Diabetes risks and solutions may lie in patients' communities

The future outcomes of chronic disease could be affected not by a lab or hospital but by the local park or corner store, according to a new study in JAMA Internal Medicine.

Neighborhood risk factors

The study found that neighborhood resources to support greater physical activity and healthy diets appear to be associated with a lower incidence of type 2 diabetes. Researchers investigated whether the physical and social environments of patients’ neighborhoods—including the availability of healthy foods, physical activity resources, and levels of social cohesion and safety—were associated with the development of type 2 diabetes during a 10-year period.

“Our results suggest that modifying specific features of neighborhood environments, including increasing the availability of healthy foods and [physical activity] resources, may help to mitigate the risk for [type 2 diabetes,] although additional intervention studies with measures of multiple neighborhood features are needed,” the study said.

While environmental factors are important in curbing the development of chronic disease, they are not the only answer, according to a related commentary in JAMA Internal Medicine.

“Having markets and recreational facilities located nearby may be necessary but not sufficient to enable healthy behaviors,” the commentary said. “Building more facilities in neighborhoods that lack them is a component of an overall strategy to address the national rise in obesity, but this strategy needs to be informed by an understanding of when such facilities are actually used and the characteristics of the individuals who use them.”

A community solution

Every year the number of people who develop prediabetes, the precursor to type 2 diabetes, increases. Between 2007 and 2012 alone, prevalence of the disease rose by about 51 percent, according to a December study published in Diabetes Care.

Because patients’ environments have such a big influence on their health, helping patients make healthy lifestyle changes within their communities is an especially effective way to help prevent the onset of chronic diseases such as type 2 diabetes.

That’s one of the reasons the evidence-based National Diabetes Prevention Program, launched by the Centers for Disease Control and Prevention (CDC) in 2012, is gaining momentum. The program is based on research led by the National Institutes of Health, which showed that individuals at high risk of developing type 2 diabetes who participated in structured lifestyle change programs saw a significant reduction in the incidence of the disease.

As part of its Improving Health Outcomes initiative, the AMA worked with the YMCA of the USA and 11 physician practice pilot sites in four states over the past year to develop tools and resources to increase physician screening and testing for prediabetes. The practices then referred their patients with prediabetes to diabetes prevention programs offered by local YMCAs, which use the CDC’s program. Medicare beneficiaries were able to participate in this program at no cost, thanks to an award from the Center for Medicare and Medicaid Innovation.

Now physicians across the country can join in this work. The AMA and the CDC have teamed up to issue a call to take urgent action with Prevent Diabetes STAT: Screen, Test, Act–Today™. This multi-year initiative will help physicians refer adults who have prediabetes to diabetes prevention programs in their communities and online.

Join this initiative in your practice: Access the toolkit to get started.