Programs in Johnson County support patients in lifestyle modifications and self-care in diabetes management

By Betty Drees, MD, FACP, FACE

Diabetes mellitus is no doubt one of our greatest global health concerns.

A study published in the June Journal of the American Medical Association using data from U.S. adults showed that the estimated prevalence of diabetes increased significantly from 9.8% in 1999 to 14.3% in 2018. Only an estimated 21% of adults with diagnosed diabetes achieved control goals for three important risk factors to reduce complications in 2015-2018, including individualized hemoglobin A1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL.

These disturbing findings are concerning as risk for associated complications increases. Add COVID-19 into the mix, and the risks increase as people have delayed care for diabetes and screening for diabetes have decreased. The pandemic spurred weight gain for many adults who were inactive, and decreased access to health screenings in peak phases of the pandemic, creating a care gap for a growing number of individuals who have diabetes but don’t know it.

In short, we have a lot of work to do to identify those at risk for diabetes, reduce risk of complications, and implement standards of care for people with diabetes.

There is encouraging news. Although the risk of cardiovascular disease is two to four times higher in people with diabetes and is the leading cause of death in diabetes, the rate of death from cardiovascular disease has decreased significantly over the past two decades, largely due to better blood pressure control and the use of statins. And now we have two new classes of diabetes medications that have cardiovascular benefit aside from the effect on glucose control, namely SGLT2 inhibitors and glucagon-like peptide-1 (GLP1) receptor agonists.  Based on cardiovascular outcomes studies, the FDA continues to approve new drugs in these two classes.

These drugs have been a game changer in algorithms for the clinical management of patients with diabetes. Updated regularly, the standards of care are available on the American Diabetes Association and American Association of Clinical Endocrinology with easy-to use-diabetes management algorithms.  These algorithms incorporate use of SGLT2 inhibitors and GLP1s much earlier in the management of those at increased risk of cardiovascular complications, but also guide choices of drugs based on cost, risk of hypoglycemia, weight management, etc.

As with most chronic diseases, diabetes requires both medical intervention and self-management, including lifestyle modification. Lists of regional, certified diabetes self-management programs can be found through the American Diabetes Association and The Association of Diabetes Care & Education Specialists.

Identifying people at high risk for developing diabetes is important for two reasons:  first, they are at increased risk of cardiovascular disease even if they don’t yet have glucose levels high enough to diagnose diabetes, and second, structured lifestyle intervention programs are effective in preventing diabetes and reducing cardiovascular risk.  In Johnson County, The Live Well Johnson County initiative through the Johnson County Department of Health and Environment offers the Diabetes Prevention Program, a year-long evidence-based self-management program for prediabetic adults. Programs are offered throughout the county. To learn more contact Anne Hayse anne.hayse@jocogov.org

The American Heart Association Kansas City affiliate has a variety of resources, including the Move More Together exercise initiative, and the “Check Change Control” program to track and manage blood pressure. Contact erin.gabert@heart.org to learn more about local resources.

Betty Drees, MD, FACP, FACE, is a professor of medicine and Dean Emerita at the University of Missouri-Kansas City School of Medicine, Department of Internal Medicine and Department of Biomedical and Health Informatics. She is also president of the Graduate School of the Stowers Institute for Medical Research.

Diabetes Management Opportunities in the Kansas City Area

Opportunities to connect patients with health promotion and recreation activities are available throughout the metropolitan area. Here are a few:

Health Promotion for Patients

Health Departments

Johnson County – https://www.jocogov.org/dept/health-and-environment

Wyandotte County – http://www.hcwyco.org/what-we-do-2

Kansas City, Mo. – http://bit.ly/kcmo-health

Jackson County – https://jacohd.org/initiatives/building-a-healthier-jackson-county

Clay County – https://www.clayhealth.com

Centers for Disease Control and Prevention – National Diabetes Prevention Program – https://www.cdc.gov/diabetes/prevention/index.html

Community Organizations

American Diabetes Association – https://diabetes.org

American Heart Association Kansas City – https://www.heart.org/en/affiliates/kansas/kansas-city

YMCA/Diabetes – http://bit.ly/ymkc-diabetes

YMCA/Chronic Disease Management – http://bit.ly/ymkc-chronic

Kansas State University Research and Extension – https://www.johnson.k-state.edu

Area hospitals also offer a wide range of health education and promotion programs.

Walking & Bicycling Trails, Recreation Programs

Providing patients with the Johnson County Park and Recreation District’s comprehensive trail guide is an easy way to encourage physical activity at no cost to the patient.

Regional – http://bit.ly/KC-trails

Johnson County – https://www.jcprd.com/592/Trail-Guide

Johnson County 50-Plus Program – https://www.jcprd.com/170/50-Plus

Wyandotte County – https://www.wycokck.org/Parks/Recreation.aspx

Kansas City, Mo. – https://kcparks.org/about-recreation/trails/

Jackson County – https://www.makeyourdayhere.com

Clay County – http://bit.ly/clay-trails

Resources for Physicians

Show-Me ECHO (Extension for Community Healthcare Outcomes) – Includes bimonthly CME sessions on diabetes, pediatric weight management, and other topics. https://showmeecho.org/

American Association of Clinical Endocrinology – https://www.aace.com/

American Diabetes Association (standards of care; list of certified diabetes education programs) – https://diabetes.org

JDRF Kansas and Missouri Chapter

Centers for Disease Control

The Association of Diabetes Care & Education Specialists (list of certified diabetes education programs) – https://www.diabeteseducator.org/living-with-diabetes/find-an-education-program