How to Lower Your Risk of Diabetes

The YMCA has invented a cheap, successful program that teaches at-risk patients how to avoid the condition.

Retired accountant Paul Mullen weighs in before a diabetes prevention class at a YMCA in Indianapolis, Tuesday, June 23, 2009. Mullen, 66, of Indianapolis, has lost 18 pounds and brought his blood sugar down because of lifestyle changes he learned in the program. He pays $115 for the yearlong program, on top of his Y membership fee.
Margot Sanger Katz
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Margot Sanger-Katz
June 13, 2013, 11:53 a.m.

Wendy Wi­ernik was sit­ting in her car, just after a doc­tor’s ap­point­ment when it hit her: She was not go­ing to get dia­betes. She star­ted cry­ing.

Wi­ernik, a 42-year-old moth­er with two jobs and a fam­ily his­tory of de­pres­sion and dia­betes, weighed more than she should and had been flagged as “pre­dia­bet­ic” half a year be­fore. That’s when her phys­i­cian’s as­sist­ant made a sur­pris­ing sug­ges­tion. In­stead of writ­ing her a pre­scrip­tion or of­fer­ing her med­ic­al treat­ment, the PA sug­ges­ted that Wi­ernik sign up for a dia­betes-pre­ven­tion class at the YMCA.

She was one of the first par­ti­cipants in a pro­gram that is now spread­ing around the coun­try and upend­ing tra­di­tion­al ideas about how to de­liv­er med­ic­al care. Through a year of classes led by a trained life­style coach, the Y has been able to help about 60 per­cent of par­ti­cipants lose 5 per­cent of their body weight and dra­mat­ic­ally re­duce their chances of de­vel­op­ing a dan­ger­ous (and ex­pens­ive) chron­ic dis­ease. “The biggest chal­lenge we have is [that] doc­tors scratch their heads when you say you want them to send their pa­tients to the Y,” says Jonath­an Lever, the as­so­ci­ation’s vice pres­id­ent for health strategy and in­nov­a­tion, who helped launch the pro­gram. “We’re not a usu­al act­or in that space.”

But it is a very ef­fect­ive one. A series of stud­ies found the YMCA class out­per­formed any oth­er treat­ment for people like Wi­ernik who are likely to de­vel­op the dis­ease. In a clin­ic­al tri­al, the ap­proach worked so much bet­ter than a dia­betes-pre­ven­tion drug that re­search­ers stopped the tri­al mid­way be­cause con­tinu­ing to deny every­one ac­cess to the class would have been un­eth­ic­al. “This is the most evid­ence-based pro­gram for the pre­ven­tion of Type 2 dia­betes for those at high risk,” said Ann Al­bright, dir­ect­or of the di­vi­sion of dia­betes at the Cen­ters for Dis­ease Con­trol and Pre­ven­tion.

All of the fi­nal­ists Na­tion­al Journ­al honored in the cat­egory of in­nov­at­ive health care pro­grams found smart ways to ad­dress prob­lems in this field. But we chose the YMCA as the win­ner be­cause it con­fronts a ma­jor med­ic­al chal­lenge with a simple and cheap solu­tion that of­fers long-term re­wards. Some 26 mil­lion Amer­ic­ans are cur­rently dia­gnosed as dia­bet­ic, a num­ber that keeps grow­ing, along with the cost. Al­to­geth­er, dia­betes cost our health care sys­tem about $245 bil­lion last year in dir­ect med­ic­al costs, ac­cord­ing to the Amer­ic­an Dia­betes As­so­ci­ation.

Even for in­di­vidu­als, the cost im­plic­a­tions are huge. On av­er­age, the YMCA course costs about $400. But a per­son who de­vel­ops dia­betes can cost the health sys­tem $12,000 to $15,000 a year, says Timothy Koehler, pres­id­ent of the Dia­betes Pre­ven­tion and Con­trol Al­li­ance, a part of United­Health Group. “The re­turn’s really a no-brain­er,” he says.

The classes aren’t com­plic­ated, and they work. Every week for 16 ses­sions and then monthly for the rest of a year, a group of eight to 15 people get to­geth­er with a trained coach and talk about strategies for eat­ing few­er cal­or­ies and ex­er­cising more. They learn to keep track of what they eat and brain­storm ways to change their life­styles. If you park at the far end of the park­ing lot, you can get in an ex­tra three minutes of walk­ing to the gro­cery store. If you have a bad day, just start again to­mor­row. The “secret sauce,” Lever said, is the well-trained, up­beat coaches, and the ad­vice and sup­port class mem­bers of­fer one an­oth­er.

People en­rolled in the pro­gram lose the weight and re­duce oth­er dia­betes risk factors. Even 10 years out, their risk of get­ting dia­betes is re­duced by more than a third. At Wi­ernik’s six-month ap­point­ment, she learned that through small diet changes and daily walks on the tread­mill, she’d cut her blood gluc­ose level in half and re­duced her hemo­globin A1C level — a key dia­betes in­dic­at­or — by a full per­cent­age point. “I just star­ted cry­ing, be­cause it’s like, this can be pre­ven­ted,” she says. She also lost 40 pounds over the year, bring­ing her down to 140.

In­sur­ance com­pan­ies have star­ted to catch on. Now 37 dif­fer­ent health plans in­clude the YMCA pro­gram as a covered be­ne­fit, and more than 10,000 people have com­pleted the class. CDC has de­veloped stand­ards to cer­ti­fy oth­er com­munity groups that want to of­fer the pro­gram.

It’s a mod­el likely to be copied. Sim­il­ar courses might be able to help at-risk people man­age arth­rit­is, re­duce their risk of hy­per­ten­sion, or pre­vent falls. And in a coun­try cop­ing with a short­age of primary-care pro­viders, there’s no short­age of YM­CAs: 60 per­cent of Amer­ic­ans live with­in three miles of a Y, and the class is low-tech — it can hap­pen in a classroom, a doc­tor’s of­fice, or even a kit­chen. It shows how pre­ven­tion doesn’t have to be med­ic­al to make a big dif­fer­ence in people’s health.

See the fi­nal­ists in each cat­egoryDi­git­al In­nov­a­tion | Ex­pand­ing Ex­ports | Work­force Train­ing | Health Care | Fin­an­cing In­fra­struc­ture | Dis­rupt­ing Gov­ern­ment | Re­gion­al Eco­nom­ic Strategies | Edu­ca­tion | En­ergy

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