Freeman, a Leader and Inspiration for Diabetes Prevention Program
To his patients, Greg Freeman is their registered nurse, but as the UVM Health Network – Champlain Valley Physicians Hospital Director of the National Diabetes Prevention Program (NDPP), he is a walking example of the program’s success.
When AHI introduced the New York State Health Foundation (NYSHealth)-funded program to its partners, Freeman enthusiastically signed on. Not only does he administer NDPP, he has followed its recommendations, resulting in a personal weight loss of 81 pounds.
AHI’s Evaluations Manager, Anne-Marie FitzGerald, interviewed Freeman, who learned about his risk for developing diabetes after taking a Centers for Disease Control and Prevention (CDC) prediabetes screening test, about the NDPP, what interested him about the program, and why it’s been such a big success while others programs seem to fail.
Q: What caught your interest in the National Diabetes Prevention Program?
A: It was the evidence of its (the program’s) success. I was looking for a program that health care providers, insurers and consumers could all recognize as a quality program; the kind of quality that would have providers buy-in, insurers invested, and consumers engaged. In health and wellness, the seemingly endless line of products and programs clogging up billboards, airways, and the Internet makes identifying a quality program very difficult. I wanted to change that.
Q: What makes this program successful?
A: The National Diabetes Prevention Program’s recognition as an “evidence-based” program is the gold seal consumers, providers and insurers really need to look for. What’s behind NDPP’s evidence-based program is an assurance that the intervention meets three important criteria: first, it’s proven effective via rigorous scientific testing; second, the testing protocol and results are reviewed and approved by peers in the field; and third, the program is clearly laid out so others can implement it in their location. That may seem like cut and dried criteria, but I feel an evidence-based approach is the foundation of the exciting success they’ve experienced in implementing NDPP at CVPH.
NDPP is a program of the Centers for Disease Control and Prevention (CDC). The program is one year long – weekly for the first six months, then monthly for the following six months of lifestyles intervention.
Q: What does this program mean to the UVM Health Network – CVPH community?
A: The program means a lot both locally and on a national level. According to the CDC, the number of Americans diagnosed with diabetes more than tripled from 5.6 million to 20.9 million between 1980 and 2011. The NDPP focuses on individuals who are identified as pre-diabetics, which amounts to a set of risk factors (i.e. obesity, family history of diabetes, low level of physical activity, age) that are associated with developing diabetes. Pre-diabetics are five to 15 times more likely to develop type 2 diabetes.
We know this is a serious health concern in our CVPH service area. CVPH’s 2013 Community Service Plan identified diabetes prevention as a top priority. The plan cites the region’s high prevalence of obesity, low access to healthy foods, and limited access to opportunities for physical activity as the key drivers behind the region’s chronic disease problem.
At the heart of it, CVPH’s National Diabetes Prevention Program is about improving the quality of life for residents of Clinton County through diabetes prevention. While the focus of the program is on improving the lives of individuals, evidence shows health care expenses are 2.3 times higher for people with diabetes; lower health care costs via prevention is pretty compelling as well.
Q: How does the NDPP program differ from other diabetes programs?
A: NDPP focuses on the barriers people confront when trying to make the kinds of lifestyle changes needed to reduce the risk of developing type 2 diabetes. We all know it’s hard to make changes that result in weight loss, such as better eating and/or exercise habits. Getting down to the root of what an individual’s personal barriers are is uplifting; a process that allows participants to recognize that there are others who know and share their struggles. I hear “What’s your trouble?” “Wow, that’s mine too and I’ve tried such-and-such, but it didn’t work for me either.” Turning those sessions around by setting meaningful and attainable goals, developing a plan to meet those goals, and checking in on successes, failures and modifications is key. There is a focus on problem-solving and coping skills which is really different from other programs.
NDPP focuses on small changes and small gains; the curriculum is designed to introduce participants to new ideas, new strategies and occasionally new places. As part of CVPH’s NDPP program, participants are encouraged to develop a relationship with CVPH’s Fitness Center. My fellow NDPP staff members and I realized early on that many of our program participants had never used a fitness center by choice or lack of opportunity. There was a very real sense of discomfort for these folks around the idea of accessing a fitness center. Perceived social barriers, anxiety around ability, and fear of injury were common. Much of this work has fallen on CVPH NDPP staffer Nicole Williams. Nicole, a wellness coordinator trained in kinesiology and exercise science, has championed the work of introducing NDPP participants to exercise and the fitness center lifestyle. She attended NDPP-Masters Training in spring 2015. This was a game changer for the program. What Nicole brought back in terms of knowledge and skills from that training really changed our work. It made us think more deeply about our NDPP program and come up with a new set of implementation plans that have been well received.
Q: Is it important that NDPP is an evidence-based program?
A: Knowing that you’re implementing an evidence-based program is really reassuring; you know it has the potential to work because it has been successful somewhere else. But just because it’s evidence-based does not mean that it is ready to go “out of the box.” I think it’s been really helpful for us to recognize that we had to take this evidence-based program and make it our own. We’ve worked hard on that over the past year, with extra training, building a learning environment for the NDPP staff and the NDPP participants we work with. Listening to the experiences of participants as they move through the program validates our work. The payoff is a program that is creating remarkable changes in people’s lives.
The CDC sets the bar very high in terms of implementing, monitoring and evaluating the program. CVPH staff members, including me, Nicole Williams, whom I mentioned earlier, and R.N. Elizabeth Badger, completed Lifestyles Coach training, one of several standards required of programs seeking CDC recognition as an NDPP-Diabetes Prevention Recognition Program. The standards focus on documenting and reporting activities to ensure program quality and reliability. Organizations are required to submit evaluation data every six months during the first year of program operation, receiving interim feedback from the CDC on progress towards meeting the standards.
Q: What has been the program’s reach thus far?
A: So far, CVPH has completed two of the yearlong NDPP series; both have been targeted to CVPH employees, spouses, and volunteers. This approach was chosen because it gave us a chance to implement and develop the program before launching it to the wider community. The two completed series started in September 2014. A third series, which started in January 2015, is presently in progress. On average, each series has had about 15 participants.
CVPH plans to roll the program out to the general public once it achieves CDC recognition, which is anticipated in fall 2016. We are working closely with health care providers on developing a referral system for the program. Those efforts focus on creating awareness around program eligibility requirements and earning provider buy-in with respect to the program’s ability to impact outcomes. We’ve relied on our initial success to help us with program promotion. Sharing program evaluation data and personal testimonials from participants has been a powerful means for stimulating interest among providers, insurers and participants.
Q: What’s the goal for the CVPH-NDPP program?
A: When an individual moves from being pre-diabetic to having a diagnosis of diabetes, their health care costs on average double. Clearly there’s a goal to lower health care costs, but lowering costs is not what’s going to sustain a program. Sustainability is going to come down to the value the program provides in making a difference in people’s lives. The NDPP program has been life-changing for many of our participants; the program reduces a pre-diabetic’s risk of developing type 2 diabetes by 58 percent. The goal is to help participants achieve “at least a five- to seven-percent weight reduction,” thus reducing their risk of developing diabetes. Our goal is to make sure participants develop problem-solving and coping skills needed that will make this entire endeavor meaningful, achievable, and sustainable.
The CVPH-National Diabetes Prevention Program is funded by a grant from the New York State Health Foundation (NYSHealth) and administered by AHI.
Watch the Video
Greg Freeman and others were featured in an AHI video describing NDPP.
- View the AHI NDPP video
Information and Resources
For more information and NDPP resources, visit the NDPP web page.