Diabetes

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WHAT IS PREDIABETES?

Prediabetes is indicated by higher-than-normal blood glucose levels, but not high enough to be
considered diabetes. Before developing type 2 diabetes, individuals usually have prediabetes. An
estimated 797,000 adult Arkansans have prediabetes and are at very high risk for developing type 2
diabetes.

Studies have shown that people with prediabetes can prevent or delay diabetes with modest weight loss, healthy eating, and increased physical activity. Diabetes Prevention Recognition Programs have been
shown to be effective and cost-effective in helping individuals with prediabetes to lose weight and
prevent or delay the onset of type 2 diabetes.

THE DIABETES PREVENTION PROGRAM

The National Diabetes Prevention Program (DPP) is a year-long program that teaches participants to
make lasting lifestyle changes—like eating healthier, adding physical activity into their daily routine, and
improving coping skills.

The CDC recognizes organizations to provide DPP as they meet certain standards and show they can
achieve results. These standards include following an approved curriculum and facilitation by a trained
Lifestyle Coach.

The Diabetes Prevention Program (DPP ) was a major multicenter clinical research study. The intervention involved a lifestyle change program focusing on calorie reduction and increasing physical activity to at least 150 minutes per week. Results from the study showed that this structured lifestyle change program—in which participants achieved weight loss of 5 to 7 percent of their body weight (10 to 14 pounds for a person weighing 200 pounds)—reduced the risk of developing type 2 diabetes by 58 percent in adults at high risk for the disease.

A 10-year follow-up study, T he Diabetes Prevention Program Outcomes Study, showed that participants were still one-third less likely to develop type 2 diabetes a decade later than individuals in placebo groups. S ummaries of additional research studies can be found in CDC’s National DPP Coverage Toolkit.

ABOUT THE DIABETES PREVENTION PROGRAM (DPP)

The program includes:

A CDC-approved curriculum with lessons, handouts, and other resources to help you make healthy changes.
A Lifestyle Coach, specially trained to lead the program, to help you learn new skills, encourage you to set and meet goals, and keep you motivated. The coach will also facilitate discussions and help make the program fun and engaging.
A support group of people with similar goals and challenges. Together, you can share ideas, celebrate successes, and work to overcome obstacles. In some programs, the participants stay in touch with each other during the week. It may be easier to make changes when you’re working as a group than doing it on your own.

Time Commitment

The program runs for 1 year.

During the first 6 months of the program, you’ll meet about once a week.
During the second 6 months, you’ll meet once or twice a month.

Delivery Method

Choose an in-person, online, distance learning, or combination lifestyle change program.

IN PERSON
Meet face to face with group members and your Lifestyle Coach. Hands-on demonstrations help with learning, and the coach will provide handouts with useful information and practice activities.

ONLINE
The program is delivered 100% online with multiple chances to interact live with the Lifestyle Coach.

DISTANCE LEARNING
Distance learning works well for participants who want group interaction but live in a remote area and can’t attend an in-person program. It’s delivered 100% by a trained Lifestyle Coach via remote classroom or telehealth.

COMBINATION
The program can be delivered as a combination of any of the program types above.

ARE YOU ELIGIBLE TO JOIN THE NATIONAL DPP LIFESTYLE CHANGE PROGRAM?

To participate, you must meet ALL 4 of these requirements:

Be 18 years or older.
Have a body mass index (BMI) of 25 or higher (23 or higher if you’re an Asian American person).
Not be previously diagnosed with type 1 or type 2 diabetes.
Not be pregnant.

You’ll also need to meet 1 of these requirements:

Had a blood test result in the prediabetes range within the past year (includes any of these tests and results):
- Hemoglobin A1C: 5.7%–6.4%
- Fasting plasma glucose: 100–125 mg/dL
- 2-hour plasma glucose (after a 75g glucose load): 140–199 mg/dL.
Be previously diagnosed with gestational diabetes (diabetes during pregnancy).
Received a high-risk result (score of 5 or higher) on the P rediabetes Risk Test.

If you’re enrolling in the Medicare Diabetes Prevention Program, different criteria apply. Find them here.

YOU CAN FIND OUT IF YOU ARE AT RISK BY CLICKING “TAKE THE RISK TEST.”

IF YOU ARE AT RISK, WHAT DO YOU DO NEXT?

Talk with your healthcare provider at your next visit and get tested.
If you have prediabetes, enroll in a National Diabetes Prevention Program Recognized Program (DPRP). These programs are effective in delaying or preventing type 2 diabetes in people with prediabetes and they are cost-effective.

Find a National Prediabetes Prevention Program near you.

WHAT IS DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT (DSMES)?

DSMES is an evidence-based diabetes management service model that is defined as “the ongoing process of facilitating the knowledge, skills, and ability necessary for diabetes self-care, as well as activities that assist a person in implementing and sustaining the behaviors needed to manage his or her condition on an ongoing basis, beyond or outside of formal self-management training.” (Source: National Standards of Diabetes Care, 2017).

Studies have shown that DSMES services can make diabetes management fit your life by helping you make positive lifestyle changes such as developing healthier eating patterns and increasing activity levels. These changes can ultimately improve your confidence in diabetes management and lead to decreases in hemoglobin A1C levels, prevention or delay of diabetes complications, and improved quality of life.

On average, a person with diabetes spends less than 1% of their life with their health care team accessing services. The focus of DSMES services is to help “the person with diabetes develop problem-solving skills and attain ongoing decision-making support necessary to self-manage diabetes (Source: National Standards of Diabetes Care, 2017).

Participation in DSMES is linked to positive changes in health behaviors and improved diabetes-related outcomes. Benefits of DSMES participation include:

Improved hemoglobin A1C levels.
Improved management of blood pressure and cholesterol levels.
Higher rates of proper use of medication.
Fewer or less-severe diabetes-related complications.
Healthier lifestyle behaviors, such as better nutrition, increased physical activity, and use of primary care and preventive services.
Enhanced self-confidence.
Potentially reduce the risk of costly medical expenses by decreasing diabetes-related complications that may require costly emergency visits, helping make appointments more effective so extra appointments are not needed, and improving shopping skills for obtaining diabetes supplies and nutritious foods.

Learn more about DSMES programs at C DCs DSMES.

WHO IS ELIGIBLE TO RECEIVE DSMES SERVICES?

There are four key times your diabetes provider can refer to DSMES services:

If you’ve been recently diagnosed.
At annual doctor’s appointments.
If you’ve developed new complications.
If other life changes happen that make diabetes management harder.

Great news! DSMES is covered by Medicare and may also be covered by private health plans. The number of hours covered vary based on the individual plans, but you can always check with your doctor or insurance company to verify coverage.

WHERE CAN A PERSON FIND A DSMES-RECOGNIZED OR ACCREDITED PROGRAM?

There are two entities that can give this recognition or accreditation, the American Diabetes Association and the Association of Diabetes Care and Education Specialists. Both programs meet the same six National Standards but have slightly different interpretive guidance on how to best meet those standards.

DIABETES IN ARKANSAS

Diabetes is a serious and costly chronic illness. In 2017, there were approximately 307,385 people in Arkansas with a known diagnosis of diabetes. There is an estimated additional 70,000 people in Arkansas who do not know that they have diabetes. Every year an estimated additional 17,969 people in Arkansas are diagnosed with diabetes. There were 796,000 people in Arkansas who had blood sugar levels higher than normal (prediabetes), in 2017.

Diabetes can also have a large financial impact on Arkansans. Diagnosed diabetes costs an estimated $3.1 billion in Arkansas each year. This includes direct cost as well as costs associated with serious complications including heart disease, stroke, amputation, end-stage kidney disease, blindness, and death.

WHAT IS DIABETES?

Diabetes (referred to in medical terminology as diabetes mellitus or DM) is a group of diseases in which the body either does not produce enough insulin or doesn’t properly use the insulin that the body makes. Insulin is needed to convert sugar in the food we eat into the energy needed by every cell in the human body. The symptoms of diabetes are often subtle and may go undetected for a long period.

Unfortunately, high sugar can cause serious and life-altering medical complications; but people with diabetes can take steps to control the disease and lower their risk of developing complications. Learn more and w atch a video on how diabetes affects the body by clicking here.

THE DIFFERENT TYPES OF DIABETES

Type 1 diabetes, formerly called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, occurs when the body’s immune system attacks and destroys its own insulin-producing beta cells in the pancreas. Individuals with this type of diabetes must be on some type of insulin every day to survive since their body can no longer create it on its own. Type 1 diabetes develops most often in children or young adults but can occur at any age. It accounts for about 5-10% of people diagnosed with diabetes. There is currently no way to prevent Type 1 diabetes, but with proper medical care it can be successfully managed. Check out C DCs about Type 1 to learn more.

Type 2 diabetes, formerly called noninsulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, usually begins as insulin resistance-metabolic syndrome, a disorder in which the body’s cells do not use insulin properly. This form of diabetes usually develops in adults older than 45, however, Type 2 diabetes increasingly occurs in children and adolescents. Being overweight, having a family history, history of gestational diabetes, and inactivity increases the chances of developing type 2 diabetes at any age. About 90-95% of people with diabetes have type 2 diabetes. The exciting thing about Type 2 diabetes is that it can be delayed or even prevented with lifestyle changes. Find out more at CDC’s about Type 2.

Gestational diabetes is a form of glucose (blood sugar) intolerance that develops during pregnancy. It occurs more often among African Americans, Hispanic/Latino Americans, and American Indians and is also more common among obese women and women with a family history of diabetes. Gestational diabetes will usually go away after the baby is born but can increase mother’s risk of having Type 2 diabetes later in life. Gestational diabetes can increase the baby’s risk for having health problems and
their risk of developing Type 2 diabetes as they get older. To learn more, check out CDCs about Gestational Diabetes.

SYMPTOMS OF DIABETES

Symptoms of diabetes can be immediate or can occur over years depending on the type of diabetes diagnosed. Individuals with Type 1 diabetes will typically develop symptoms withing a few weeks or months of their body producing less insulin and eventually not making insulin at all. Symptoms can become very severe and result in a medical emergency. People with Type 2 may or may not notice symptoms at all until they have become so intense that they are interfering with daily life or result in a medical emergency. If you have any of the following diabetes symptoms, see your doctor about getting your blood sugar tested:

Urinate (pee) a lot, often at night
Are very thirsty
Lose weight without trying
Are very hungry
Have blurry vision
Have numb or tingling hands or feet
Feel very tired
Have very dry skin
Have sores that heal slowly
Have more infections than usual

Learn more about diabetes symptoms.

The most important thing you can do is find out if you are at risk for developing Type 2 diabetes. You may be at risk if you:

Have ever been diagnosed with being overweight or having obesity.
Are age 45 or older.
Have a parent or sibling with type 2 diabetes.
Are physically active less than 3 times a week.
Have non-alcoholic fatty liver disease (NAFLD).
Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed over 9 pounds.
Are an African American, Hispanic or Latino, American Indian, or Alaska Native person. Some Pacific Islander people and Asian American people also have a higher risk.

If you have any of these risk factors, talk to your doctor about getting tested for prediabetes and diabetes even if you have no symptoms.

Social Determinants of Health (SDOH)

Social Determinants of Health (SDOH) are non-medical factors that affect a wide range of health, functioning, and quality-of-life outcomes and risks. They include the conditions in which people are born, grow, work, live, and age. SDOH also include the broader forces and systems that shape everyday life conditions.

Arkansas Diabetes Prevention and Control Program (DPCP) adapted this definition from CDC and Healthy People 2030 definitions of SDOH. You can also find more information about SDOH at the links above.

“Diabetes can be prevented or controlled only through supportive policies, social conditions, and environments and by promoting more prepared, proactive health systems practice teams that enable informed and activated patients.” (Source: Connecting SDOH and HRSN to Prediabetes and Type 2 Diabetes).

ARKANSAS DIABETES PREVENTION AND CONTROL PROGRAM’S APPROACH TO ADDRESSING SDOH FOCUSES ON:

Food and Nutrition Security – Having reliable access to enough high-quality food that is safe, affordable, and culturally acceptable to avoid hunger, and lead an active, healthy life.
Built Environment – Human-made surroundings that influence overall community health and people’s behaviors that drive health.
Community-Clinical Linkages – connections made between healthcare, public health, and community organizations to improve population health.

ARKANSAS WALKING COLLEGE

In July 2021, the Arkansas Department of Health engaged America Walks to deliver its national Walking College program within the State of Arkansas (Arkansas Walking College).

Goal: build the capacity of local change agents to increase walking and improve walkability in their communities

Focus: organizing for policy change to create safe, walkable, livable communities through:

16 week online educational program for walkable community advocates
each fellow develops a Walking Action Plan for their community, which establishes specific goals and an implementation strategy

SDOH ASSESSMENTS

The Arkansas Diabetes Prevention and Control Program conducts periodic assessments in collaboration with Diabetes Self-Management Education and Support programs, Diabetes Prevention Programs, and complimentary diabetes programs in various communities. These assessments help those programs understand the current strengths, resources, and needs of the identified communities that will allow the programs and the Diabetes Prevention and Control Program to tailor activities, communications, and partnerships so that they are well-received and address the unique needs of the priority populations. The aim is to increase participation and retention in the diabetes programs, and to identify resources to assist participants in addressing social determinants of health to achieve prevention and management goals.

Complete a 1-hour interview (via zoom).
Introduce project team members to potential & current diabetes program participants who may be interested in participating in a focus group (via email, flyers, etc.).
Introduce project team members to additional practitioners who may be interested in completing an interview (via email)
Help us find a community space to conduct focus groups.

Partners will receive results of the assessments and financial (as available) and technical assistance with implementing awareness/marketing campaigns and tailoring materials.

For more information or to nominate your program/community for the assessments, please contact the Arkansas Diabetes Prevention and Control Program at 501-661-2075.

COMMUNITY HEALTH WORKERS (CHWS)

The Arkansas Diabetes Prevention and Control Program is collaborating with the Arkansas Community Health Worker Association (ARCHWA) to:

Implement a state-wide summit of Arkansas CHWs including sessions on diabetes related topics;
Train CHWs on barriers to social services and support needs (e.g., childcare, transportation, language translation, food assistance, and housing) within populations at highest risk of diabetes and/or cardiovascular disease;
Equip CHWs with regional community resources to enhance community-clinical links with HUD, food banks and pantries, and transportation resources for patients identified to have SDOH-related social service and support needs;
Host the Diabetes Prevention CHW Network and train the Network to better integrate diabetes Team-Based Care and referrals to National Diabetes Prevention Program (DPP) lifestyle intervention and Diabetes Self-Management Education and Support (DSMES) services;
Engage community organizations (e.g., churches, employers, healthcare clinics) to facilitate integration of CHWs into DPP/DSMES delivery teams.

OTHER STRATEGIES TO IMPROVE SOCIAL DETERMINANTS OF HEALTH

FOOD ENVIRONMENT

Promote local garden projects, small farms, farmers’ markets, farm to school, and gleaning programs.
Promote participation in nutrition assistance programs.
Utilize evidence-based nutrition education programs.
Educate health care professionals and cross-functional hospital teams in nutrition education and about access to healthy food.
Promote current public policies to assure inclusion of healthy foods for distribution to low-income Arkansans.

BUILT ENVIRONMENT

Connect more people to parks, particularly in nature-deprived communities.
Promote active transportation and land use policies to support physical activity.
Promote built environment interventions, (e.g., parks, walking paths) community programs (e.g., social support programs), and policies (e.g., complete streets policies) which can help reduce or eliminate barriers to making it easier for people to be physical active.

COMMUNITY-CLINICAL LINKAGES

Provide training and disseminate training resources on SDOH for CHWs, DSMES and DPP partners, Office of Health Disparities, Arkansas Pharmacy Association (ArPA), and other healthcare professionals through partnership with relevant entities.
Improve capacity of the diabetes workforce to address social determinants of health (SDOH) related barriers.
Collaborate with the Arkansas Community Health Worker Association (ARCHWA) to engage and educate CHWs to promote and disseminate diabetes-related culturally adaptive materials and services in Team-based Care for priority populations with diabetes.

FIND SDOH RESOURCES HERE.

Programs & Services