Abstract
TERESA PEARSON, MS, CNS, MBA, CDCES, FADCES
Two years ago, we went into COVID lockdown. And we are still dealing with it. I’m tired of it. My family and friends are tired of it. And I know you are too. But we are resilient, and we keep moving forward—for our patients, for our families, and for ourselves and each other. Ryder Carroll once said, “No matter how bleak or menacing a situation may appear, it does not entirely own us. It can’t take away our freedom to respond, our power to take action.” So onward we go, and we push beyond what we thought we had within ourselves. It’s what we do. It’s who we are. It is why we signed up.
March is also when we mark National Diabetes Alert Day, which occurs on March 22 this year. It is a 1-day “wake-up call” focused on the seriousness of diabetes and screening those at risk for prediabetes and type 2 diabetes. In 1990, when I first became a DCES (aka CDE), there were an estimated 4.9% people with diabetes in the United States. I honestly and naively thought we would someday put ourselves out of a job and I’d be on to the next thing. Young optimism kept me going, but the data tell us there is no end in sight. So, we keep going. Talk about resilience.
Today, CDC estimates 37.3 million, or 11.3%, of the US population has diabetes. More than twice that in 1990. An estimated 1 in 5 are not yet diagnosed. Another estimated 96 million people have prediabetes with an astounding 80% not yet diagnosed. In 1990 we did not even talk about prediabetes, let alone do anything about it. Early epidemiological studies pointed to a correlation with lifestyle, but it wasn’t until 2001 when results of the Diabetes Prevention Project (DPP) indicated a modest weight loss and moderate physical activity could prevent or delay type 2 diabetes. The study showed a 58% reduction in risk for diabetes for those in the study group. That number jumped to 71% for those 60 years of age and older.
The 10-year findings of the DPP Outcomes Studies (DPPOS) indicated participants in the DPP Lifestyle Change Program (LCP) continued to have a delay in the development of diabetes by 34% and by 49% in those ages 60 and older. Furthermore, participants who continued to take metformin had a delay by 18%. All 3 groups had improved blood pressure and cholesterol, but those from the DPP-LCP achieved these results with fewer medications. Additionally, the DPP-LCP was shown to be cost-effective, and metformin was shown to be cost-saving. The 15-year DPPOS indicated participants from the DPP-LCP continued to have a delay in the development of diabetes by 27% compared with the placebo group. Those who continued to take metformin still had a delay in the development of diabetes by 18%. A third phase of DPPOS began in 2016 and will end in 2026.
The data are strong, and the need to identify those with prediabetes and type 2 diabetes and to provide access to appropriate interventions is a critical part of our work if we ever hope to turn the tide on diabetes. The US Preventive Services Task Force, Healthy People 2030, the American Medical Association (AMA), and the American Diabetes Association all recommend screening for people at risk for type 2 diabetes and referring them to a National DPP-LCP or similar program based on the findings of the DPP or to DSMES as appropriate. ADCES is actively involved in the National DPP, training and supporting lifestyle coaches and promoting its benefits. Many of you are already doing this. Kudos to you.
The need to identify those with prediabetes and type 2 diabetes and to provide appropriate interventions is a critical part of our work if we ever hope to turn the tide on diabetes.
Yet, this is not without challenges. With limited resources, we need to find more efficient ways to screen and identify people with prediabetes and type 2 diabetes to get everyone connected to the services they need. The AMA partnered with CDC to create the Prevent Diabetes STAT
Simple local PSAs can also be effective. But, be sure to think it through. In a previous position, we put the diabetes risk test in local newspapers inviting people to call or email us if they found they were at risk. We received over 10 000 calls and emails! Yikes! Who wants to deal with 10 000 calls? But we learned that people are worried about this, and we’re taking it seriously. Many contacted us for themselves. Some contacted us about a family member. We urged people to see their primary care provider (PCP) for a diagnosis and a referral to the appropriate services. The next time, we included a call to action to first contact their PCP. That reduced the contacts we received but still resulted in people engaging in our programs once they were appropriately diagnosed.
Every person we identify as having prediabetes or type 2 diabetes and engage with as a DCES is one more person we have helped. It’s one more step. And our collective steps make for many steps, and with commitment and resolve, we march on.
We need to also consider disparities in health care and the need to adjust our approach and our programs to meet the unique needs of those we serve. This means attention to social determinants of health, culture, race/ethnicity, language, access, disabilities, and so on.
As a group, we are resilient. We keep fighting the fight even when it seems we are not making progress. It is the little steps that matter. Confucious says, “It does not matter how slowly you go, as long as you do not stop.” Every person we identify as having prediabetes or type 2 diabetes and engage with as a DCES is one more person we have helped. It’s one more step. And our collective steps make for many steps, and with commitment and resolve, we march on. ■