A one-size-fits-all approach to prediabetes treatment does not work for all patients. Intermountain Healthcare, headquartered in Salt Lake City, Utah, offers three pathways to help patients find the right journey toward preventing type 2 diabetes. Since 2013, more than 10,000 patients have completed one of three pathways for diabetes prevention at Intermountain.
Intermountain Healthcare has several published studies that demonstrate a 3 percent reduction in the incidence of type 2 diabetes among participants as compared to a matched control group. Avoiding or preventing one case of diabetes will save Intermountain’s insurance arm about $3,500 per patient per year in diabetes-related costs.
“By preventing diabetes we’re putting more money into the pockets of families,” said Liz Joy, MD, medical director of health promotion and wellness and nutrition services at Intermountain. “Even if you just delay their type 2 diabetes by five years, at $3,500 a year for five years that’s $17,500 in savings.”
The AMA’s Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies. This comprehensive and customized approach helps organizations identify patients with prediabetes and implement a National Diabetes Prevention Program lifestyle-change program based on their individual needs.
“We recognize that one size does not fit all for all of our patients and our community members, as well as our insurance members and Intermountain employees,” said Kim Brunisholz, PhD, senior scientist at the Intermountain Healthcare Delivery Institute. “We came together and developed a system wide approach for different populations and groups of people.”
Here are the three pathways that Intermountain has taken to prevent type 2 diabetes in their patient population.
Prediabetes 101 is a two-hour group class distributed among most Intermountain clinics and hospitals in Utah. This free class is an engagement tool for patients and provides educational information on prediabetes and preventing type 2 diabetes, including facts and definitions.
The class, said Brunisholz, provides first steps around what patients can do to change their behavior and incorporate healthier lifestyle choices.
“Preventing diabetes is really all about helping people make appropriate lifestyle changes and losing 5-10 percent of their body weight,” said Dr. Joy.
Patients are encouraged to bring their spouse or partner with them, as well as other family members or friends because learning together can “really impact the household,” said Dr. Joy.
This course is also available online through a series of videos—including a Spanish-language version—to improve accessibility.
Patients can also enroll in medical nutrition therapy, a customizable, one-on-one visit with a registered dietician. This service is accessible for patients up to five times a year.
“People have different physiologic needs, they have different learning needs, learning styles, and resources,” said Dr. Joy.
For patients with prediabetes, this option has been successful in achieving weight-loss goals and reducing incidence of type 2 diabetes.
“It’s this idea that we in health care really struggle with. We need to understand that evidence, but then customize it in a plan that is personalized,” said Brunisholz. “We all know what is good for us.”
“It is living a healthy lifestyle, eating a balanced diet, getting enough sleep, and being active,” she added. “Personalizing is the hardest part.”
Another pathway is the Weigh to Health Program, which is recognized by the Centers for Disease Control and Prevention (CDC) as a diabetes prevention program for weight loss. Using evidence-based methods, this program helps patients increase physical activity, improve nutrition and address health concerns such as prediabetes.
Weigh to Health offers 16 sessions of didactic curriculum delivered through group classes with registered dietitians. The program serves between 500 and 600 people each year, and is deployed across the entire state. This program has been around for years, but through CDC recognition, Intermountain improved the curriculum to deliver evidence-based care to their patients and members.