A Primer on Developing Office and Community-Based Prediabetes Programs

AADE Program Session
Friday, August 13, 2004
3:15 PM - 4:15 PM

Prediabetes is a disease defined by the American Diabetes Association. It is estimated that 16 million American adults have prediabetes, and the disease is on the rise among children and adolescents. To help curtail the rising epidemic of obesity, many educators are seeking to educate community members with prediabetes about prevention strategies before it develops into diabetes. Educators are encouraged to form prediabetes programs as a community service, but this is not an easy goal to achieve.

There are many reasons why prediabetes programs are a good idea. The preponderance of obesity indicates a clear need for diabetes education. Prediabetes is a good time to teach patients about preventative strategies. Also, if any of these patients go on to develop diabetes, the prediabetes program is an effective way to funnel them into diabetes education programs. But because the federal government and most private insurance companies do not regard prediabetes as a disease, prediabetes programs face substantial obstacles. There is usually no insurance reimbursement, so grant money or funding must be obtained to run the program, or a nominal fee basis must be established. Patients must be alerted about the cost before entering the program. Because of this cost to the patient, prediabetes programs need to be marketed well to help the patient understand the value of spending money out-of-pocket for such counseling. Prediabetes requires a multidisciplinary team-usually an exercise specialist, a nurse or diabetes educator, and a nutritionist. Multiple professionals increase scheduling problems, and most must be willing to perform their services for no or nominal payment. Another problem is that of continued contact with the patient, as lifestyle modifications comprise a large part of the strategy to treat prediabetes. However, in spite of such obstacles, many prediabetes programs have been successful.

Some diabetes educators are working to set up prediabetes programs at after-school times in cooperation with local schools. Younger children can be involved in games, such as guessing how many apples it would take to equal the calories in a fast-food hamburger. Older children can be given incentives to take up healthy activities such as walking with creative group functions. Starting a school-based prediabetes program requires at least as much planning as starting a community-based or clinic-based program. Relationships must be built with school board members, teachers, and school administrators so that they understand the need for the program. Laws and legalities must be carefully reviewed, and funding must be obtained. It is also helpful to organize the program in a way that outcomes can be shown-for instance, BMI, food choices, or exercise can be monitored to show before-and-after differences. This increases the value of the program. It is also a good idea to involve teachers, especially the physical education teacher, and the school nurse so that they can promote the program. Considering that 25% of very obese children are estimated to have prediabetes, organizing a school-based program is a very worthwhile endeavor.