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Assignment 5.1: Diabetes Prevention

Aynabeba Singh

Department of Nursing, Maryville University

NURS 610: Health Promotion

Dr. Lois Ewen

May 15, 2020

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Assignment 5.1: Diabetes Prevention

Diabetes is a global health issue affecting approximately half a billion of the world

population. It is expected to rise by 25 % in 2030 and it mainly affects people in high income

countries (Saeedi et al., 2019). In the United States 88 million people or 34.5 percent of the adult

population have prediabetes (Centers for Disease Control and Prevention, 2020). The rate of

prediabetes in young adults and children is also high. One in five adolescents and one in four

young adults in the United States live with prediabetes The rate of diabetes related complications

in the United States is also increasing among young and middle-aged adults (Centers for disease

Control and Prevention, 2019).

In the United States diabetes is the 7th leading cause of death and morbidity (New Jersey

Department of Health et al., n.d.). Undiagnosed prediabetes and insulin resistance often lead to

full blown diabetes. Left untreated diabetes results in complications like cardiovascular disease,

dementia, Alzheimer's disease, kidney failure and some types of cancer (Centers for disease

Control and Prevention, 2019).

The cost of diabetes care has risen in the past decades, and it continues to rise. The cost

of diabetes care in 2017 was a staggering 237 billion dollars compared to 116 billion dollars in

2007 (Riddle & Herman, 2018). Considering the increasing number of young adults and children

who are diagnosed with diabetes every year and those living with prediabetes the cost will

continue to rise creating a significant burden on the health care system (Centers for Disease

Control and Prevention, 2019).

National and State Goals

National Objective
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The national objective chosen to be discussed in this paper is, D-01, the objective to

reduce the number of diabetes cases diagnosed in the United States. The base line for this

objective is 6.5 new cases of diabetes per 1000 adults. The target is to decrease the number of

new cases of diabetes to 5.6 per 1000 adults by 2030 (U.S Department of Health and Human

Services, 2020).

The National Diabetes Prevention Program led by the Centers for Disease Control and

Prevention coordinates an alliance between local governments, insurers, employers, community-

based nonprofits and academic institutions to promote healthy lifestyles and education of the

public to achieve this goal (Centers for Disease Control and Prevention, 2019).

State Goals

The state of New Jersey does not have an exact goal matching that of the national

objective. However Healthy New Jersey 2020, an initiative to promote health in New Jersey, has

two related objectives. These objectives are, reduce diabetes death rate and increase percentage

of diabetic adults who get a glycosylated hemoglobin test at least twice a year (State of New

Jersey Department of Health, 2017c).

Healthy New Jersey 2030 is still in the process of being developed. The state's efforts are

focused more on treatment and self-management of diabetes rather than prevention as evidenced

by lack of clearly stated objectives to decrease the prevalence of newly diagnosed diabetes.

However, other objectives like the initiative to decrease adult and child obesity are helpful in

fighting diabetes and prediabetes in the state.

State Action to Meet the National Objective

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New Jersey has 21 counties all with different health outcomes and health factors. The

five lowest ranking counties are all found in southern NJ (County Health Rankings and

Roadmaps, 2021). According to the New Jersey Department of Health et al. (n.d.), Hunterdon

County is the healthiest county and last on the list is Cumberland County.

According to Healthy NJ, a state initiative to promote health in the state, some of the ten-

year objectives from 2011 to 2020 were to decrease adult obesity, to decrease high school

student obesity, increase adult physical activity and high school student physical activity. These

goals were not met, rather data collected during the 10-year period shows there was an increase

in lack of physical activity both in adults and teens (State of New Jersey Department of Health,

2021).

Assessment of Resources

Local Resources

The NJ Diabetes Control and Prevention Program provides grant to federally qualified

health centers and other health care organizations who are designated as Diabetes Resource

Coordination Centers (State of New Jersey Department of Health, 2019a). These organizations

promote diabetes prevention through education focused on high-risk individuals and

communities. Universities, nonprofit organizations, hospitals and local health departments serve

as Diabetes Resource Coordination Centers (DRCCs) (State of NJ Department of Health, 2019a).

Diabetes Prevention Education

There are 32 programs recognized by the Centers for disease Control and Prevention for

diabetes prevention in the State of New Jersey (Centers for Disease Control and Prevention,

n.d.). Federally Qualified Community Health Centers, local nonprofit organizations and health
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systems like Hackensack Meridian, RWJ Barnabas and Jefferson Health. Thes programs provide

diabetes prevention services in several locations in the state. The programs are part of the

national diabetes prevention program through the Centers for Disease Control and Prevention

(CDC). Classes are offered both in person and virtually.

The Camden Coalition of Health Care Providers (CCHP) is one of the nonprofit

organizations serving the city of Camden in New Jersey. It is funded by the government and

membership dues from local hospitals (Kaufman et al., 2014). The organization provides early

case management programs to at risk individuals and those with diabetes and prediabetes to

prevent costly complications.

Healthy Food Initiative for Underserved Communities

The Healthy Corner Store Initiative is a program in New Jersey which works with

neighborhood convenience stores in several underserved areas to enable them to stock and sell

healthy food alternatives. The program is funded by the New Jersey Department of Health and

operated by The Food Trust, a national nonprofit organization headquartered in Philadelphia,

Pennsylvania (State of New Jersey Department of Health, 2017b). Food insecurity is shown to be

associated with poor glycemic control (Berkowitz et al., 2018)

Fitness and Exercise Programs for Seniors

Throughout New Jersey several local programs are offered in each county to promote

health and wellness for senior citizens aged 50 and above. Health Ease is one such statewide

program provided by the State of New Jersey Department of Health and Senior Services (NJ

DHSS). It is funded by a grant from Robert Wood foundation (State of New Jersey Department

of Human Services, 2013).

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Health Ease provides trained peer led exercise program, self-assessment of health

behavior, fall prevention and improving flexiblity. Participants report improved blood glucose

control, weight loss and improved self-care knowledge after completing the program. This

program offers education on several health topics including nutrition and physical activity (State

of New Jersey Department of Human Services, 2013).

Fitness and Nutrition Programs for Schools

The New Jersey Department of Health funds programs and organizations like the Y

alliance, The New Jersey Association of Health, Physical Education, Recreation and Dance

(NJAHPERD) and health corps to promote healthy school nutrition, physical activity programs

and implement other school-based health promotion activities (State of NJ Department of Health,

2017).

The New Jersey Healthy Communities Network

This network is a statewide coalition of government and non-government organizations.

It supports communities to implement healthy living and eating habits and improve living

conditions of residents. Among many things, communities use the grant from this coalition to

install walking and biking trails, promote farmers markets and healthy corner store markets

(State of New Jersey Department of Health, 2019b).

Effectiveness of Local Resources

A randomized control trial has shown lifestyle changes can produce a 58% reduction in

progression of prediabetes into full blown diabetes (Diabetes Prevention Program Research

Group, 2012). The effects have lasted up to 15 years (Diabetes Prevention Program Research

Group, 2015). A systematic review and metanalysis of studies published between January2003
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and February 2016 has shown diabetic prevention programs that promote lifestyle change in the

form of healthy nutrition and weight loss are effective especially when they include in person

behavioral support given by counselors (Joiner et al., 2017).

Automated behavioral interventions and support via email, text, and phone are also

shown to be effective in diabetes prevention enabling participants to keep healthy body weight,

healthy cholesterol and blood glucose levels (Block et al., 2015). In addition, environmental

interventions in the form of increased healthy food alternatives, encouraging corner stores to sell

healthy foods, reducing food insecurity, improving neighborhood accessibility for walk, biking

and community programs that increase physical activity are shown to reduce the prevalence of

chronic illnesses like diabetes (Gittelsohn & Trude, 2017).

Conclusion

Diabetes is a significant public health problem. To prevent individuals from developing

type 2 diabetes a combined effort from both governmental, non-governmental and community

members are needed. Education, early screening and intervention, community and school-based

programs to encourage physical activity and healthy food choices are important.

The state of New Jersey Department Health in partnership with local governments,

nonprofit organizations, health systems, schools and academic institutions provides diabetes

prevention programs. Despite these efforts obesity and type 2 diabetes are prevalent in the state

therefore further work is needed.

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References

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S., Atlas, S. J., & Wexler, D. J. (2018). Food insecurity, food "deserts," and glycemic

control in patients with diabetes: A longitudinal analysis. Diabetes care, 41(6), 1188–

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County Health Rankings and Roadmaps. (2021). 2020 New Jersey report.

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Diabetes Prevention Program Research Group. (2012). The 10-year cost-effectiveness of lifestyle

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