When It Comes to Diabetes, Say "Not Me"

Diabetes NOT ME program enhances community-based health care

/ Author:  / Reviewed by: Joseph V. Madia, MD

Diabetes is sweeping across the United States, affecting millions of Americans and costing billions of dollars. Solving this huge health problem will be no easy task, but people are making the effort.

According to the Diabetes Prevention and Control Alliance, "Changing the course of diabetes in America starts by getting personal, really personal." In other words, giving individuals the tools to fight off diabetes may help slow the growing rates of diabetes throughout the country.

The Diabetes Prevention and Control Alliance - which was launched in 2010 by UnitedHealth Group in partnership with the YMCA and Walgreens - aims to bring community-based diabetes prevention and diabetes control programs to communities across America. That is, the Alliance intends to teach prevention to people at risk for type 2 diabetes and to show those who already have diabetes how to control their disease.

This effort is all part of the Alliance's NOT ME initiative. NOT ME is made up of two key programs that focus on teaching individuals about diabetes.

The first program is the NOT ME Diabetes Prevention Program. This part of the NOT ME initiative brings in lifestyle coaches across the country to educate and inform people who have a high risk of developing type 2 diabetes. Participants in this program can attend up to 16 sessions of lifestyle-coaching. They will learn about healthier eating and how getting just a little more exercise can prevent or delay the onset of type 2 diabetes.

The second program is the NOT ME Diabetes Control Program, which links people already living with diabetes to specially trained community pharmacists. These pharmacists make it easier and more affordable for patients to follow the treatment plans given to them by their doctors. With their special training, these pharmacists can give patients private one-on-one counseling.

The fact that both of these programs have been tested in various ways gives strength to their effectiveness. They have been tested in controlled trials and pilot projects through the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), the YMCA, Indiana University, clinical centers, employers, and retail pharmacies. The research suggests that early and aggressive intervention - such as that involved in the NOT ME programs - can help individuals avoid the health toll and financial costs of diabetes.

Almost 26 million people in the United States have diabetes, more than eight percent of the population. About seven million of these Americans with diabetes go undiagnosed. It is estimated that the cost of diabetes in the United States in 2007 was $174 billion. This cost is expected to rise as diabetes becomes increasingly more common, mainly due to growing rates of obesity and prediabetes - two factors that put people at a high risk for diabetes. In fact, one report says that more than half of Americans could have diabetes or prediabetes by 2020 if the current trends continue. This would cost an estimated $3.35 trillion over the next decade.

The good news is that something can be done about these growing trends. In many cases, type 2 diabetes is preventable. This is where the NOT ME initiative comes in.

"We have a prevention program that works," said Dr. Anne Albright, director of the Division of Diabetes Translation for the CDC, while speaking at the launch of NOT ME in Houston, Texas. "To help us change the course of diabetes in America, we need health professionals, lay workers, employers and the private sector. Our goal at the CDC is by 2020 for 15 million Americans to improve their long-term health through the National Diabetes Prevention Program. The [YMCA] has projected that it can reach about 6 million of these people. So, clearly, we need even more partners to come onboard." 

People who participate in the NOT ME Diabetes Prevention Program are taught by a lifestyle coach in small group settings about how to eat healthier and increase physical activity on a daily basis. Research has shown that this program works for many people. Losing as little as five pounds can stop or slow down the onset of diabetes by as much as 58 percent.

For those who are already diagnosed with type 2 diabetes, there is much that can be done to lower both the health and financial costs of the disease. As part of the NOT ME Diabetes Control Program, specially trained pharmacists help diabetes patients understand the treatment plans that often can be very confusing. While patients still need to maintain a relationship with a doctor, these trained pharmacists can make it much easier and cheaper to keep diabetes under control.

When patients meet with the trained pharmacists, they are coached and counseled on how best to stick to their treatment plan. The end goal is to get these patients to keep down their HbA1c levels - a measure of blood sugar control over a three-month period of time. Lowering HbA1c levels can protect patients from complications involved with having diabetes. According to findings from a study by David M. Nathan, M.D., from Harvard Medical School, overtime a patient lowers HbA1c levels by one percentage point, the risk of complications is reduced by 40 percent.

The NOT ME Diabetes Control Program has also been tested. A study by Carole W. Cranor and colleagues - called "The Asheville Project: Long-Term Clinical and Economic Outcomes of a Community Pharmacy Diabetes Care Program - showed that patients involved in the program gain better control of their HbA1c levels, while also lowering medical costs and increasing productivity for employers (meaning these patients were taking less sick days from work).

The success of the NOT ME programs in these studies suggests that they may help slow down the growing number of people being diagnosed with diabetes. However, it will be hard to see the initiative's overall impact until more communities and employers around the United States adopt the NOT ME programs. Until then, one-on-one coaching and counseling will likely give individuals the tools they need to prevent and control diabetes. 

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Review Date: 
September 2, 2011