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Preventing Diabetes Transcript

Jan Stankiewicz and Nikki Johnson from NDSU Extension talk about Type 2 diabetes, how to reduce the risk of getting it, and how the Diabetes Prevention program can help.

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Jan Stankiewicz: Welcome to Thriving on the Prairie a podcast exploring issues concerning families and communities that inspires North Dakota movers, shakers, and community difference makers to engage in lifelong learning. I’m Jan Stankiewicz, community health and nutrition specialist, and I with my colleague and friend, Nikki Johnson also a community health and nutrition specialist. Nicki is here to lead us in a conversation about the diabetes prevention program. A national program that is truly changing people's lives. Nikki, it's so nice to have you here today.

Nikki Johnson: Thanks for having me, Jan. 

Jan: Yeah. Great. So we’re just going to again be talking a little bit about, umm, diabetes in North Dakota and something that's called pre-diabetes. And then a program we have that Extension offers that you, kind of, are in charge of, called the diabetes prevention program. So if you just want to kind of, like, open up a little bit about what diabetes is, the current state of diabetes in North Dakota, or maybe even the nation. So, what kind of information do you have to kind of start us off with?

Nikki: Sure, so maybe let's just start off thinking nationally. So in the U.S. right now there are over 34 million adults with diabetes. On a more localized level, there’s over 54,000 North Dakotan adults that have diabetes. 

Jan: 54,000. Okay. 

Nikki: 54,000. And if you put it into perspective, that’s about 1 in 10 people. So when you think about going to the grocery store and you know standing in the produce aisle or in the produce section there, you know 1 in 10 people that you are being surrounded by likely has type 2 diabetes. 

Jan: And then I guess that's something to clarify it’s Type 2 Diabetes right, Nikki?

Nikki: Yes. Type 2 diabetes and that’s going to be a little bit different than type 1 diabetes. Type 1 diabetes is an autoimmune disorder, nothing you can do about developing type 1 diabetes. Type 2 diabetes on the other hand has some preventable factors to it and it's more linked to lifestyle rather than genetics.

Jan: Yeah and that’s where the term chronic disease comes in, right?

Nikki: Yes. So, type 2 diabetes is considered one of those chronic diseases. It’s longer term. It has some adverse health effects if you're not managing it or you're not controlling it. And like I said, it is something that is preventable.

Jan: Yeah, so when we’re talking about type 2 diabetes what does that mean? So we've got a large amount of people in North Dakota with type 2 diabetes. What does that mean for those individuals, and then what does that mean for, you know, community members or the state? Why are we concerned about those kinds of things?

Nikki: You know, it's going to be different for every individual, of course. Everybody’s journey with any chronic condition is going to look a little bit different but there's a couple common pieces. So, an individual with type 2 diabetes is going to have to be very diligent about their health. Type 2 diabetes is categorized as having blood glucose are blood sugar levels that are outside of the normal range. And if you're not watching those your body can experience some very adverse health effects, right? And so they have to be very concerned. So that means they're going to have to go to the doctor more frequently. They're probably going to have to have a team of physicians that they're going to need to work with or of healthcare providers. So thinking they’ll have to work with a dietitian. They need to get their eyes checked regularly. They need to have their feet checked. They’re going to need to talk to their regular family care physician just to make sure that their blood levels are where they need to be. And that's going to mean that not only higher medical cost for them, but it's also going to affect their employers and potentially family members and things like that. Just thinking about the amount of days you have to be out of work, or maybe there's days that your blood sugar you just can't get it under control and say you have to miss because you're not feeling well. And if you're not feeling well you know who's taking care of you? You might need that support person in your life to help you out. So there are a lot of implications to developing type 2 diabetes. And maybe i’ll go back just to the money piece for a second there. You know nationally, we spend over $327 billion on diabetes. 

Jan: And billion with a B? 

Nikki: Billion with a B. $327 billion. And that's not all direct medical costs. A good chunk of it is medical cost. I think a person spends 2.3 times more money annually if they have diabetes versus if they do not have diabetes.

Jan: Okay.

Nikki: And that's on a personal level, but you have to think about all those other medical costs and implications for that for your employer or health insurance companies, the healthcare system and things like that. And then part of that is going to be those indirect costs. So thinking about absenteeism from work or presenteeism for that matter. 

Jan: Umm hmm. Yeah. So the impacts kind of build upon each other and then you feel them further and further down the line, yeah. So our healthcare system is set up in a decent way to treat these kinds of things. So there's medications that folks can get on. But again taking a step back, looking at it, you know, more from a preventative side. So that's where pre-diabetes comes in right?

Nikki: Yes. So prediabetes, I would say, is this newer….newer term. And maybe I use that in quotations. But it’s one of those newer terms and it's really just stating that people are getting close to having type 2 diabetes. They've got these elevated blood sugar levels but they're not quite to the point of type 2 diabetes. And it's this stage in a person's life where you can make some lifestyle modifications and actually prevent developing type 2 diabetes. So you can prevent eventually getting that chronic condition.

Jan: Yeah that is really something, especially going back to, you know, thinking about the numbers of people who are impacted by type 2 diabetes and the dollars that are associated with it. So if there's things that we can do to stop that from happening, yeah I think that would really peak some people's interest and I, yeah, I just find it it's so interesting that you know when the terms come up and I can...you know when you said…. you had your air quotes and we could hear it in your voice.

Nikki: Laughing

Jan: When we, even if we can't see it. So yeah, so how does somebody know if they have prediabetes? 

Nikki: And that’s the tricky part. So, prediabetes is not something that you're just going to all the sudden feel all of these symptoms. You know if you've got... you got a cold or you're running a fever you can…. you can feel those... those symptoms, right? Prediabetes, you're not going to... you're not going to notice those. The way you're going to be able to tell is really by going to see your healthcare professional and getting your blood glucose levels checked. But there are certain risk factors that you might be able to check off, that would maybe push you to go see a healthcare professional to get tested. You do need to have a blood glucose test to know whether or not you're not you have pre-diabetes.

Jan: Okay, and so then that's usually like just one of those finger-prick things right and then you get the number?

Nikki: It depends on. There's a couple different test sometimes it's a finger prick test, sometimes it’s a full blood draw.

Jan: Okay. 

Nikki:  But yes it does... it does include some blood.

Jan: Okay. Alright

Nikki: (Laugh)

Jan:  So, so what are some of these risk factors? So if I...I'm hearing about prediabetes, I'm wondering if I might be at risk for something like that, what can I do or what are some of the risk factors?

Nikki: Some of the risk factors, so we've got a whole list of them. Some are going to be modifiable risk factors. Some of them we just simply can't do anything about, they’re just part of...of our genetics. Or the way life is. So age is going to be a risk factor.

Jan: Okay.

Nikki: The older we get the more likely it is that we might develop type 2 diabetes. so it's more likely that we would eventually have prediabetes.  So over the age of 45, your risk starts going up. 

Jan: Okay.

Nikki: Family history is going to be another one and again something you're... you're not going to be able to change as well as your health background. So for example, if you've got a parent or sibling that had Type 2 diabetes, you would be at higher risk for developing type 2 diabetes or prediabetes. Same if you had gestational diabetes while pregnant or if you have polycystic ovary syndrome. It also places you at a greater risk.

Jan: Okay.

Nikki: Couple other things, high blood pressure, high cholesterol or high triglycerides are going to put you at greater risk. Your race, so some of our races puts us at a greater risk, just genetically. So if you are American Indian, African American, Latino, or Asian-American you're at greater risk for developing type 2 diabetes. And then here's where the modifiable risk factors come...come in.

Jan: Yeah so the things that we maybe can do something about. 

Nikki: Exactly. Those little pieces that we might be able to change. Weight and physical inactivity. 

Jan: Okay.

Nikki: So if we’re overweight, um, and depending on how overweight you are or being physically inactive, can increase your risk for developing type 2 diabetes. So usually what I encourage people to do if they’re curious whether or not they have prediabetes and they're just not sure. Do I go see my physician? I don't really know? We have a really quick risk test that we encourage people to take. It’s about seven questions long. Takes a maximum of I would say thirty seconds to complete. But within that thirty seconds, you're going to know whether or not you would be considered high risk or not. And then I would say you know what that you hit that high risk on our risk test, schedule an appointment with your physician or your family practitioner and just get a blood test scheduled. It’s pretty quick, fairly painless and then you'll know right then and there if you're at risk for developing type 2 diabetes or not.

Jan: Yeah that risk test sounds pretty handy and it's just like yes or no questions right?

Nikki: Exactly. Yeah it’s yes or no questions, like I said, it's 7 questions long. Really it maybe takes thirty seconds total.

Jan: Yeah and on your website that we’ll have a link to in the show notes we can actually put the link in for that risk test, so it will be easier for people to find even. So…

Nikki: Perfect. 

Jan: Yeah so we’ve talked a little bit about diabetes, we’ve got some risk factors for prediabetes. So then let's move into actually what we're here to talk about today, the Diabetes Prevention Program. So it’s something that is across the nation right? Not just North Dakota.  

Nikki: Right. So it’s the National Diabetes Prevention Program and it is a…..I always chuckle when I have to talk about this, a lifestyle change program. And people are like, what!? And basically what it’s saying is that this isn't some quick fix. It is going to take time but we want the changes that individuals are making to be sustainable and to last the duration of their life. Because really, they're not only going to help to lower the risk for developing type 2 diabetes but it's going to lower their risk for a lot of other chronic conditions as well.  Which is, I think, really exciting. Maybe you're going in for a one sole purpose but it's going to be tenfold what you’re coming out with. 

Jan: Yeah because some of those risk factors, you know, for diabetes, are very similar to some risk factors for developing certain types of cancer or heart disease and other things

Nikki. Oh, absolutely. Yeah, I mean, when you look at it, a couple of those risk factors, you know, high cholesterol and high blood pressure. When you think about heart health, that's...those are...those are heart health problems. So if you're going into a program and it's going to help to lower those risk factors as well, I mean, it’s exciting that it can do, this program really is helpful for more than just the prevention of diabetes. 

Jan: Umm hmm, yeah. Okay, so lifestyle change program

Nikki: Yes.

Jan: So what does that entail? If somebody’s interested in checking out DPP, what are they going to see? What are they going to find and what can they expect?

Nikki: What they can expect, so the scariest part about this program, and its….okay...its the scariest part but it’s also probably the most beneficial piece. It is a year-long program and when I tell people it’s a yearlong program their eyes get really big and their like, oh my gosh I don’t wanna…..I’m signing up for a whole year of my life, right? (Laughing) but the program is really designed to be slow baby steps. So change takes time. Change is scary. And when we take off too much at one time, people tend to not be successful. They tend to get overwhelmed and want to quit and that is the exact opposite of what this program is. We take small baby steps introduce small changes and little things that they can do week after week to make lifestyle changes that fit their lifestyle. So it’s a very individualized program.

Jan: That's so cool because there are, there's actual, like research associated with these like quick fix programs where they go hard for like 3 months or 6 months, they could see some amazing results and it's mostly like weight loss or behavior change like working out or smoking cessation and those kinds of things. And they have really great results in those 3 to 6 months. But then in the follow-up, they find that almost everybody is either back to their starting point or even a little bit worse off. Right?

Nikki: Exactly. And we do not want to see that in this program. So it's really designed to take things slowly, to make changes manageable and again to make them sustainable. So that you know if you're making a change this week, it’s something that you're going to be able to live with one year from now, five years from now, 20 years from now. 

Jan: Umm hmmm. Yeah, so then I'm assuming with the numbers that you've talked about before that it's like what so when somebody is signed up in a DPP class are they with and around other people? Is it an individual kind of a thing?

Nikki: Great question. So it is meant to be a group class. Group sizes range from anywhere, I would say, between 6 and 20, just depends on. But what is great about that is you have a trained lifestyle coach or two that's kind of guiding you through the... through the program itself but then you got this wonderful support system around you with people who are going through the same or a similar journey. You know everyone’s journey is a little bit different, but they're coming in joining the program with a lot of the same motivations that you probably are joining for. And I should point out so the program itself, we do focus around a couple main goals. Weight loss is one of them. Moderate weight loss, so like, 5 to 7%. And to put that into perspective, if you were a 200 pound individual, we’re asking that you would try to lose 10 pounds. So it's not this really scary number I don't think it's a very moderate, easy to work towards number. Now that’s not to say that’s all you're allowed to lose. If you wanted to lose more you definitely could, but that's our jumping-off point. We look for that weight loss as well as incorporation of physical activity. So we're hoping to increase people's movement throughout the duration of the year. And again all of this happens really gradually it’s not something we ask people to start making all of these changes at once. We do things little by little. And then in addition to that, we don't just go through those two pieces we really want to make sure everybody has the tools to be successful. So we go through, you know, stress reduction and problem-solving and going through all of the social and psychological issues that might come up when you're in... in a year right? You know, how do you handle the holidays? What do you do around birthdays? Or if you're having a really awful day at work are there certain triggers that cause you to be inactive or to choose certain foods. So we go through a lot of different pieces to make sure that people are really set up for success when their year with us is done. 

Jan: Yeah that’s actually, you know, when you put it that way. You can see a lot of benefit for it, something lasting an entire year. You know, so you can actually go through the seasons of life, while you're in the program so you can apply things directly to from what you’re learning. So I think that's actually pretty cool when you think of it like that. 

Nikki: It’s such a fun program. That’s the other thing too. I make it sound really formal but it’s a really fun class too.  We’ve been teaching it in North Dakota, I would say for about seven years or so getting pretty close to 8, and participants absolutely love their year with us.  Like I said it sounds scary right away and people are like, oh my gosh do I really want to sign up for an entire year? But by the time the year ends people are wanting more. They're not….they don't necessarily want to leave the group that they’ve been apart of the last year of their life. And actually a lot of them still end up staying connected with their coaches and with the participants that they've gone through the program with.

Jan: Yeah I can definitely see that bonding and then cohesion of those groups, kind of taking hold and and being one of the helpful factors and you know success,  individual success on whatever terms that they’re kind of working towards. So that... that's kind of cool to see. So then  with some changes that we've had in the last several months across the nation, DPP is typically in person right so then you can build relationship and bond with people. So tell us a little bit about what,  like how different is DPP now than it was before the pandemic?

Nikki: You know, before the pandemic, so okay, so you mentioned that most of our classes were happening in person. I think, in part it’s just because we weren’t necessarily ready to start things online. Not to say that we hadn't thought about it. It had been a part of our thought process I would definitely save for quite some time and and there were plenty of organizations across the nation who are offering DPP via distance or with an online platform of some sort. And I guess since the pandemic we transitioned to distance learning and it has still gone phenomenally. Our participants transitioned really really well and I have to say I got to sit in on a lot of classes that I wouldn't have normally just because I got to be that technical person that was running our Zoom sessions. But people really appreciated that additional connection that they were able to have via Zoom or via our online classes. They still got to see their classmates even if it was via the screen. They still got to, you know, we still got to do a lot of the same things you would do in a face-to-face class. So really right now, extension, as well as a good majority of our partner agencies are still going to be running their classes via distance. Once things change up again we will be offering in person as well. But we do plan on offering both options moving forward. So for some people it’s just easier to join on their computer and hop online to….to take a class. We’re going to have that option. Once things open up... open up and are safe enough we’re going to have those in person classes. And then we're actually hoping to add a third option here in the coming... coming months. We’ll have something called the HALT program. Where it’s an online class that you can basically just check in whenever works out for your schedule. Which is really cool. So we're going to have three different options for people out there to check out and choose which fit is the right fit for them.

Jan: Yeah, that's such a great thing for extension to be able to offer that. And yeah, so you're right, and I'm even thinking like in the winters in rural North Dakota how nice would it be, you know, if your class is at a 7 p.m. on a Thursday night and it's storming you can still get to class if it's held virtually or online without having to cancel or to, you know, brave the roads and head in to class. So I think that’s so great to be able to partner with a lot of other people across the state who again we might not have had the option or or this soon might not have the option this soon I suppose.

Nikki: Exactly. No, and you make a great point about the North Dakota winters are not exactly (laugh) always easy to navigate. So it's... it's great that we're going to have that option.

Jean. Yeah. Very cool. Okay so if...if somebody's heard this information they're a little bit interested, what's the like... what's the first next step so you mentioned maybe a risk test but how does somebody sign up for a class or find out about things? 

Nikki: Sure, so like you said, the risk test is probably the number one thing that I would encourage people to do first. So check out the risk test and then I would say if you're interested in the class you want to sign out there's a couple different ways you can go about that. The first is going to be ndc3.org and I know Jan, I think you said you were going to include that link for people to be able to click on. 

Jan: Absolutely. 

Nikki: But that is a wonderful website that includes a variety of what we call evidence-based programs. Basically saying like, hey, these programs are successful. There has been research done around them saying like this is this is a positive program and you know, people can take it or should take it we encourage you to do so. We've got a variety of evidence-based programs on NDC3, including the diabetes prevention program. And all you have to do is go to NDC3.org  in the toolbar on at the top, type in diabetes prevention program or click that button and it will give you all of the offerings for the diabetes prevention program from across the state. So I mentioned extension teaches the classes but there are many partner agencies across the state that are also offering the program. I would say the second way, if they weren't sure about going to NDC3.org, I would just say to reach out to me. I would be happy to connect them with any lifestyle coach or program across the state. 

Jan: All right, great. Thanks Nikki, that's really helpful information and then to I guess the clarify maybe one thing. Do you need to have a doctor's referral like you have to go to the doctor and then schedule a class or how does that work?

Nikki: Great question. So no, you do not need a doctor's referral in order to join the class. If you decided you just wanted to take the risk test, and yes you were a high-risk. We would absolutely welcome you into any diabetes prevention class.  

Jan: Yeah, great. I think, yeah, that NDC3.org will have a lot of information for people and then yeah of course we'll link everything in the show notes so be sure to check that out to. All right Nikki, thanks so much for spending time with me today. This information is so important and impactful and it makes a difference for so many of us here in North Dakota. So truly I appreciate your time today.

Nikki: Thanks for having me.

Jan: Yeah. Thanks for listening to Thriving on the Prairie. To subscribe to the podcast and access a full transcript and resource links from this episode visit www.ag.ndsu.edu/thrivingontheprairie.  You can find more resources for families and communities at www.ndsu.edu/extension. This has been a production of NDSU Extension, extending knowledge, changing lives. 

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