According to newly released data from the Centers for Disease Control and Prevention (CDC), 84 million American adults have prediabetes and about 90 percent don’t know they have it. To raise awareness and reverse prediabetes, Loma Linda University Health (LLUH) created a diabetes prevention program (DPP) that offers nutritional and exercise options, as well as other lifestyle changes for their employees to begin with.  However, while the program is proving to be beneficial, LLUH has encountered barriers that triggered a need for adjustments to improve reach.

Through the presence of scheduling conflicts and other issues, LLUH is problem solving how to improve in the next phase of their DPP. The health system received approval for its application in March and completed its first class on April 26. After a 24-month recognition period, if the program meets requirements, it will become one of the first DPPs in Southern California’s Inland Empire to gain an official recognition as a CDC provider.

“During our pilot in April we utilized the health care teams to do an electronic medical records search for those who met the criteria and our care management team reached out,” Brenda Rea, MD, DrPH, RD, PT told AMA Wire®. Dr. Rea is a physician lead for the diabetes prevention program and preventive medicine specialist at Loma Linda University Health. “For the next group we will be doing biometric screenings for our entire population and, based off of those results, we will send out invitation letters.”

Working with Loma Linda University’s Office of Preventive Care and its Diabetes Treatment Center, the health system offers resources to help participants lose weight, reduce blood glucose levels and control triglycerides and cholesterol in a program approved by the CDC. As the program enters its fourth month, LLUH has adjusted its DPP layout to address barriers exhibited by participants.

By broadening participation options for the DPP, the team hopes to help more participants slow the progression of prediabetes and prevent the development of type 2 diabetes.

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“The most significant issue has been that our class is in-person once a week and people who are working at our institution have had a lot of changes in their schedules,” Dr. Rea told AMA Wire. “This scheduling issue has been the most significant barrier for our participants to be able to continue in the program.”

To overcome some of these hurdles, Loma Linda University Health’s prediabetes program is offering an opportunity to do extra take-home virtual learning modules to make up for any classes participants might miss. With 20 available classes, participants are allowed a maximum of two missed sessions in a row but must participate in at least 15 classes, five of which can be virtual.

“We put a lot of structure in place, but it is still probably not enough,” said Dr. Rea. “We are looking at trying to create a strong virtual aspect of our program to allow for more flexibility.”

With the prediabetes program initially starting with over 20 participants, it is now down to about 12-13 committed participants who are highly engaged because they didn’t have scheduling issues. Among this group, Dr. Rea states the participants are “very happy with the teamwork, the structure and the commitment.”

While the DPP requires a significant commitment from participants, results have shown the success of class implementation and the availability of instructors. When asked about the most successful aspect of the program, Dr. Rea told AMA Wire that one part is the ability to engage multiple entities on campus to synergistically work towards the prevention of diabetes.

When it comes to the actual participants in the program, the connection between instructors and the class is key to maintaining commitment and ensuring the success of the DPP, she added. 

“Our instructors and participants have had a great deal of connection with each other and they are helping and supporting each other,” said Dr. Rea. “The success is in creating a support team for those who are really engaged to be able to make long-lasting sustainable changes.”

This strong instructor-participant relationship is the cornerstone for care in the program at LLUH. By creating lasting connections, participants remain dedicated and committed to reversing prediabetes and preventing type 2 diabetes.  

When asked about her hopes for the future of Loma Linda University Health’s diabetes prevention program, Dr. Rea told AMA Wire she hopes “patients will actually have long-term sustainable lifestyle changes that will last and that they will never progress to diabetes. It will actually truly be diabetes prevention and not just slowing it down.”

While the current Loma Linda University Health program is only offered to employees, Dr. Rea states, “We’re starting with our own, but our hope is to expand to other populations.”

Recently, the AMA, CDC and the Ad Council launched a public service announcement ad campaign to urge Americans to take the one-minute prediabetes risk test. The campaign highlights the importance of following up with a physician to learn more about prediabetes.

The AMA offers online CME to expand your knowledge in diabetes management. Explore educational content such as “Prevent Diabetes STAT.”

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