Northeast Louisiana Regional Pre-Diabetes Prevention Program

Evidence-level

Promising (About evidence-level criteria)

Description

The Northeast Louisiana Regional Pre-Diabetes Prevention Project (RPDP) was created by the North Louisiana Regional Alliance (NLRA) Health Network in response to medical providers' growing concerns about the lack of disease prevention and management programs in their rural areas. Using the American Diabetes Association as their guide, they set up a pilot project in Louisiana's Richland Parish in 2009 that expanded to Franklin, Morehouse, Richland, Tensas, and Union parishes with outreach activities reaching to East Carroll, West Carroll, and Madison parishes.

All five parishes RPDP served are designated as Medically Underserved Areas (MUAs) and Health Professional Shortage Areas (HPSAs). According to research funded by the Health Resources and Services Administration (HRSA), diabetes was reported as one of the top health disparities in the area. They found that the rate of elevated blood sugars was higher than the national average, and people were not concerned about reducing them.

RPDP's goal was to help prevent or slow diabetes progression through:

1. Repeated adult screenings over a 3 year period
2. Health education that promoted behavioral and lifestyle changes
3. Medical management with pharmacological intervention

Partners of RPDP included organizations that are NLRA members, shared a desire to implement a diabetes prevention program, and had the capabilities of implementing a project in their respective parishes.

RPDP partners included:

• Franklin Medical Center
• Union General Hospital
• Morehouse General Hospital
• Richland Parish Hospital
• North Louisiana Regional Alliance

This program received support from a 2012-2015 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant. The program is no longer active.

Services offered

Through a heavy promotional campaign, 64,000 people were exposed to information regarding RPDP's progressive diabetes prevention track. Below is an outline of their diabetes prevention initiatives.

1. Prediabetes screenings – The RPDP sets up screenings in different locations, including local businesses that promote the screenings to the public and their employees.
2. Point-of-contact education – Every participant received health education during the time of their screening, including their current health status and their risk of developing diabetes and other chronic diseases.
3. Follow-up testing – If the screening's result suggested the participant was prediabetic, they were asked to come back for additional tests.
4. Pre-Diabetes Prevention Program (PDP) – After a prediabetes diagnosis, an intensive course invited the participant to attend regular health assessments, screenings, personal wellness profiles, health education sessions, one-on-one coaching sessions, and advice on diet and exercise. Participants also received a monthly newsletter, bimonthly phone calls, and an annual PDP dinner invitation for extra encouragement.
   
5. Certified Diabetes Education Development – This certification qualified clinicians to offer in-depth education to other healthcare professional on issues that included prediabetes diagnoses, treatments, and the risks of type 2 diabetes.

Results

• 1,839 people completed a prediabetes screening, exceeding their original goal by 125% in the second year of the program
• 1,659 screenings were conducted on participants who had never before been screened, of which 10.7% met the preliminary criteria for prediabetes
• Over one quarter (26.7%) of PDP enrollees graduated with normal blood sugar scores
• Nearly 42% of enrollees who were re-screened during the third year of the program improved their A1C (blood sugar) scores, while almost 47% improved their fasting blood sugar levels
• As a result of this project, 6 clinicians became Certified Diabetes Educators
• RPDP launched an annual "Grin & Bear It" 5K/10K race in Richland Parish. Local businesses sponsored over 100 runners from all over Northeast Louisiana

This program was inspiration for The Adolescent Pre-Diabetes Prevention Program, managed by Richland Parish Hospital.

Challenges

• The FDA ruled against any off-label (non-FDA approved) use of certain tests. The RPDP complied, but due to higher cost, more stringent screening methods and longer test-processing times, they had to close their prediabetes screenings across the region during the third year of the program.
• Specific processes established by the Richland Parish were difficult to duplicate on a broader scale.
• Commitment from participants was inconsistent. Many who signed up for the PDP course did not take full advantage of the opportunities offered to them.
• Personnel turnover in partner parishes was a continual problem during the grant period

Replication

Many of the lessons learned through the RDPD experiences were put into an extensive toolkit that can be accessed upon request. Below are a few of key principles:

• Take the initiative with community partnerships. They will see your dedication, and their trust will be more-easily gained.
• Seek out other prediabetes programs in your area and offer to collaborate with their efforts.
• As you initially collaborate with your partners, decide on a shared mission, vision, and strategic priorities together.
• Engage a program evaluator in the early stages of your planning and act on their input.
• Rigorously work out your screening model by setting up a pilot program before launching your services regionally.
• Use multi-media avenues, including traditional and social media, in promoting your prediabetes screening and diabetes prevention information to your communities.
• Have experienced staff from your pilot project work side-by-side with new staff, closely training them on how to conduct the screenings.
• When conducting screenings, ask the patient if they are already aware of their blood levels and take time to talk about them. One-on-one education about the dangers of high blood sugar levels is an important aspect in gaining results.
• Use a system that collects and stores data in a way that can be easily retrieved and analyzed.

Contact Information

Charlotte Poland, RN, Certified Diabetes Educator
Richland Parish Hospital
318.878.2845
cpoland@delhihospital.com