A Pilot Program for: Activity, Nutrition, and Diabetes in Pregnant Oklahoma City Women ANDPOW Josh New, Virginia Landrum, Lindsay Clifton, & Taylor Lile.

A Pilot Program for:A Pilot Program for:

AActivity, ctivity, NNutrition, and utrition, and DDiabetes in iabetes in PPregnant regnant OOklahoma City klahoma City WWomenomen

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Josh New, Virginia Landrum, Lindsay Clifton, & Josh New, Virginia Landrum, Lindsay Clifton, & Taylor LileTaylor Lile

OKC has ~21,000 American Indians (AI)28.4% in poverty (state-wide)

Needs assessment of adults in OK:6th most obese state (67.8%)8th worst in diabetes (11.5%)9th worst in hypertension (35.5%)AIs highest prevalence in:

Hypertension (36.2%)Diabetes (17.5%)

What’s NeededWhat’s Needed

Robert Wood Johnson Foundation, 2013;National Health Statistics Reports, 2010 ;

Needs assessment (con’t.)18% of pregnancies affected by diabetes16.3% of AI women have gestational diabetes

Brief survey provided to participantsDay/timeBackground/familyEducation level

What’s NeededWhat’s Needed

National Health Statistics Reports, 2010 ;Thompson et al., 2008;

Nutrition therapy is an effective treatment

Providing easy, affordable options for preventing complications and risk factors associated with gestational diabetes is needed for American Indian women.

What’s NeededWhat’s Needed

Buchanan, 2012

Pregnant, American Indian women ages 18-49 years in the Oklahoma City area attending the Oklahoma City Indian Clinic

Target PopulationTarget Population

Classes will be at the OKC Indian ClinicThursday nights from 7-8 p.m. (tentative)

Initial 15 minutes to eat and confab30-35 minutes for the education session5-10 minutes for wrap-up & Q/A

Incentives:Provide dinner each week through catered food plattersProvide childcare during the session

Program PlanProgram Plan

Participants recruited/informedIn-person at OKC Indian Clinic

8-10 a.m. & 4:30-5:30 p.m. on alternating days for one week

RecruitmentRecruitment

Reserved classroomNo cost – approval required

Proposal placed in advanceAllow time for planningSubmit in writing

Oklahoma City Indian ClinicOklahoma City Indian Clinic

Place a request with Clinic SupervisorMust include:

PurposeGoals/ObjectivesProposed dates/timesCovered topicsTentative agendaMethod of recruitmentFunding

The Chain of CommandThe Chain of Command

Measure specific components related to gestational diabetes mellitus with a brief survey assessing a 3-day diet recall (for caloric intake, fruit intake, & vegetable intake), fasting blood glucose, blood pressure, body mass index (BMI), and weekly physical activity habits in each woman attending the education program.

Program GoalsProgram Goals

Measure specific components related to gestational diabetes mellitus with a brief self-administered questionnaire assessing participants’ knowledge of specific dietary and exercise recommendations.

The dietitian will have one assistant for each education session, whom is a student pursuing a nutrition degree.

Program GoalsProgram Goals

Educate participants by conducting individual nutrition/exercise information sessions on the following topics (5 total classes) -

Program GoalsProgram Goals

Objectives & SessionsObjectives & Sessions

What is gestational diabetes?

Gestational NutritionGestational Nutrition

1st trimester needs2 cups of fruit2½ cups Vegetables6 oz Grains5 ½ oz Meat & Beans3 cups Dairy

2nd and 3rd trimester needs2 cups Fruit3 cups Vegetables8 oz Grains6 ½ oz Meat & Beans3 cups Dairy

Gestational NutritionGestational Nutrition

3 oz cooked meat = deck of cards1 c cooked rice or pasta = tennis ball1 oz cheese = 4 dice or 1 domino Medium piece of fruit = baseball1 tsp butter/margarine = 1 die1 small baked potato = computer mouse2 tbsp (PB, salad dressing…) = golf ball1 oz chocolate = packet of floss

Serving Size ComparisonsServing Size Comparisons

Label Reading: The breakdownLabel Reading: The breakdown

Serving sizes are not

“typical” food portion sizes

Calories reference

serving sizes and not the

entire package

Daily Value (DV) is for a 2,000 calorie diet reference

Daily Value (DV) is for a 2,000 calorie diet reference

The food profile: How things break

down

Use the 5-20 rule!

Logic ModelLogic Model

Measure specific components related to gestational diabetes mellitus with a brief survey assessing a 3-day diet recall (for caloric intake, fruit intake, & vegetable intake), fasting blood glucose, blood pressure, body mass index (BMI), and weekly physical activity habits in each woman attending the education program.

Measure specific components related to gestational diabetes mellitus with a brief self-administered questionnaire assessing participants’ knowledge of specific dietary and exercise recommendations.

Program GoalsProgram Goals

Screening instruments:Height/weight and BMIGlucometer Electronic blood pressure cuffPhysical activity in the last 3 days: amount of physical activity in minutes, type of physical activity, and number of times engaged in physical activity3 day dietary recall:

Caloric intake/macro- and micronutrient breakdown in FoodWorks softwareNumber of fruits/vegetables eaten daily

ToolsTools

1. What is gestational diabetes?

a) A form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas

b) A metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency

c) Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy

2. What are the five food groups?

a) Grains, fruits, vegetables, dairy, protein

b) Grains, fruits, vegetables, dairy, meat

c) Bread, fruits, vegetables, milk, meat

d) Bread, fruits, vegetables, dairy, protein

3. What is the recommended serving of vegetables throughout pregnancy that should be consumed each day?

a) 2-3 servings

b) 3-4 servings

c) 4-5 servings

d) 5-6 servings

4. A woman of average weight should gain how many pounds during her pregnancy?

a) 10-20 lbs

b) 15-25 lbs

c) 25-35 lbs

d) 35-45 lb

5. Folic acid, a key nutrient to the growth of your baby, can be found in which foods?

a) Dark, leafy greens

b) Peas and beans

c) Citrus fruits and juices

d) Whole-grain breads and cereals

e) All of the above

QuestionnaireQuestionnaire

QuestionnaireQuestionnaire 6. What is a normal fasting blood glucose during pregnancy?

a) <130 mg/dLb) 130-145 mg/dLc) >145 mg/dL

7. Which food is considered not safe to consume during pregnancy?a) Hard-boiled eggsb) Caesar salad made with raw eggsc) Pasteurized egg products

8.  How many extra calories should a woman consume during each trimester?a) 1st trimester: 350 calories per day, 2nd trimester: 350 calories per day, 3rd trimester: 350 calories per dayb) 1st trimester: no additional calories, 2nd trimester: 350 calories per day, 3rd trimester: 500 calories per dayc) 1st trimester: no additional calories, 2nd trimester: 200 calories per day, 3rd trimester: 350 calories per dayd) 1st trimester: 200 calories per day, 2nd trimester: 350 calories per day, 3rd trimester: 500 calories per day

9. Fish highest in mercury should be avoided during pregnancy. Which of the following fish below are highest in mercury?a) Marlin, tuna, swordfish, mackerelb) Catfish, crab, oysters, tilapiac) Shrimp, snapper, sea trout, lobsterd) Tilapia, shrimp, lobster, crab

10. What is a normal blood pressure?a) 110/90 mmHgb) 130/70 mmHgc) <140/90 mmHgd) <120/80 mmHg

Outcome VariablesOutcome VariablesNumber of servings of dairy consumed per day?

0-1 servings 1-2 servings

2-3 servings 3-4 servings

4-5 servings 5+ servings

Number of servings of grains do you consumed per day?

0-1 servings 1-2 servings

2-3 servings 3-4 servings

4-5 servings 5+ servings

Number of servings of protein/meat consumed per day?

0-1 servings 1-2 servings

2-3 servings 3-4 servings

4-5 servings 5+ servings

What is the fasting blood glucose?

What is the blood pressure? Systolic ⁄ Diastolic

Body Mass Index (BMI) (weight in kg) / (height in m2)

0= BMI less than 19.5 1= BMI 19.5 or less than 25

2= BMI 25 to less than 30 3= BMI 30 or greater

Pre- & Post MeasuresPre- & Post Measures

Weight gain/loss during the last 3 months

0 = weight loss greater than 3 kg (6.6 lbs) 1= does not know

2= weight loss between 1 and 3 kg (2.2 and 6.6 lbs) 3= no weight loss

Activity Times Per Week Minutes Per Session

Brisk Walking

Aerobics

Run

Dance

Bicycle

Stretching

Weight lifting

Team sports: basketball, football, soccer, volleyball, etc.

Swimming

Golf

Tennis

Lead Dietitian - Michelle Denison RD/LD, BC/

ADM, CDE (Harold Hamm Diabetes Center)Researcher - Gina Herbert, RN

Maternal Fetal Medicine (OU College of Medicine, OBGYN)

Exercise Physiologist - Josh New, CI-CPT

ManagingManaging

The Cost of InterventionThe Cost of Intervention

NIH – NIDDK - Translational Research to Improve Diabetes and Obesity-related Outcomes; PA-13-352 - (R01) Research Project Grant

Eligibility for the grant:Research for “practical, sustainable, and cost-efficient strategies or approaches…”

Research focused on the “prevention or reversal…”

Research that focuses on “prevention or delay of the complications of these conditions…”

“Approaches must have potential for wide dissemination/implementation in communities at-risk”

How do we Fund it?How do we Fund it?

Proposed TimelineProposed Timeline

Step 1: Evaluate needs assessment and determine goals/objectives

Step 2: Obtain funds and supporting partnerships with local agency

Step 3: Develop program materials

Step 4: Implement education program

Step 5: Begin evaluation of program

Step 6: Final evaluation of impact/effectiveness