Community-based strategies are recognized as a key facilitator of sustainable behavior change in diabetes prevention and self-management. Still, lifestyle changes can be difficult to implement without support. Community-based efforts provide accountability and encouragement for individuals seeking to shift their patterns to support positive outcomes. Notably, these approaches can be used among those diagnosed with prediabetes to aid in type 2 diabetes prevention via lifestyle behavior change.

In Kentucky, prediabetes is a major public health challenge. According to the 2023 Diabetes Report from the Cabinet for Health and Family Services, 12.2% of Kentucky adults (345,083 people) were diagnosed with prediabetes. This means that individuals are at an elevated risk of developing type 2 diabetes within the next 3-5 years. The prevalence of prediabetes is actually estimated to be much higher, considering only about half of adults are screened for prediabetes each year. Further, those with prediabetes are at an increased risk for cardiometabolic illness, including both heart attack and stroke. Unfortunately, rural regions of Kentucky, including the eastern half of the state, present diabetes prevalence rates that are higher than the state and national averages. This disparity may be due to several factors, including limited access to diabetes education and poor healthcare infrastructure, among other things. 

In response to the rising prediabetes and type 2 diabetes rates in rural Kentucky, UK Family & Consumer Sciences (FCS) Extension established a new partnership with the UK HealthCare Barnstable Brown Diabetes Center (UK BBDC) in 2019. The initial partnership was centered around securing external grant funding from UnitedHealthcare that would support a proof-of-concept model offering the National Diabetes Prevention Program (NDPP). The NDPP is a CDC-recognized, research-based year-long program that focuses on lifestyle change related to nutrition, physical activity, stress management, and problem solving. Studies show that those who complete the program reduce their risk of developing type 2 diabetes by 58 percent and 71 percent for those over the age of 60. This model would train and support FCS Extension Agents to offer the program across Kentucky with technical assistance provided by UK BBDC, further expanding the reach of NDPP programming through UK BBDC and providing a new mechanism for diabetes education for FCS Extension.

Since 2019, four cohorts have completed the year-long program, with one in progress, and one currently recruiting with a start date of August 2024. The median age for all participants was 60 years old with an average of 10 people completing within each cohort. Within the four completed cohorts, 40 people have averaged 10 pounds of weight loss for a total weight loss of 455 pounds. Participants also averaged 138 minutes of physical activity each week (weight loss and physical activity minutes are required outcomes for reporting to the CDC). 

Cohorts were located in Washington County, Scott County, and two entirely virtual (due to COVID-19). The current cohort is virtual, with participants from across Kentucky, and the planned cohort for August 2024 will also be virtual allowing for statewide reach and access to the program. 

To date, six current Extension staff have received training and the required credential as a Lifestyle Coach to offer the NDPP program leveraging funding and external partnerships with the Kentucky Department of Public Health. This collaborative and innovative approach to NDPP programming has been published and recognized nationally. 

• In 2022, a poster was accepted and presented at the Association of Diabetes Care & Education Specialists Annual Meeting in Baltimore, Maryland. 
• In 2023, one journal article was published discussing the community-clinical linkage used to support the program through FCS Extension (https://doi.org/10.1177/2633559X231159379). 
• In 2024, the project received first place at the Kentucky Extension Association for Family & Consumer Sciences within the Program Excellence through Research category and is under consideration for a national award.

Moving forward, UK FCS Extension and UK BBDC have received an additional $30,000 from UK HealthCare's Healthy Kentucky Initiative to support the program through 2024. This has allowed both entities to establish a structure for cross-referring patients from UK BBDC to Extension programs and Extension clientele to be referred to virtual UK BBDC program offerings. Efforts will continue to be made to disseminate the progress and success of this partnership as other state’s Extension services look to offer the NDPP.