Out of shape and at risk

There’s a push on in northern Michigan to get people who are prediabetic into a program meant to modestly change their lifestyle and significantly reduce their chances of getting diabetes.

By Patrick Sullivan | Jan. 7, 2017

Kathy Rogols didn’t do much for several years after a doctor told her she was prediabetic. The status was a looming specter in her life, but on her own she found it tough to make the changes she knew she needed to make.

A year ago, the 58-year-old Fife Lake resident received a letter about a prediabetes class she could enroll in that her insurance provider, Priority Health, would cover.

“I knew I was headed toward diabetes if I didn’t do something about it,” Rogols said.

The first class met March 15. Today, Rogols is 40 pounds lighter and feels worlds better.

“It’s been a miracle,” she said. “It’s just been very supportive. I needed some motivation, I think, and I really wasn’t thinking that I needed to do the low-fat diet that we follow” to lose weight to prevent diabetes.

Classes meet almost weekly for the first six months and then monthly six more times after that.

Priority Health is the first (and currently only) insurance provider in Michigan that covers Diabetes Prevention Program classes, but Medicare will begin cover to them in 2018, and some program providers offer discounts or scholarships to people with prediabetes who aren’t covered for preventative care.

The prevention program, which is sanctioned by the Centers for Disease Control and Prevention and has been in development for decades, has only recently become widespread.

Priority, the Michigan Department of Health and Human Services and the CDC want to see the program expanded in Michigan because the state has higher-than-normal rates of diabetes.

Michigan has the 22nd-highest prevalence of diabetic adults in the country, according to the Michigan Department of Health and Human Services. It’s the seventh-leading cause of death in the state.

LEARNING HOW TO EAT AGAIN

For Rogols, the hardest part of the program in the early days was getting used to keeping track of everything she ate. She had to track every bite and write the fat content in a diary.

She said she started using an app to keep track of what she eats, and it’s been an eye-opener.

“I mean, you can sit there and eat your meal, and it doesn’t seem like you’re eating very much. But the content of what you’re eating — you put butter on everything and there’s a lot of fat and cholesterol in butter,” she said. “We were eating popcorn and putting butter on that, every day. You know, wow. That’s amazing. And so we’ve really cut down.”

Rogols learned how to measure portion sizes and make sure she’s not eating too much.

She learned how to eat at restaurants and how to deal with the struggles posed by friends who didn’t understand what she is up against.

“People will still ask me, ‘Are you still on your diet?’ And it’s not a diet. It’s a lifestyle change,” she said. “And I try to explain that to them. This will be a way of life for me. And I am always going to be prediabetic. I may not look prediabetic, but I am prediabetic.”

Now that the changes have been made and new habits have been formed, Rogols said adhering to the new way of life isn’t a hardship. She’s gotten used to eating in a different way.

Rogols and her husband, Kevin, still go to the same restaurants; they just pay a lot more attention when they order.

Kevin is not prediabetic, but he wanted to lose weight and be supportive, so he’s followed the program’s guidelines too.

ONE IN THREE ARE AT RISK

The goal of the program is modest — after a year, each patient should have lost 5 to 7 percent of body weight. Patients should also get 150 minutes of exercise per week.

Study after study have proved that those two benchmarks can show huge returns, said Kandi Jezak, senior clinical program manager with Priority Health.

The program is for people who are at risk for Type 2 diabetes, which develops because of poor diet and lack of exercise.

“The biggest causes for Type 2 are brought on by lifestyle,” Jezak said. “So if you are overweight, if you’re sedentary, the foods that you eat, those all come into play to develop Type 2, because Type 2 is preventable.”

Michigan experiences higher rates of Type 2 diabetes, Jezak suspects, because Michigan also has high rates of obesity. There is also a correlation between diabetes and bad diet, which means the disease is prevalent in poor, rural areas where cheap processed food is plentiful and grocery stores with good selections of fruits and vegetables are too far away or too costly.

Jezak said diabetes is on the verge of becoming an epidemic in the state.

Around a million people have diabetes in Michigan, she said, and as many as 2.6 million are thought to be prediabetic.

“That is about one in three adults who are at risk for diabetes or have prediabetes,” she said. “It’s going to be one in three who have diabetes if there’s not change to people’s lifestyles.”

What’s more, out of the third of adults who are prediabetic, it’s estimated that only 7 percent of them are aware of their condition.

“The other 93 percent have no idea that they’re prediabetic,” she said.

HIGH SUCCESS RATE

Priority has made it a policy to focus on chronic disease with preventative care. That makes sense for a health-care provider — it’s far cheaper to prevent a disease than it is to treat one, but Jezak said her company is interested in improving health overall.

“Our mission is to improve the health and lives of our members, as well as the communities that we’re serving,” Jezak said. “Obviously, costs are rising and rising and rising. If something doesn’t stop or intervene, then costs for the country are going to be high. So, prevention is key.”

Jezak said Priority began covering the program a year ago, and at least eight classes have started with an average of 15 students since then. The program costs the provider around $500 per patient.

The cost of the program is miniscule compared to the cost of treating a case of diabetes, which the American Diabetes Association estimates is $13,700 per year, said Amanda Woods, coordinator of the Northern Michigan Diabetes Initiative, a collaboration of Munson Healthcare, Priority Health, local health departments and Michigan State University Extension.

The success rate for the prevention program is impressive and long lasting. Woods said there is a 58-percent reduction in the rate of Type 2 diabetes among patients who complete the program. Perhaps even more impressive, positive results hold on five years after completion, she said.

The secret of the program’s success may be the modest demands it places on participants.

“Those little changes, they just keep accumulating, and then they start telling their friends, and their friends’ family and it starts to catch on,” Jezak said. “People say, ‘What are you doing? Oh, my gosh you look great; you’ve got more energy.’”

CLIMBING STAIRS: BEFORE AND AFTER

With only a couple of months of meetings left, Rogols said she will miss the program when it’s done.

She plans to stay in touch with her group. She also plans to investigate becoming certified to teach the class herself because she is now a passionate believer.

“I’ve always struggled with a roller coaster weight problem all of my life. I’ve had various-sized clothes in my closet. I mean, I won’t tell you what sizes I’ve had in my closet, but I’ve always been on a roller coaster,” she said. “And in going to this class and just having the support and listening to other people, it’s just been that motivation that I’ve needed.”

The 40 pounds she’s lost is well over what was called for in the class, but she hasn’t quite reached her personal goal. Despite the progress, her blood sugar level remains in the prediabetic range. Nonetheless, she wouldn’t reverse course even if it fell out of range. On the other hand, her cholesterol is way down and she feels like a new person.

“I can go up the stairs now without being out of breath,” she said. “I would take a flight of stairs and I’d just have to rest. I didn’t want to go out of the house because I didn’t like the way I looked. I didn’t like the way I felt.”

WHERE TO GET HELP

If you think you might be at risk of prediabetes because of weight, diet, lack of physical activity or family history, talk to your doctor or search online for the CDC Prediabetes Screening Test. For information about the Diabetes Prevention Program through the Northern Michigan Diabetes Alliance, visit nmdi.org.