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Helena’s Chuck Ball knew a couple years ago that he needed to make a change. 

Ball’s blood pressure was skyrocketing. And, he was starting to put on weight. 

Then, the 62-year-old noticed an advertisement for the St. Peter’s Health Diabetes Prevention Program (DPP) named Inch by Inch. So, he looked into it. 

“It seemed like something that would work,” he said. “It was a way for my wife and I to improve our eating habits, lose weight and improve our overall health.” 

The issue for Ball was that he’d never really adjusted his eating habits from when he was younger. “I was used to eating as many calories as I wanted to and I never gained any weight,” he said. “I found out through the class that I was eating double the number of recommended calories each day.” 

Once he began implementing the healthy habits he learned in Inch by Inch, he was able to lose 30 pounds and his blood pressure, with the help of medication, improved. 

Helena’s Liesel Curtiss is another success story. Curtiss, age 75, was told by her doctor recently that she was high risk for pre-diabetes. So, she decided to enroll in Inch by Inch, and 16 weeks into the program she lost 20 pounds. “It’s a wonderful program, and I’ve learned some new tricks about improving my eating habits,” she said. “And, I’ve learned to watch what I eat. You just have to decide that your health is more important than food.” 

Curtiss said the program does take a commitment from participants to make sustainable lifestyle changes. One of the program goals is to exercise at least 150 minutes a week. Curtiss says through walking and water aerobics, she has averaged about 180 minutes a week. 

Lt. Gov. Mike Cooney attended a 10-year anniversary celebration at St. Peter’s Health held Tuesday, June 12. “Prevention is the key and this program has been successful by connecting Montanans to the information and tools they need to improve their health,” Cooney said “The program has also been adapted to work for rural Montana as well. I congratulate all those who have made the last 10 years so successful, and look forward to what can be accomplished in the next decade.” 

DPHHS State Medical Officer Greg Holzman said it’s important for Montanans, especially as they age, to assess their current eating habits and develop a regular exercise routine which can include walking, biking, low impact yoga, hiking and more. “In Montana, the outdoor opportunities to exercise are endless,” Holzman said. “My advice is to find a routine that works, and then stick to it. The Diabetes Prevention Program is a great place to start for those seeking lifestyle change guidance. It’s a very effective program that has helped thousands of Montanans.” 

St. Peter’s Health is one of over 30 DPP sites in Montana that receives funding from the Department of Public Health and Human Services (DPHHS). This includes programs that offer the DPP on-site, through telehealth or serve as a satellite location. The program helps persons at high risk for type 2 diabetes and cardiovascular disease, such as stroke and heart attack. 

The Inch by Inch program is one of four sites that launched in 2008 and has served about 1,200 people. The other three original sites are Community Medical Center (Missoula), St. Vincent Healthcare (Billings) and Holy Rosary Healthcare (Miles City). 

The DPP is an intensive lifestyle change program. Trained lifestyle coaches use a curriculum focused on sustainable nutrition, physical activity and behavior change. The average participant age is 54 years old. 

More than 30 million people in the United States have diabetes, up from the previous estimate of 26 million in 2010, according to a recent report released by the Centers for Disease Control and Prevention. 

St. Peter’s Health CEO Wade Johnson said the health system he oversees is proud to partner with the state, and points to the program’s lifestyle coaches as one of the keys to its success. Johnson said it’s a team effort, but St. Peter’s has been fortunate to have lifestyle coaches Yvonne Tapper-Gardzina and Tolly Patten leading Inch by Inch since it launched 10 years ago. “There are many success stories of participants who have truly made major lifestyle changes, and both ladies have played major role in this effort,” Johnson said. 

DPHHS Diabetes Program Manager Sarah Brokaw said that type 2 diabetes is the most common form of diabetes. “The good news is that most type 2 diabetes cases are preventable with weight loss and increased physical activity,” Brokaw said. 

The DPP is a 12-month group lifestyle change program for those at high-risk for type 2 diabetes. 

DPP is based on the National Institutes of Health Diabetes Prevention Program Lifestyle Balance curriculum. Sessions include strategies for healthy eating, ways to increase enjoyable physical activity and advice on how to address and overcome challenges. 

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Nationwide, all 50 states have DPP, and Montana’s version has been referred to as one of the most successful programs created in the country. 

Since 2008, nearly 9,000 Montanans have participated in the program, including over 500 Medicaid beneficiaries since 2011. And, participants are achieving weight loss outcomes similar to the National Institute of Health’s original program. Diabetes and risk factors for it, such as obesity, are more common among adults enrolled in Montana Medicaid. Beginning in 2012, Medicaid included DPP as a covered benefit for its beneficiaries and reimbursed sites for providing the service. 

Program goals include self-monitoring nutrition and physical activity, achieving appropriate fat gram intake, increasing moderate to intense physical activity to 150 minutes or more per week and reducing body weight by 5 to 7 percent. The evidence-based program reduces the risk for developing diabetes by 58 percent over three years and by 34 percent over 10 years after participating in the program. 

Participants have realized numerous benefits including 63 percent met a goal of 150 minutes of physical exercise per week; 47 percent lost 5 percent body weight; and 33 percent lost 7 percent of their body weight. 

In addition, significantly few participants need to take medication after 10 months in the program compared to baseline. 

The program has also been just as successful in rural Montana where many do not have the capacity to implement these services locally. Beginning in 2008, Holy Rosary Healthcare in Miles City collaborated with DPHHS on a study to provide the DPP to participants on-site in one community and simultaneously through telehealth to participants in multiple other communities. 

From 2008 through 2015, 894 participants were enrolled in the program (29 percent at telehealth sites). The purpose of this study was to compare participation, monitoring of diet and physical activity, and weight loss in participants receiving the intervention on-site and those participating virtually through telehealth. 

The findings suggest that participants receiving the DPP through telehealth have similar rates of participation and achieve similar weight loss as participants attending the program on-site. Since 2008, Holy Rosary has provided the DPP to participants onsite in Miles City and through telehealth video conferencing to participants in Ashland, Baker, Broadus, Colstrip, Ekalaka, Forsyth, Jordan and Wibaux. 

Based on the success of the delivery of the lifestyle intervention through telehealth at Holy Rosary, DPHHS collaborated with the Benefis Health System, Billings Clinic and Kalispell Regional Medical Center to provide the program through telehealth, allowing access to these services in additional rural communities. Currently, Benefis Health System delivers the DPP via telehealth to Cut Bank, Chester and White Sulphur Springs, and Kalispell Regional Health to Plains. 

All Montanans are encouraged to find out if they have pre-diabetes by consulting with their health care provider. Classes are being held this fall across Montana, and will also be offered again next spring. 

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