Prediabetes treatment takes team effort to change lifestyles

While studying for his board certification in obesity medicine in 2016, North Mississippi Health Services (NMHS) internist Vernon Rayford, MD, learned about the value of the National Diabetes Prevention Program (National DPP) lifestyle-change program and found it to be an increasingly popular form of obesity therapy. So when he got the chance to be trained as a lifestyle coach for the program, he leapt at the opportunity.  

One year later, Dr. Rayford joined a physician leadership program where he completed a capstone project that looked at the prevalence of prediabetes at NMHS. He found that about 1,000 employees within his system’s health plan had prediabetes, signaling a need for a lifestyle-change program. From there, he helped develop a diabetes-prevention strategy, which included launching the lifestyle-change program for employees in June 2018.   

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 clinical practices and health care organizations identify patients with prediabetes and manage the risk of developing type 2 diabetes, including referring patients at risk to a National DPP lifestyle change program based on their individual needs. 

Located in Tupelo, Mississippi, NMHS serves a population of about 700,000 people in 24 counties in north Mississippi and northwest Alabama.  

At NMHS, physicians see a lot of complications from diabetes and the cost associated with those difficulties. In terms of safety and quality, diabetes is a significant contributor to many other complications seen at NMHS.  

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“Being able to speak to the far end of the spectrum for diabetes really helped in making the case for prevention,” said Dr. Rayford. “It helped to have the primary care perspective, but it also helped to be able to have the data out there—there’s almost $2,700 a year saved for every prevented case of type 2 diabetes.  

“The AMA has been really instrumental in helping me refine the argument that preventing diabetes is an important aspect in the care of diabetes, and really helping supply data and tools to help me learn more about diabetes prevention,” he added.  

The main component of success for diabetes prevention at NMHS has been the people. These key team members played a crucial role in the prevention of type 2 diabetes through lifestyle changes.   

Leadership buy-in 

During his capstone project, Dr. Rayford found that the vice president of human resources was very interested in the lifestyle-change program. With her support, they assembled a group to make the diabetes prevention strategy a reality.  

“Having the blessing and guidance of leadership, and the clout to assemble a group across different segments of our system, was instrumental,” said Dr. Rayford, now board certified in obesity as well as pediatrics.   

HR’s help enabled the construction of “an all-star team that has been responsible for planning and implementing the pilot, which we are still continuing, as well as planning for expansion,” he added.  

The lifestyle-change program at NMHS lasts a year and includes 22 one-hour group sessions. Participants attended 16 sessions during the first six months and six sessions in the last six months with weekly weigh-ins.  

However, not all participants could commit to the one-year program. For those people, Dr. Rayford suggested a “hybrid model” of the lifestyle-change program that stays true to the curriculum, but offers more flexibility.  

Lifestyle coaches from diverse backgrounds 

The pilot group had members from different departments of NMHS, with the Wellness Center serving as both the location and conduit to provide lifestyle change services for participants. This is also where lifestyle coaches are trained, including dietitians, nurse practitioners and exercise specialists.  

Through the Wellness Center and the Population Health Service, dietitians periodically offer healthy-cooking classes. Sessions include a cooking demonstration and recipe sampling to teach participants how to modify recipes and lower sugar and fat while incorporating portion control. Other topics include food-label education and shopping tips.  

Participants can also visit the Wellness Center to work with exercise specialists on improving their physical activity. In a recent session, an exercise specialist showed participants how to use hydraulic exercise machines and how to incorporate them into their physical activity.  

“What’s great about it is the hydraulic machines are often underutilized and so these machines are the ones that many people don’t use—because they don’t know how to use them—and so it was more than just showing them simple exercises,” said Dr. Rayford. “It ended up being showing them how to use a set of machines that would be more available if they wanted to use them.”   

Through a team effort, executive leadership, dietitians, nurse practitioners and exercise specialists, worked together to ensure the success of the diabetes prevention program at NMHS.  

The AMA Ed Hub™—your center for personalized learning from sources you trust—offers CME on a broad range of topics including chronic disease treatment, which includes a module on prevent diabetes STAT