medical wellness
where people get their healthcare, to a community sector where people spend most of their lives – looking at what can we do to push out the walls of the clinical sector, making sure that people who are diagnosed with pre-diabetes are referred to a programme that’s genuinely accessible to them.”
quality control Albright continues: “The other three pillars support and feed into the first pillar. Pillar two is our recognition scheme, by which we ensure that DPPs meet the standards we’ve set and adhere to the approved programme structure (see information box, p54). On our website, we offer an approved curriculum which providers can download. “Members of the public can also access
a list of approved DPPs on our website. The programmes might have different names: there’s the YMCA’s Diabetes Prevention Programme, for example, and the University of Pittsburgh’s Group Lifestyle Balance programme. But if they’re recognised on our website, they’ll all be delivering an approved curriculum – either the one we’ve made available, or one they’ve designed that the CDC has approved – and meeting the standards we’ve set. “When we see that a provider is
offering an approved curriculum, we give them ‘pending recognition’ status, but it takes two years to achieve full recognition: the programme is a year long and we need to see suffi cient outcome data, with a certain percentage of participants achieving a minimum 5 per cent weight loss. During those
international diabetes prevention
learned from each other – we’ve used their recognition programme as the basis for our own, for example. And I think one of the things they’ve learned from us is that you really do need a community infrastructure – you can’t just deliver this through the healthcare system. “We’ve also been part of the longest-running prevention study in the
“W
world: the Daqing study in China. United has gone to China and to India to share our work too. Those countries are very much focused on a medical model though, so the question is whether they’ll be able to make the transition and expand into the community. “There’s also a web-based prevention network, organised by a
physician named Peter Schwartz and connecting people around the world who are working on diabetes prevention. He’s based in Germany and they’re interacting particularly with other European countries – the UK, for example. “I’d say Finland is probably is the furthest along though, alongside
the US. They have the original Finnish DPP and have been trying to nationalise their intervention programme.”
two years, we’re on-hand to provide technical assistance, to help with trouble-shooting and so on. “Another pillar is training: if we’re
going to roll out a programme like this nationally, we have to expand the workforce – we have 79 million people with pre-diabetes in the US, and not enough healthcare professionals to deliver the programme to all these people. The YMCA has its own amazing training infrastructure, but for other organisations which may not have this, we’ve worked with Emory University in Atlanta to develop a special DPP training
Even the medical community is unsure what to do with pre-diabetes patients
course. Again, it’s about ensuring standards as we roll out nationally.”
lack of awareness Albright concludes: “The final pillar is marketing and communication. Just because you have programmes in communities, doesn’t mean people are going to come, and doesn’t mean healthcare professionals will refer.” Lever agrees: “I describe it thus: ‘If
you build it, they may come; if they come, they will stay and they will lose weight; and if they lose weight, they will not convert to diabetes.’ So the biggest challenge is getting them there in the fi rst place. We’re trying many different strategies around this – employer engagement, insurer engagement, primary care doctor engagement, posters in our facilities – but it’s defi nitely a challenge. “There are occasionally people who
refer themselves onto the programme – maybe they’ll see a poster in their YMCA and they know their dad had diabetes, so they decide to see if they’re at risk. But pre-diabetes is completely asymptomatic, so people are generally unaware – and even when they’re told they have the condition, the red fl ag fails to go up. They just think: ‘I don’t have diabetes, so I can carry on doing what I’m doing.’ In fact, they should be as concerned as if they were told they had a high risk of developing cancer.”
56 Read Health Club Management online at
healthclubmanagement.co.uk/digital april 2012 © cybertrek 2012
e’re in regular contact with the Australian authorities as they move forward with their diabetes prevention programme,” says Dr Ann Albright of the CDC. “We’ve
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