High risk strategy

High risk High risk strategystrategy

Eeva Korpi-HyövältiEeva Korpi-Hyövälti

04.06.200704.06.2007

Type 2 diabetes – Type 2 diabetes – Prevention strategiesPrevention strategies

A population strategy – prevention of A population strategy – prevention of obecityobecity

A high risk strategyA high risk strategy persons with high risk of DM are persons with high risk of DM are

encouraged to take part in systematic encouraged to take part in systematic screening, education and monitoring screening, education and monitoring activitiesactivities

An early detection and treatment An early detection and treatment strategystrategy lifestyle interventions, systematic lifestyle interventions, systematic

treatmenttreatment

07.08.1908 Austria,miniature statuette of paleolitic Stone Age

Venus von Willendorf Venus von Willendorf 25000 b. Chr25000 b. Chr

Kouluterv.hoit. Paula Etula Diabeteshoitaja Kirsti Mäkinen

Overweight of the Children Overweight of the Children at Junior Grade of Alajärvi at Junior Grade of Alajärvi

Basic School Basic School

0

10

20

30

40

50

%

A ala-asteB ala-asteC ala-aste D ala-aste

A ala-asteB ala-asteC ala-asteD ala-aste

Kouluterv.hoit. Paula Etula Diabeteshoitaja Kirsti Mäkinen

Overweight at the Basic Overweight at the Basic School School

(7-15 years) in Alajärvi (7-15 years) in Alajärvi 20052005

0 %

5 %

10 %

15 %

20 %

25 %

Yhteensä Years

13- 15

Years

7- 12

Yhteensä

Years 13- 15

Years 7- 12

Total

Total

THE WEIGHT AND HEIGHT OF CONSCRIPTS IN MILITARY SERVICE

HEIGHT

WEIGHT

CONDITION OF CONSCRPTS IN MILITARY SERVICE

MEAN WEIGHT MUSCLE STRENGHT

COOPER TEST

South Ostrobothnia

Type 2 diabetes 2002

Prevalence of Type 2 diabetes in hospital districts 2002

Population study 2004Population study 2004(45-74 years)(45-74 years)

33 %42 %Abnormal glucose regulation

11 %16 %DM after the study

4,3 %7,4 %DM before the study

76 %69 %Central obesity Waist(>94/80cm)

67 %62 %Participation rates

Women 45-74Men 45-74Random selected

Duodecim 2004;120:2173-9

Life expectancyLife expectancy 2002 men 74,9 years2002 men 74,9 years 2002 2002

women81,5yearswomen81,5years 2030 men 79,2 years2030 men 79,2 years 2030 2030

women84,5yearswomen84,5years How to intensify the How to intensify the

care?care? Mortality rates in Mortality rates in

cardiovascular cardiovascular complications?complications?

FIN

Type 2 diabetes – Type 2 diabetes – Prevention strategiesPrevention strategies

A Population Strategy – prevention of A Population Strategy – prevention of obecityobecity

A High-Risk StrategyA High-Risk Strategy persons with high risk of DM are persons with high risk of DM are

encouraged to take part in systematic encouraged to take part in systematic screening, education and monitoring screening, education and monitoring activitiesactivities

An early detection and treatment An early detection and treatment strategystrategy lifestyle interventions, systematic lifestyle interventions, systematic

treatmenttreatment

Improvement of health care Improvement of health care processes in primary and processes in primary and occupational health care occupational health care

Screening method of persons with Screening method of persons with high riskhigh risk

Organize a lifestyle interventionOrganize a lifestyle intervention co-operation with the municipal field of co-operation with the municipal field of

physical activities and with other groups physical activities and with other groups concerned concerned

co-operation with groups concerning co-operation with groups concerning nutritional education – lack of nutritional education – lack of nutritionists nutritionists

co-operation with the local service co-operation with the local service networksnetworks

Project funding in every Project funding in every hospital districthospital district

Hospital district 100 000 €Hospital district 100 000 € Ministry of Social Affairs and Ministry of Social Affairs and

Health 100 000 €, common Health 100 000 €, common costs of the project 20 000 €costs of the project 20 000 €

180 000 €/ year in every hospital 180 000 €/ year in every hospital districtdistrict

That means salary of a nurse for That means salary of a nurse for 2-8 months/ year/a health care 2-8 months/ year/a health care centrecentre

The staff of the project in The staff of the project in South Ostrobothnia South Ostrobothnia

Nutritionist 12 - 11 months (2003-2007)Nutritionist 12 - 11 months (2003-2007) Health care nurse 12 - 4 months (2003-Health care nurse 12 - 4 months (2003-

2004)2004) Nurse - secretary 11- 12 months (2003-Nurse - secretary 11- 12 months (2003-

2007)2007) Diabetes-nurse 8 – 2 months ( 2003-2007)Diabetes-nurse 8 – 2 months ( 2003-2007) Physician 2 months (2003-2007)Physician 2 months (2003-2007) Physiotherapist 12 months (2006 – 2007)Physiotherapist 12 months (2006 – 2007) Regional coordinator - Finnish Diabetes Regional coordinator - Finnish Diabetes

Assosiation (RAY-fundingAssosiation (RAY-funding))

SENUKO – EDUCATION FAIR 2007

Goals during years 2003 Goals during years 2003 - 2007- 2007

Improvement of health care Improvement of health care processes in primary health careprocesses in primary health care

Municipal exercise calendarsMunicipal exercise calendars Co-operators in the field of nutritionCo-operators in the field of nutrition Step-by-Step lifestyle educationStep-by-Step lifestyle education VLCD- educationVLCD- education Regional Health Fair 2005, Farmers Regional Health Fair 2005, Farmers

Fair2006Fair2006 Regional education and training Regional education and training

Education and trainingEducation and training Step-by-step weigth control nurses(42 + 20)Step-by-step weigth control nurses(42 + 20) VLCD – education, doctor + nurse (40)VLCD – education, doctor + nurse (40) 2 days education for psychologists including 2 days education for psychologists including

psychological support of the health care psychological support of the health care teamteam

Seminars for collecting regional ideasSeminars for collecting regional ideas Doctors lectures in the hospital districtDoctors lectures in the hospital district Lectures in Seinäjoki PolytechnicLectures in Seinäjoki Polytechnic

The care and education in diabetesThe care and education in diabetes Intervention education and data collectionIntervention education and data collection

Screening of high risk Screening of high risk patientspatients

Women with a history of gestation Women with a history of gestation diabetes – diabetes – maternal- and child health maternal- and child health centrescentres

Patients who have PAD, CVD, AMI or Patients who have PAD, CVD, AMI or who have to undergo a coronary who have to undergo a coronary interventionintervention OGTT is performed in central hospital OGTT is performed in central hospital

Previously diagnosed IGT = Impaired Previously diagnosed IGT = Impaired glucose tolerance or IFG = Impaired glucose tolerance or IFG = Impaired fasting glucosefasting glucose

Findrisk score > 15Findrisk score > 15

High risk patients High risk patients treatment pathstreatment paths

Nurse intervention 1: FINDRISK, Nurse intervention 1: FINDRISK, personal risk score and personal goalspersonal risk score and personal goals

Nurse intervention 2: all the risk factorsNurse intervention 2: all the risk factors OGTT, lipids, hypertension, smoking habits, OGTT, lipids, hypertension, smoking habits,

lack of physical activity, nutrition habits, lack of physical activity, nutrition habits, status of mental healthstatus of mental health

lifestyle intervention in groups or personally, lifestyle intervention in groups or personally, step- by- step educationstep- by- step education

Doctor / nurse intervention - once in a Doctor / nurse intervention - once in a yearyear risk factors and personal goals, interventionsrisk factors and personal goals, interventions

8.2.2005

FINDRISK-nurse-doctor

GESTATION DM-one year after delivery in child health centres

AMI, PAD, CVDOGTT IN CENTRAL

HOSPITAL

IFG (6.1-6.9) or IGT (7.8-11.0)

> 15D2D-etl

OGTT + LIPIDS

DIABETES- in health care centre

Nurse in occupational health care

Diabetes

Doctor

IFGIGT

NORM.

DM-Nurse in health

care centre

DOCTORS interventionin occupational care

INTERVENTION once in a year

DM-nurse

INTERVENTION-personally or in groups-nurse occ, DM-nurse

PHYS.ACT.PRESCRIPTION

PRIVATE OCCUPATIONAL HEALTH CARE

PREVENTION OF DMTREATMENT PATHS

Hovinmäki2005

9

Treatment pathsTreatment paths In every municipal health care centresIn every municipal health care centres Treatment paths has been done Treatment paths has been done

together with the occupational health together with the occupational health care staffcare staff

More advising is still neededMore advising is still needed The price: 50 000 €The price: 50 000 €

Salary of the nurse 2 weeks – 2months Salary of the nurse 2 weeks – 2months Local expert knowledge is neededLocal expert knowledge is needed

Education of diabetes Education of diabetes treatment and weight treatment and weight control groups 2006 control groups 2006 PlacePlace First First

HandHand

InformatiInformationon

EducatioEducation n

of of treatmentreatmentt

weighweight t

controcontroll

VLCDVLCD

health health carecare

centrecentre

1010 11 1717 44

mun. mun. occ.occ.

health health carecare

22 77 88 00

priv. priv. occ.occ.

health health carecare

00 22 3+2 3+2 cont.cont.

00

Groups Groups Tot. 57Tot. 57

1212 1010 30+30+

1 ite1 ite44

Results of weight control Results of weight control groupsgroups

2004 - 20062004 - 2006 Meetings x 10 -19(10/04 – 8/05 occ. Meetings x 10 -19(10/04 – 8/05 occ.

health c)health c) Size of groups 10 – 27(interrupted 1-7)Size of groups 10 – 27(interrupted 1-7) Age 47 years ( 26 – 67years)Age 47 years ( 26 – 67years) BMI in the beginning 37 (28 – 60)BMI in the beginning 37 (28 – 60) Weight change – 4,6 kg (1,3 – 7,8 kg)Weight change – 4,6 kg (1,3 – 7,8 kg) Waist circumference – 7 cm(2,5 – 11,9 Waist circumference – 7 cm(2,5 – 11,9

cm)cm) BP change - 5,7/- 4,4 mmHgBP change - 5,7/- 4,4 mmHg

Doctors orders in group counselling

Physical activity Physical activity prescriptionprescription

Liihota-project and Kuortane Sport Liihota-project and Kuortane Sport InstituteInstitute

Physical activity prescription-projectPhysical activity prescription-project 264 doctors educated264 doctors educated 500 nurses educated500 nurses educated

Soininhoikka – The Slim of Soini Soininhoikka – The Slim of Soini – project – project physical activity prescription in physical activity prescription in

groupsgroups

Municipal exercise Municipal exercise calendarscalendars

in 2 municipalities in 2 municipalities in 2003in 2003

in every in every municipalities on municipalities on the internetthe internet

D2D-, Liihota-, D2D-, Liihota-, phys.act.prescriptiophys.act.prescription-, Verka-projectsn-, Verka-projects

For the For the professional use professional use and for inhabitantsand for inhabitants

www.TEP.fi, www.TEP.fi, updated 2x/yearupdated 2x/year

Low level exercise groups in the week 19. WWW.TEP.FI

Ti 09.05.2006        oTerveysasemaSoiniTerveysaseman ulkoliikuntaryhmä

Ti 09.05.2006        oliikuntatoimiSeinäjokiMielenterveyskuntoutujien liikuntaryhmä

Ti 09.05.2006        oEläkeliittoYlistaroEläkeliitto

Ti 09.05.2006        oliikuntatoimiSeinäjokiLiikkuva luokka

Ti 09.05.2006        oKKIYlistaroKKI- kunta, ikäihmiset

Ti 09.05.2006        oliikuntatoimiYlistaroTuolijumppaa naisille ja miehille

Ti 09.05.2006        oSeinäjoen Voimistelijat rySeinäjokiLady-Jumppa

Ma 08.05.2006        oAlahärmän terveyskeskus

AlahärmäKuntovoimistelu varttuneille

Ma 08.05.2006        oAlahärmän terveyskeskusAlahärmäNiskaryhmä

Ma 08.05.2006        oliikuntatoimiSeinäjokiTULES-kuntosaliryhmä

 Kokoontuminen Rasitustaso Järjestäjä Kunta Toiminta

o (matalan kynnyksen ryhmät)x (helppo, vasta-alkajille sopiva, ei vaikeusasteita)xx (kuntotasoltaan vaativampi)xxx (rasittavuudeltaan vaativin)-- (kaikille sopiva)

Activities Municipality Organizer Exercise level Time

0 low level groups and x easy groups

together

TEP-municipal exercise TEP-municipal exercise calendarscalendars

Filled in 26 municipalities, used in 50%-70%Filled in 26 municipalities, used in 50%-70% more practising is neededmore practising is needed

The number of different organizers: 160The number of different organizers: 160 municipal physical training activities, health care municipal physical training activities, health care

centres, private associations, pension federations, centres, private associations, pension federations, gymnasts etcgymnasts etc

Low level exercise groups + easy groups: Low level exercise groups + easy groups: hundredshundreds chair gym, neck group, lady gym, mental physical chair gym, neck group, lady gym, mental physical

activity group, the lowest level: exercise or not, etcactivity group, the lowest level: exercise or not, etc in seven municipalities no low level groupsin seven municipalities no low level groups

Nutritional educationNutritional education Co-operators in the field of nutritionCo-operators in the field of nutrition ””Positive lifestyle intervention” 632 Positive lifestyle intervention” 632

participitantsparticipitants Kauhajoki Polytechnic – nutritionKauhajoki Polytechnic – nutrition Pilot schools: Lintuviita, Aapiskuja, Pikku-Alvari Pilot schools: Lintuviita, Aapiskuja, Pikku-Alvari

”Healthy kids” ja ”Healthy snacks after school””Healthy kids” ja ”Healthy snacks after school” Domestic science teachersDomestic science teachers

Senior Grade of the Basic School Senior Grade of the Basic School ”Kitchen ”Kitchen Novice”- education materialNovice”- education material

Large scale catering, Meeting catering Large scale catering, Meeting catering ”Coffee ”Coffee and catering” and ”Heavenly delicious and and catering” and ”Heavenly delicious and healthy” healthy”

ITE-selfhelp-peer groupsITE-selfhelp-peer groups Local Associations, Hearth AssociationLocal Associations, Hearth Association

Recipes for Healthy snacksRecipes for Healthy snacks after school after school

Healthy Kids - Education Material for Junior Grade of the Basic School

and Day Care

Kitchen Novice - Education Material for Domestic Science Teaching

Kaffit&

Trahteerit

KOKOUSTARJOILURESEPTITEtelä-Pohjanmaan sairaanhoitopiiriDehkon 2D-hanke ja Ravintokeskus

Coffee &

Catering

RECIPES FOR MEETINGS

FIN-D2D, Hospital District of South Ostrobothnia

Heavenly delicious and Heavenly delicious and healthyhealthy

for large-scale cateringfor large-scale catering

Health Fair in South Health Fair in South Ostrobothnia 09.04.2005Ostrobothnia 09.04.2005

A great success: 7000 guestsA great success: 7000 guests fair guests from young to oldfair guests from young to old looking for true knowledge of healthlooking for true knowledge of health

A careful planningA careful planning The municipal regions in key position The municipal regions in key position No-nonsense – everything controlled No-nonsense – everything controlled

by our nutritionistby our nutritionist The support of pharmaceutical The support of pharmaceutical

industryindustry

SOUTH 0STROBOTHNIA HOSPITAL DISTRICT THE HUNTING OF MISSING WAIST 8/2006

Co-operation Co-operation partnershipspartnerships

Kuortane Sport Institute Kuortane Sport Institute Several Projects, e.g. Syke-projectSeveral Projects, e.g. Syke-project

” ” Fit for Life” for adultsFit for Life” for adults Heart Association of South Heart Association of South

Ostrobothnia: ”Health is a Super Ostrobothnia: ”Health is a Super Thing” – for Senior Grade at the Basic Thing” – for Senior Grade at the Basic SchoolSchool

Diabetes - and Heart Associations, Diabetes - and Heart Associations, ITE-peer groups, Ruukki-Steal ITE-peer groups, Ruukki-Steal CompanyCompany

FAT-PONDSFAT-PONDS

LAKE SLIM-HOIKKA

The SLIM of SOINI - PROJECTSOINI

The Slim of SoiniMiss Finland 2007

DM-luokitus 30.3.2007LEHTIMÄKI

SOINI

ÄHTÄRI YHT

KAIKKI

Pieni riski sairastua tyypin 2 diabetekseen (<7) 92 108 375 575 690

Jkv kohonnut riski sairastua tyypin 2 diabetekseen (7-11) 79 203 354 636 710

Koht. kohonnut riski sairastua tyypin 2 diabetekseen (12-14) 42 107 150 299 335

Suuri riski sairastua tyypin 2 diabetekseen (15-20) 20 63 93 176 197

Hyvin suuri riski sairastua tyypin 2 diabetekseen (>20) 1 4 10 15 17

Kohonnut paastoglukoosi (IFG, fP-Gluc 6,1-6,9) 52 62 127 241 245

Heikentynyt glukoosinsieto (IGT, 2h Gluc 7,8-11,0) 22 57 107 186 189

Ruokavaliohoitoinen tyypin 2 diabetes (E11) 29 109 112 250 258

Tablettihoitoinen tyypin 2 diabetes (E11) 48 76 180 304 312

Insuliinihoitoinen tyypin 2 diabetes (E11) 33 46 100 179 179

Tyypin 1 diabetes (E10) 4 15 3 22 24

Muu diabetestyyppi (E12-14) 1     1 1

Kaikki yhteensä 423 850 1611 2884 3157

THE REGISTER OF DIABETESin Lehtimäki, Soini and Ähtäri

246

119

67

Soini: Inhabitants 2579, screened inhabitants for DM 850,DM-patients 246 = 10 %IFG + IGT patients 119 + high risk patients 67 = 186

The second round in The second round in municipalities – the first municipalities – the first

one 2003one 2003 A letter to all municipal managers, who A letter to all municipal managers, who

invite the municipal management, elected invite the municipal management, elected officials and local associations to a meetingofficials and local associations to a meeting

The matters considered at the meetingThe matters considered at the meeting Overweight as a risk factor of loosing health(EK-Overweight as a risk factor of loosing health(EK-

H)H) Promotion of health in our municipality (mun. Promotion of health in our municipality (mun.

man)man) Promotion of health in health care and social Promotion of health in health care and social

affairsaffairs D2D in our municipalityD2D in our municipality DiscussionDiscussion

Challenges in the futureChallenges in the future

Prevention of obesity of children and Prevention of obesity of children and young people young people

Unemployed people – low level of Unemployed people – low level of education education

A connection between depression A connection between depression and diabetes, 30 – 40 %and diabetes, 30 – 40 % Ostrobothnia – project: mental Ostrobothnia – project: mental

health and intoxicantshealth and intoxicants