Community Outreach Project

Improving access for at-risk adults with prediabetes:

The implementation of the National Diabetes Prevention Program
at the Free Clinic of Southwest Washington
D. Crowley, T. Heyerman, S. Michael, C. Reeser, E. Torres
NUTN 500 / Fall
Instructor: Carol DeFrancesco, MALS, RDN, LD
OHSU Graduate Programs in Human Nutrition

Project Overview
Team Members: Denise Crowley
Tess Heyerman
Stephanie Michael
Cassidy Reeser
Liz Torres
Mentor: Lexie Jackson MS, RDN, CDE
Free Clinic of Southwest Washington
National Diabetes Prevention Program (DPP)

Goals One and Objectives

Goal 1: Increase access to evidence-based nutrition education.
Objective 1: Develop and facilitate ten lessons from the Center for Disease
Control and Preventions (CDC) National Diabetes Prevention Program (DPP)
for prediabetes patients at the Free Clinic of Southwest Washington by March
2016.
Objective 2: Develop six nutrition education handouts on the topics of
hypertension, hyperlipidemia, prediabetes, diabetes, physical activity and
healthy eating, and eating out by January 27, 2016 for patients at Free Clinic
of Southwest Washington.

Goal Two and Objectives

Goal 2: Evaluate the effectiveness of a modified program for the prevention of
type 2 diabetes in at-risk adults with prediabetes.
Objective 1: Conduct program assessments using participant knowledge
surveys, weight information, blood pressure and blood glucose
measurements, physical activity and food logs and self-efficacy surveys at
week one, week five, and week ten.
Objective 2: Conduct a qualitative assessment of program participants
experience as part of the modified prediabetes prevention program.

Qualitative Assessment
Information gathered:
Clinic shift observations
Interviews with clinic volunteers
Clinic clients:
Underserved population
Medically uninsured
Range of age, gender, ethnicity

Spanish speaking population

Urgent care to chronic disease

Assessment themes:
Efficient use of resources
Communication can be difficult, especially with limited interpreters
Clinic clients are best served from teamwork

Literature Review

Prediabetes and Diabetes (1-4)

Hypertension (5,6)

Hyperlipidemia (7,8)

Health Eating and Activity (9,10)

Dining Out (11,12)

Focus on the diseases impacted by nutrition and nutritional counseling topics that will
inform the development of educational handouts for the clinics clients.

Significance

Fills an important gap at clinic

Nutrition education can decrease progression to diabetes

Standardized program

Methods and Design

Program eligibility:
> 18 year of age
BMI greater than 24 except Asians which are 22
Hemoglobin A1C of 5.7-6.4%, or fasting plasma glucose of 100-125
mg/dL, or a two-hour plasma glucose (after a 75 g glucose load) of
140-199 mg/dL
Previously diagnosed with gestational diabetes
No previous diagnosis of type 1 or type 2 diabetes

Methods and Design

Implementation Details
Interview staff and volunteers
Recruit participants
Develop nutrition education handouts
Facilitate modified 10-week DPP program
Evaluate and assess

Methods and Design

Project Timeline
Class Flyers

Handouts

DPP class

Implement

November 2016

January 2017

January 2016

Evaluate

January 2016

December 2016

March 2016

Various course assessments will take place at the beginning,

midpoint and conclusion of the program

Budget

Assessment
The following chart outlines
the course assessments and
course impacts over the
10-week class

Sustainability

Archival of program documents

Surveys and assessments
OHSU partnership

References
1.
2.
3.
4.
5.

6.
7.
8.
9.
10.
11.
12.

Centers for Disease Control and Prevention. National Diabetes Prevention Program. January 2016. Internet: http://www.cdc.gov/diabetes/prevention/index.html (accessed 10
November 2016).
Knowler WC, Barrett-Conner E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or
metformin. N Engl J Med 2002;346:393403.
Albright A, Gregg EW. Preventing type 2 diabetes in communities across the US: the National Diabetes Prevention Program. Am J Prev Med 2013;44(4):S346-S351.
Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM. 10-year follow-up of diabetes
incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):167786.
Paula TP, Viana L V, Neto ATZ, Leito CB, Gross JL, Azevedo MJ. Effects of the DASH Diet and Walking on Blood Pressure in Patients With Type 2 Diabetes and
Uncontrolled Hypertension: A Randomized Controlled Trial. J Clin Hypertens (Greenwich) [Internet]. 2015;17:895902. Available from:
http://eds.a.ebscohost.com.ezproxy.endeavour.edu.au/eds/pdfviewer/pdfviewer?vid=4&sid=4abece31-9292-4185-a6fa-ba55229812fd@sessionmgr4001&hid=4105
Arguedas J, Leiva V, Wright JM. Blood pressure targets for hypertension in people with diabetes mellitus. Cochrane Database Syst Rev [Internet]. 2013;10:145. Available
from: http://www.ncbi.nlm.nih.gov/pubmed/24170669 intervention and type 2 diabetes.
Nasser R, Cook S.L., Dorsch K.D., Haennel R.G. Comparison of Two Nutrition Education Approaches to Reduce Dietary Fat Intake and Serum Lipids Reveals Registered
Dietitians Are Effective at Disseminating Information Regardless of the Educational Approach. Journal of the American Dietetic Association. 2006; 106(6): 850-59.
Kelly, R.B. Diet and Exercise in the Management of Hyperlipidemia. Am Fam Physician. 2010;81(9):1097-1102.
Scarinci IC, Moore A, Wynn-Wallace T, Cherrington A, Fouad M, Li Y. A community-based, culturally relevant intervention to promote healthy eating and physical activity
among middle-aged African American women in rural Alabama: Findings from a group randomized controlled trial. Prev Med (Baltim). Elsevier Inc.; 2014;69:1320.
Weir DL, Johnson ST, Mundt C, Bray D, Taylor L, Eurich DT, Johnson JA. A primary care based healthy-eating and active living education session for weight reduction in the
pre-diabetic population. Prim Care Diabetes. Primary Care Diabetes Europe; 2014;8:3017.
Bahadoran Z, Mirmiran P, Azizi F. Fast Food Pattern and Cardiometabolic Disorders: A Review of Current Studies. Health Promotion Perspectives Health Promot Perspect.
2015;5:23140.
Krishnan S, Coogan PF, Boggs D a, Rosenberg L, Palmer JR. Consumption of restaurant foods and incidence of type 2 diabetes in African American women 1 3. 2010;102.

Questions / Comments