| Montana Diabetes Prevention Program
The Montana Department of Public Health & Human Services expanded access to the DPP by supporting two organizations in delivering the DPP for their communities. This prevention service supports adults at high risk for type 2 diabetes and cardiovascular disease in preventing or delaying the disease through health eating habits, increased physical activity, and weight loss as well as confidence in making and sustaining behavior change. Trained lifestyle coaches educate, empower, and motivate participants in a group-based environment using coaching techniques and an evidence-based curriculum.
In 2011, the Missoula City-County Health Department and the Butte Diabetes Network (which includes a partnership between St. James Hospital and the Butte Family Y) were awarded a Request for Proposal and contracted to deliver the DPP. In 2012, a policy change was made so that Montana Medicaid covered the program for Medicaid members, which further increased access to and awareness of this service especially among low-income, disabled, or elderly Montanans.
The Montana DPP is committed to reducing the burden of cardiovascular disease and type 2 diabetes by utilizing sustainable community partnerships to provide opportunities for primary prevention emphasizing healthy lifestyle change among high risk Montanans. To achieve this vision, the Montana DPP organizes, educates and supports community partners in reducing the risks of cardiovascular disease and type 2 diabetes in Montana.
Need for Diabetes Prevention:
Type 2 diabetes is common, costly, and preventable. Modifiable risk factors for diabetes and cardiovascular disease are prevalent. In 2011, diabetes was the 6th leading cause of death and cardiovascular disease was Montana’s leading cause of death. Eight percent of all Montana adults reported having diabetes with a significantly higher percentage being reported by American Indians compared to whites, 17% vs. 8%, respectively. Pre-diabetes affects up to 38%of adults according to national estimates.
Area for Improvement:
In 2011, there were no local health departments in Montana that delivered the DPP and Butte lacked an organization that delivered the DPP in the community.
Obesity raises the risk of type 2 diabetes, cardiovascular disease, hypertension and other chronic diseases. One-fourth of Montana adults reported being obese (25%). Montana adults aged 45-54 years had the highest prevalence of obesity (31% of both men and women). Obesity is also significantly more prevalent among adult Medicaid beneficiaries aged 18 to 64 (41%).
Planning and Execution Details
The Montana Department of Public Health and Human Services has well established programs and partnerships, has demonstrated positive outcomes to address chronic disease, and has the structure to effectively coordinate implementation of the DPP. We built on existing strengths to meet our goals by improving prevention of type 2 diabetes and control of associated risk factors. The State Diabetes Program Staff support the prevention system by conducting needs assessment, selecting and adapting the intervention, supporting organizations and lifestyle coaches, and promoting and marketing the DPP, conducting program evaluation, and planning for sustainability. Community-clinical linkages helped ensure that adults at high-risk diabetes have access to community resources, programs that address risk factors, prevention strategies, and support to prevent or delay the disease.
The two community programs employed lifestyle coaches and enrolled participants into the DPP to provide education services and support in increasing physical activity, improving dietary choices, and creating environments that promote achieving and maintaining a healthy weight and ultimately prevent or delay the onset of type 2 diabetes for adults at high risk. This activity supported two state health objectives by reducing the percent of adults who engage in no leisure time physical activity and who are in the overweight or obese weight categories according to their BMI.
Missoula City-County Health Department featured cooking demonstrations with their new kitchen in 2015. Butte Diabetes Network recently employed a mental health counselor to guide participants through the lifestyle change, support improved participant interactions, and supplemented the curriculum content on coping, problem solving, resilience, and reacting to negative thoughts.
In addition to the Preventive Health and Health Services Block Grant, funds leveraged f State of Montana Master Settlement Agreement supported the contracts with these two
communities as well as contracts with 16 additional organizations to deliver the DPP intensive lifestyle intervention. Centers for Medicare & Medicaid Services funding supported these organizations with promotion, outreach, adaption of the intervention and evaluation of the program for Medicaid beneficiaries and Medicaid providers. Montana was the first state to achieve reimbursement by Medicaid for the DPP.