Innovation: Diabetes Prevention Programme with the YMCA
USA
AAI Domains:
Independent, healthy and secure living (improving access to health and care services, increasing levels of physical activity)
Participation in society (social connectedness)
There are an increasing number of people developing diabetes in wealthy societies with the rise in type 2 diabetes being responsible for the vast majority of this increase. People with diabetes are at greater risk of heart disease and stroke, kidney failure, sight loss and foot or leg amputation. There are an estimated 32 million people in the 20–79 years age range in the European Union with diabetes, approximately six per cent of the population, and is projected to increase to 38 million people by 2035.
In the USA, there are nearly 30 million people with diabetes and an estimated 86 million people have pre-diabetes, a term to describe people with raised blood sugar who are clinically close to developing diabetes, of whom only 9 million people are aware of the risks to their health that they face. Type 2 diabetes typically affects people from adolescence onwards and there is no cure for it but it is preventable through leading a healthy lifestyle.
The Centers for Disease Control in the USA, developed an evidence-based intervention – the Diabetes Prevention Programme – based on gradual weight loss, increased levels of physical activity and healthy eating to reduce the incidence of type 2 diabetes. This ‘Lifestyle Balance’ involved individual support from trained case managers (‘lifestyle coaches’) who ran exercise sessions, provided motivational support to participants and could utilise a range of materials and strategies to encourage adherence to the programme.
The Diabetes Prevention Programme (DPP) is a twelve month community-based intervention consisting of 16 one-hour weekly sessions followed by monthly sessions with small groups of people who want to reduce their risk of developing diabetes. The DPP was shown to be effective for people of all ages but implementing it was proving to be challenging as local public health authorities lacked the capacity to deliver it on a sufficiently large scale.
The YMCA has a national (and international) network of provision that significantly increased the scale and reach of the DPP right across the USA. With training and financial support from the Centers for Disease Control, the Diabetes Prevention and Control Alliance and a range of charitable foundations the YMCA was able to mobilise more than 500 lifestyle coaches across 46 communities in 23 states in less than two years. This supplemented existing provision of the DPP, which has more than 600 registered examples, and provides a cost-effective preventative intervention.
In terms of active ageing domains, the DPP with the YMCA provides improved access to health and care services with an important emphasis on prevention. If the DPP is successfully completed then it increases the level of physical activity and the process is based on groups supporting each other through the process of achieving ‘Lifestyle Balance.’
Diabetes is a major public health challenge, particularly in societies with increasing levels of obesity and sedentary lifestyles, that affects people over the life course and the DPP is a good example of an innovative way of using an existing network (the YMCA) to scale up a community based intervention.