Funding Area: Improving Diabetes Prevention and Management

The National Diabetes Prevention Program (NDPP) is a lifestyle intervention program that has been proven to help participants achieve sustained weight loss and reduce their risk of developing Type 2 diabetes by 50%. NYHealth has worked to support the dissemination of the NDPP, with the program being implemented widely by community-based organizations across New York State.

However, participant attendance and retention are major concerns. To successfully complete the NDPP, participants are required to make significant time and behavioral commitments, which may lead to disengagement for some. For example, results from an evaluation of the Y-DPP (the YMCA’s adaption of the NDPP) in New York State found that 72% of participants attended more than half of the 16 sessions. In 2016, NYHealth awarded the New York Academy of Medicine (NYAM) a grant to develop a study on the factors that contribute to discontinued participation in the NDPP.

Under this grant, NYAM developed and conducted a study on the individual, social, environmental, and programmatic factors that lead to discontinued NDPP participation. Specifically, NYAM conducted interviews with individuals who stopped participating after attending at least two sessions, selecting participants from a minimum of 10 NDPP programs throughout the State. NYAM interviewed participants who discontinued the program about their motivation, perceived risk of diabetes, self-efficacy, barriers to attendance, perceived effectiveness of the NDPP, and recommendations for program improvement. Results of the study were shared through presentations, publicly available reports, and/or journal articles, with the goal to better inform NDPP implementation and improve retention rates.

In New York State, an estimated 4.5 million people have prediabetes, a condition which heightens a person’s risk for developing diabetes and its complications.

While curbing the diabetes epidemic is a daunting task, strong evidence has emerged in support of strategies to prevent diabetes. Specifically, the National Diabetes Prevention Program (NDPP) was identified by the Centers for Disease Control and Prevention (CDC) as an effective, evidence-based public health program. This lifestyle intervention has been shown to help participants lose 5–7% of their body weight and reduce their risk of developing diabetes by nearly 60%. Building on previous work to replicate the NDPP, NYHealth issued a request for proposals, Laying the Groundwork to Scale Up the National Diabetes Prevention Program in New York State, to help disseminate and grow the NDPP. Through this initiative, NYHealth awarded grants to organizations to implement, expand, and secure the sustainability of the NDPP in community-based settings across the State. NYHealth awarded Montefiore Medical Center a grant to participate in this initiative.

With NYHealth funding, grantees of this initiative reached communities with high rates of diabetes and prediabetes, making this effective program available to New Yorkers in places where they live, work, and worship. The grant awards supported a range of activities to help organizations implement and grow the NDPP, including the expansion of existing programs; communication, outreach, and education activities to obtain a steady flow of participants; and development of business plans to ensure the sustainability of the program. Specifically, Montefiore worked to earn CDC accreditation to offer the NDPP in-house. It hired an outreach coordinator who was responsible for working with providers, patients, and lifestyle coaches to ensure that eligible patients connect with NDPP classes and remain engaged in the program. Montefiore evaluated its efforts by tracking patient outcomes and health measures and will increase the number of classes available to patients, including in Spanish.

In January 2017, a paper on the lessons learned from implementing the NDPP at Montefiore Medical Center’s health system was published in Population Health Management.

View a complete list of Laying the Groundwork grantees.

The Bronx consistently has ranked as the unhealthiest county in all of New York State by the County Health Rankings and Roadmaps, a Robert Wood Johnson Foundation project.

In the south and northeast Bronx specifically, there is a 13.9% prevalence of diabetes. The Centers for Disease Control and Prevention (CDC) has stated that individuals with diabetes are at a greater risk of heart attack, stroke, blindness, kidney failure, nerve damage, and amputations. The Urban Health Plan (UHP), a federally qualified community health center, has been serving disadvantaged sections of the Bronx since 1974. In 2015, NYHealth awarded a grant to UHP to develop and implement the National Diabetes Prevention Program (NDPP), an evidence-based lifestyle program that reduces participants’ risk of developing diabetes, within its facilities.

Under this grant, UHP worked toward becoming a CDC-recognized certified master trainer of the NDPP. Specifically, UHP designated a coordinator to ensure health educators and nutrition assistants are trained to lead the NDPP. Potential participants were referred to the program by their providers and through UHP patient registries. UHP offered additional programs to complement the NDPP classes, including a demo kitchen program run by a nutritionist to teach patients how to prepare and purchase healthy foods. Ultimately, UHP created a sustainable system for health educators to deliver the NDPP across UHP sites.

In 2014, the City of New York reached an agreement with its municipal unions to generate health care savings of $3.4 billion over the 2015–2018 fiscal years.

New York City provides health insurance to its current employees, retirees, and their dependents—an estimated 1.3 million people. To help save more than $3 billion in health care costs within three years, the City recognizes the importance of a healthy workforce, as well as the benefits of workplace wellness initiatives. As of January 2015, the Centers for Disease Control and Prevention recognizes online versions of the National Diabetes Prevention Program (NDPP), an evidence-based lifestyle program to prevent Type 2 diabetes. This recognition marks a significant step in scaling up the program, as it may reach participants who would not have joined in-person wellness programs. In 2015, NYHealth awarded a grant to The Fund for Public Health in New York, as fiscal sponsor to the Mayor’s Office of Labor Relations, to launch an online NDPP pilot for City employees.

Under this grant, the Mayor’s Office of Labor Relations worked in partnership with Fund for Public Health in New York to pilot an online NDPP version for 1,000 City employees. Classes used the same content as the in-person NDPP, spanning 16-weeks and accompanied by a six-month follow-up session. During the first year of NDPP expansion, a project coordinator launched and referred participants at two City agencies; three additional agencies followed the second year. To examine the effectiveness of the program, evaluations were completed to determine best practices in program participation and completion, as well as health outcomes and cost savings generated from the program. Overall, this pilot program worked to demonstrate the feasibility of offering the NDPP to City employees on a larger scale.

Although health care workers provide essential services for the health care system, a recent study found that hospital employees are more likely to require treatment for chronic diseases, such as diabetes, and less likely to receive preventive care than non-health care workers.

Approximately 35% of 1199SEIU United Healthcare Worker East members in New York City have prediabetes, the precursor to diabetes. The evidence-based National Diabetes Prevention Program (NDPP) helps participants with prediabetes develop lifestyle skills and behaviors that can reduce their risk of developing diabetes by 50%. NYHealth awarded the Healthcare Industry Grant Corporation, on behalf of 1199SEIU Labor Management Initiatives, a grant to offer 1199SEIU members the NDPP.

Under this grant, Healthcare Industry Grant Corporation established a pilot program to offer the NDPP to 1199SEIU members at their worksites. Workers were screened at health care facilities to identify and enroll those with prediabetes into the NDPP. The State University of New York at Albany’s Quality and Technical Assistance Center provided training and supervision to union workers from the health care workforce to become lifestyle coaches and deliver the NDPP. A project coordinator was hired to oversee the pilot program’s implementation, which included identifying members with prediabetes, managing referrals, organizing lifestyle coach training, coordinating classes, and ensuring participation. In addition, a labor management committee, comprising key representatives from both the union and management, guided and supported key aspects of the program, which included addressing barriers for workers to enrolling in and completing the NDPP.