KYONE HEALTH

SAINT JOSEPH DIABETES & NUTRITION CARE

LEXINGTON, KENTUCKY

Dana Graves RN, MSN, CDE, CPT has been in diabetes care and education for more than 15 years, after spending 15 years and then some in other areas of nursing. Similarly, Barbara Baumgardner MS, RD, LD, CDE is an Outreach Dietitian for Saint Joseph Hospital who has worked in other areas of dietetics but has been focused on diabetes care and education over the last 12 years. Both are now trained Lifestyle Coaches for the National Diabetes Prevention Program at Saint Joseph Hospital in Lexington, Kentucky.

St. Joseph Diabetes and Nutrition Care Center started in 1999. At that time, Dana was hired as the Diabetes Clinical Nurse Specialist; Barbara joining just a few years later. With several other CDEs hired, the clinic started an ADA recognized diabetes self-management education program. Though the program, they offered a wide array of services including a 4 class series, individual education sessions for carb counting, medical nutrition therapy, gestational diabetes education, insulin pump training, blood glucose monitoring, insulin administration, and medication management. Within a few short years they became an AADE recognized program, serving central and eastern Kentucky at five different site locations.

St. Joseph Hospital sought to increase programming on diabetes prevention and were pleased when they applied and received the AADE/CDC grant last year.

Starting a program from a blank canvas is an undertaking for any organization, allowing for opportunities of creativity, innovation, and design but also encompassing many challenges. Two challenges faced by this organization were how to market and recruit participants. They were fortunate in finding generous colleagues in their Physician Recruiter and Public Relations Department to work with. These individuals helped the program place newspaper ads, produce a newspaper health calendar, draft letters about the National DPP to send to physicians employed by the hospital, letters to physician office managers in the surrounding counties, as well as letters and emails for former patients. Even emailing an announcement about availability of the program and posted flyers to make all employees aware of this new offering.

Their first three cohorts started in the summer of 2013. Each group having its own personality. Lifestyle coaches soon realizing that their rural based classes greatly differed from those in the urban setting. Dana Graves noted, "It seems that participants in the urban based classes were more computer literate, more up to date on health care, and exposed to more varieties of food whereas rural based classes overall were a bit lower socioeconomically, self-image lower, and had less local resources to help them. However, all 3 groups were very cohesive and fun to teach!"

Holding participants interests and providing a mix of educational activities is key to having an effective program. Classes at St. Joseph Hospital have included practicing measuring (each participant was given a clear measuring cup and food scales with nutrient values); walking through office park hallways (learning to use a new pedometer); participating in a pot luck (recipe sharing with nutrition labels); and eating out together after class (assisting each other with reading menus and make healthier choices). The exercise class was particularly entertaining and lighthearted as lifestyle coach, Dana Graves, demonstrated her hula hoop skills, encouraging all to try a 'different' type of exercise.

Each cohort had their own successes; approximately 70% of participants lost 7% of their body weight. All enjoyed the support and camaraderie the group gave, so much so that they wanted to continue meeting and walking together. The biggest difficulty over time was attrition due to personal & health issues, weather, and work in spite of weekly reminder emails, letters, and/or calls. Nonetheless, the participants reported success as demonstrated by their increased activity, improved labs/A1C, and heightened awareness of food selections leading to better choices made when shopping and dining out.

Determining future program fees remains St. Joseph's biggest challenge. Through support from their hospital's Foundation and new grant monies, they look forward to providing two more cohorts this spring and focusing on obtaining payer support.

PHYSICAL ACTIVITY:

Warm-Up Tips:

• Warm up for 5 to 10 minutes. The more intense the activity, the longer the warm-up. 
• Do whatever activity you plan on doing (running, walking, cycling, etc.) at a slower pace (jog, walk slowly). 
• Use your entire body. For many people, walking on a treadmill and doing some modified bent-knee push-ups will suffice.

Cool-Down Tips:

• Walk for about 5 minutes, or until your heart rate gets below 120 beats per minute. 
• Stretching:

1. Hold each stretch 15 to 30 seconds. If you feel you need more, stretch the other side and return for another set of stretching. 
2. The stretch should be strong, but not painful. 
3. Do not bounce. 
4. Breathe while you're stretching. Exhale as you stretch, inhale while  holding the stretch.