April Reese is happy that diabetes awareness has reached a broader segment of the public in recent years. As the Programs Manager for the Community and Clinical Connections for Prevention and Health Branch within the Chronic Disease and Injury Section of the North Carolina Division of Public Health, diabetes is one of three major chronic illnesses she’s devoted her career to combatting. Reese credits several factors to the recent increase in diabetes awareness: an expansion of diabetes prevention programs by the Centers for Medicare and Medicaid (CMS), increasing interest in lowering health care costs, and celebrities affected by the disease speaking out.

Last July, CMS proposed to expand the Medicare Diabetes Prevention Program (MDPP), beginning in January 2018. “The move to start covering Diabetes Prevention Programs is epic. This investment in prevention not only creates access to a program that is proven to reduce the risk of developing diabetes, but the programs can be sustained by having a third-party payer,” Reese says.

Reese also touts the recent focus on cost savings that health care teams can reap when they work to eliminate preventable trips to the emergency room and support better self-care. “Diabetes is expensive,” she says, “and expanding Diabetes Prevention Programs is cost-effective.” Both prevention programs and self-management education promote better self-care, which creates a culture of better health and decreases the number of people needing long-term medical care. Recent announcements by high-profile personalities such as Tom Hanks, who revealed he has type 2 diabetes, and the late Mary Tyler Moore have also put the spotlight on diabetes.

“That spotlight on diabetes is welcome and necessary,” Reese says, although it may be the cause of an unexpected challenge to her work in public health. The proliferation of diabetes programs can sometimes cause confusion and participant fatigue. Not all programs are using a curriculum that has been proven to lower A1c for people with diabetes or to reduce the risk of developing diabetes. Recognition by the American Diabetes Association (ADA) or accreditation by the American Association of Diabetes Educators (AADE) is the gold standard for diabetes self-management education and support. Program recognition or pending recognition by the Centers for Disease Control and Prevention indicates that a prevention program is following a standard curriculum that is supported by evidence. There are other evidenced-based programs, such as the Stanford Programs or Everyone with Diabetes Counts that are nice complements to recognized/accredited programs, but there are also programs that are created by an individual or an organization that don’t have enough evidence to support their effectiveness.

Though the appeal for some unrecognized programs is natural, participants should be aware that they are not held to the same standard as recognized programs, Reese says. “Community-based programs can be a lot of fun. Participants go to the grocery store together, or sometimes the programs serve as important support groups.”

Often people with diabetes or those who are at risk for diabetes are not sure which programs are the most effective and may not choose the one that will yield the desired results. While those types of programs may be helpful in generating awareness of diabetes, as well-intentioned as they may be, they are not subject to the same rigor as (ADA) or (AADE) programs. “My concern is that some people may think they are cured of their diabetes after participating in one of those programs and perhaps not realize that diabetes isn’t something that can be cured but must instead be carefully managed.”

The time commitment of some of the recognized programs scares away many people, particularly for diabetes prevention, Reese says. “We have to do something different in the way we market Diabetes Prevention Programs (DPP). Look at the way that Weight Watchers promoted Oprah’s most recent weight loss in 2016. They ran ads early in the year and not again until late 2016, almost a full year later when she’d lost 40 pounds. Weight Watchers emphasizes that participants should keep coming back instead of emphasizing how long it is going to take to lose the weight…and they do come back. Why don’t we, in public health, employ a similar strategy?”

Reese’s knowledge and passion for the subject of diabetes prevention is palpable, and that’s the kind of enthusiasm she tries to infuse in the young professionals she oversees. The challenges are real, but she focuses on the positives. In the face of such difficulties, she asks her protégés, “What can we do? We can scale and sustain evidence-based programs. We can look for ways to change and improve existing programs. We can develop health literacy information that brings complex subjects down to a level that’s easily understood and usable by community members and health care providers.”

She cites North Carolina’s Guide to Diabetes Prevention and Management, a resource she helped to create for the North Carolina Diabetes Advisory Council, which offers specific recommendations for community groups, health care providers, and employers. “People use the guide,” she says. “I’m proud of the work we did. In 2015 we developed a strategic plan, which we’ve taken off the shelf and given some legs.”

It’s important to remember such big wins, Reese says, and to remind those who are new to public health that gains have been made. Still, she is hard at work in her fight against diabetes, having secured free advertising at A&T University basketball games to promote diabetes prevention programs and received funding from the Kate B. Reynolds Foundation to improve health information technology around diabetes detection and management.

“Look for the winning message you can bring to an issue to help reach your demographic,” she advises her mentees and less experienced colleagues to encourage them in their work. “They want to help people. They can’t wait to help people, but we’re a step removed. We’re creating systems and increasing capacity within communities. That takes some adjustment in perspective. The trick is in learning to slow down and allowing time for relationships to build,” she adds. “It’s good advice for them and for me.”

For further reading, consider these related articles from the Journal of Public Health Management & Practice:*

• Poorly Controlled Diabetes in New York City: Mapping High-Density Neighborhoods
• Diabetes Among People With Tuberculosis, HIV Infection, Viral Hepatitis B and C, and STDs in New York City, 2006-2010
• Putting Diabetes on the Map: What Does Population Health Really Look Like at the Local Level?

*Articles may require a subscription to JPHMP or purchase.

Share this story with your colleagues!