%–50% and the risk of eye,
kidney, and nerve diseases by 33%.
Making Diabetes A Winnable Battle in
Kentucky
 Improving control of low-density lipoprotein (LDL)
cholesterol can reduce cardiovascular complications
by 20%–50%.
 Treating diabetic eye disease with laser therapy can
reduce the risk of loss of eyesight by 50%–60%.
Making Diabetes A Winnable Battle in
Kentucky
Accessing comprehensive foot care programs can
reduce amputation rates by 45%–85%.
Taking Ownership of Your
Diabetes Curriculum
Intro
Lesson
Unit One Unit Two Unit
Three
Diabetes
Intro to the Lesson
Lesson 4: Lesson 7:
Choose
information curriculum 1:
A1C
Your Food
Note to
Facilitator’s Diabetes
Lesson 5:
Exchange
Agents
Guide
Blood
Basics
List
Agents’
Role
Power Point
Lesson
Content
(Pre-Test) Managing
Outcomes
Curriculum
Theory and
Approach
Evaluation
Lesson
2:
Diabetes
Lesson
3:
Physical
Activity
and
Diabetes
Pressure
Lesson 6:
Cholesterol
Lesson 8:
Carb
Counting
Unit
Four
Final
Lesson
Lesson
10:
Monitoring
Introductio
n to the
curriculum
Blood
Glucose
Facilitator’s
Guide
Lesson
11: Foot
Care
Lesson
Lesson 9: 12:
Think
Working
Your Plate with Your
Health
Care
Team
Evaluation
(PostTest)
Power Point
PowerPoint
Outline
What do you notice about the steps we can take to make diabetes a winnable battle
and the plan we have in the Diabetes Curriculum? - Write responses
What Have We Done in the Past?
 A total of 50 counties reported under PAC 213 –
Taking Control of Your Diabetes
 In the meantime, for 2014 reporting year, 30
counties reported under PAC 213 Taking Control of
Your Diabetes.
What Have We Done in the Past?
 A total of 3,085 individuals participated in the Taking
Ownership of Your Diabetes Program.
 Of these individuals:
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1,532 were seen by their health professional as a means of managing
their diabetes
1,218 had their A1C checked
1,033 took part in physical activity for 30 or more minutes on five
or more days of the week.
1,206 checked their blood glucose 1 or more times a day
999 utilized a meal plan,
Over 770 set and accomplished goals for themselves.
Over 591 individuals mentioned that they moved into Action
and Maintenance stages of diabetes management.
Moreover, based on similar studies by colleagues in other states, this
program has the potential to save 7,897,600 in healthcare
costs.
Share some Other Things Done in Your CountiesPoll- Please write your Response!
 How many of you have done the following?
 Partner with Health care professionals to offer diabetes
programs?
 Serve as a member of a Diabetes Advisory Group?
 Shared diabetes information at health fairs?
 Other things that are not listed above?
Cooperative ExtensionNational Approaches
 Graduate student in Dietetics and Human Nutrition
examined“ reasons for low fidelity to educational programs in
patients with gestational diabetes: a qualitative study”
 Graduate student in DHN conducted a national
survey to document Cooperative Extension’s role in
diabetes management
 Identify what Cooperative Extension has done in the
area of diabetes self-management
Results
 Twenty-nine different states were listed, and some
states had more than one university offering diabetes
education programs.
 Arkansas (n=4, 9.3%) and Tennessee (n=4, 9.3%)
had the greatest number of programs offered in their
states.
Participants
Program Offerings
 The universities represented in the survey offered a
total of 72 programs.
 Twenty-one (48.8%) participants indicated that their
university offered only one program.
 Fourteen (32.6%) offered two programs and
 Eight (18.6%) offered three programs.
Target Audience
 Adults with type 2 diabetes (n=64, 88.9%) and
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adults at risk for type 2 diabetes (n=37, 51.4%) were
the most frequently targeted audiences overall.
Fourteen programs targeted adults with type 1
diabetes (19.4%)
A total of six programs targeted children with type 2
diabetes (n=3, 4.2%)
Children with type 1 diabetes (n=2, 2.8%)
Children at risk for type 2 diabetes (n=2, 2.8%)
Questions from you?
Activity Break
What are the next Steps
1. Document the
effectiveness of
the program
2. Develop the
evidence base for
the program
Steps in Building the Evidence Base
1. Develop and design - Logic model and
replication materials – Completed!
2. Ensure Fidelity of implementation- Process
evaluation- Upcoming.
3. Obtain Evidence of positive program outcomesCarry out evaluation with a comparison group
(Quasi-experimental)- Upcoming.
Steps in Building the Evidence Base
4. Attain strong evidence of positive program
outcomes- Conduct evaluation with random
assignment (experimental design); Carry out
multiple evaluations with strong comparison
groups (quasi experimental)
Questions About the Evidence Based
Approach?
What is needed?
 Agents to implement the program in collaboration
with a health care professional
Meeting with Statistician
 For a Quasi-experimental study
10 groups to implement 12 week curriculum
10 groups to implement control for 12 weeks
10 groups to implement 6 weeks
10 groups to implement control for 6 weeks
10 groups to implement 4 weeks
10 groups to implement control for 4 weeks
Total: half of our counties – 60 agents
Questions from you?
What is the Timeline?
 February- Ask agents to share the need with agents
in their district
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Brainstorm about the best times to conduct the intervention
 March to April – Agents indicate their interest
 Develop an implementation committee of Agents
and other health professionals
 May – Agent training on the curriculum and
program marketing
What is the Timeline?
May: KEHA Presentation- Diabetes the winnable battle
• Train KEHA members to serve as diabetes
volunteers
 June to November – Agents implement the
curriculum using a quasi-experimental approach
Joan Martin
 Implement Taking Ownership of Your Diabetes
Curriculum in Guyana
Ingrid Adams- Sabbatical