Biannual Diabetes Research Newsletter

SUMMER/FALL 2019 EDITION

“A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities”

Greetings from the PaTH to Health: Diabetes Research Team!

As Principal Investigator on this project, I’d like to welcome you to the most recent issue of our biannual research study newsletters. We work closely with our awesome team of patients, community stakeholders, clinicians and researchers to co-create this publication! Inside this edition, be sure to check out the study progress, learn about recent trends in diabetes management, try a new healthy diabetes-friendly recipe, and sign up for a local diabetes related community event in your area. Happy reading!

Jennifer L. Kraschnewski, MD, MPH

Associate Professor of Medicine and Public Health Sciences Vice Chair of Clinical Research, Department of Medicine Director, Penn State Project ECHO® Penn State College of Medicine

HIGH FIVES

We would like to give a HIGH FIVE to the fourth annual stakeholder conference attendees (both in-person and remote), which was held on June 3, 2019. We especially appreciate everyone’s feedback during the breakout discussion and we now have a solid plan in place for future analyses based on the direction and feedback provided.

A special thank you to our guest speakers, Dr. Nazia RajaKhan and Ms. Holly Socolow, for their thought-provoking presentation on mindfulness eating!

We would also like to give a HIGH FIVE to all patient partners and stakeholders who completed the Year 3 Engagement Evaluations. The evaluations are an incredibly important assessment that we review every project year to ensure we continue to meet your goals of involvement.

UPCOMING TRAININGS This fall, we are excited to provide a training to patient partners about “Study Results Dissemination.” Now that the study’s data extraction has occurred and it is currently being analyzed, the Just-In-Time (JIT) training session will cover how we plan to disseminate the study results.

During the training, we will discuss to how to disseminate information to both the scientific and the lay public audience. The importance of this critical research phase will be highlighted to educate others how to best translate findings which can help improve practice or policy.

Research Study Overview & Update

For new readers (or returning readers) enjoy an overview about our current research study, “A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities” which is funded by the Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent, nonprofit organization that envisions a research world addressing questions and concerns most relevant to patients, while including them, their caregivers, clinicians and other stakeholders in the research process. We are thrilled to be working alongside our patient partners and stakeholders throughout each phase of our project. Our awesome community team consists of six patient partners, six primary care providers, and ten stakeholders who continue to contribute their ideas, expertise and lived experience to our project. They have been the driving force of key study decisions and are a constant reminder of why our research matters.

Patient Partners

Primary Care Providers

To give you some background on our PaTH to Health: Diabetes study, let’s take a brief look at the literature. You may be aware that obesity is a big issue in the US. In fact, it’s our number one health concern. Addressing obesity through lifestyle interventions (i.e. healthy eating and increased physical activity) decreases the risk of developing type 2 diabetes, a disease that affects over 29 million people (9.3% of the US population). Diabetes is associated with serious complications, including heart disease, blindness, renal failure and lower extremity amputation. Although complications are preventable with proper medical and lifestyle management, including weight loss, nearly half of diabetic patients do not have adequate glycemic control.

Recent policy changes and health insurance expansion have resulted in coverage for obesity counseling by Centers for Medicare and Medicaid to improve weight loss for adults either with or at high risk of type 2 diabetes. Obese beneficiaries are eligible for up to 20 face-toface visits for weight counseling in the primary care setting. However, it is unknown whether or not this benefit has helped patients lose weight and better control their diabetes.

This is where the PaTH to Health: Diabetes study comes into play. We are looking at Electronic Health Record (EHR) and claims data across three states to see if obesity counseling has improved weight and diabetes outcomes. For patients with or at risk of developing type 2 diabetes, are they receiving obesity counseling? If so, is it leading to weight loss and better blood sugar control? These are questions we hope to answer by analyzing the data. We are utilizing the PaTH network, an integrated research collaboration between Maryland, Pennsylvania and Utah, to pull EHR data on over two million patients with or at risk of type 2 diabetes.

This project began in early 2016 and is set to continue until the year 2021. We have finished extracting EHR data from each of the universities collaborating in this research: Penn State Health, University of Pittsburgh, Temple University, Geisinger Health System, Johns Hopkins University and University of Utah. We are thrilled to announce that we now have a complete dataset that is currently being analyzed! Our preliminary results have found that weight counseling rates are low; only two out of our six partnering sites have data on providers who have used billing code(s) for weight counseling. We plan to dig a little deeper into this data to better understand what may be happening with other patients. For example, are the patients receiving weight counseling but the provider is not coding for the counseling or are the patients being referred to a specialist? Gaining a better understanding about the providers that offer weight counseling and also insight into the patients that have received weight counseling will shed light on how to best disseminate their approach to other practice sites.

Stay tuned for more updates!

2 | SUMMER/FALL 2019 EDITION

Stakeholders Each individual engages in key research activities, strengthening our project through their perspective and experience.

Style Guide for Internal Audiences

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updated: July 21, 2016

SPOTLIGHT: Team Member Lan Kong, MS, PhD,

Co-Investigator for PaTH to Health: Diabetes study at Penn State College of Medicine

Meet Dr. Lan Kong!

Dr. Kong serves as Co-Investigator for the PaTH to Health: Diabetes study at Penn State College of Medicine. She is a Professor of Public Health Sciences in the Division of Biostatistics and Bioinformatics. As a seasoned biostatistician and co-leader of the Biostatistics, Epidemiology, Research Design (BERD) core of the Penn State Clinical and Translational Science Institute, Dr. Kong is well positioned to lend her statistical expertise to our multidisciplinary study. She has extensive experience working with large multi-site observational studies and analyzing complex health related data through multi-level modeling. In her role as study Co-Investigator, she provides statistical insights on study design, monitors data quality, performs statistical analyses, and collaborates on manuscripts and publications.

Dr. Kong holds two MS degrees in Mathematics and Biostatistics and

earned a PhD in Biostatistics from the University of North Carolina, Chapel Hill.

In her free time, she enjoys spending time with family, cooking and watching college basketball games.

► Meet Dr. Sadie Peters, one of our PaTH to Health: Diabetes study stakeholders! in relation to clinic-based obesity counseling for people with diabetes and at risk for diabetes.

At MDH, Dr. Peters presently leads the Multi-state EHR-based Network for Disease Surveillance (MENDS), a pilot project to demonstrate that clinical data captured in electronic health record (HER) systems can be effectively used by health systems and public health agencies for continuous quality improvement, population health management, and statewide chronic disease surveillance. MENDS data, intended to encompass a broad array of health variables, including sociodemographics, will be collected daily. With the availability of such up-to-date data, interventions can be designed to address current disease trends and changes in these trends can be measured in a timely fashion.

It is hoped that lessons learned from the PaTH to Health: Diabetes study will inform the MENDS project.

Cool Connections

Sadie Anthea Peters, MD is the Medical Director in the Center for Chronic Disease Prevention and Control at the Maryland Department of Health (MDH). An Internist who spent eight years in clinical work at Johns Hopkins Community Physicians before joining the public health sector, Dr. Peters is very interested in innovative interventions that expand population level preventive health services. The Center for Chronic Disease Prevention and Control is working to increase the availability of Diabetes Self-Management Education and Supports (DSMES) and the National Diabetes Prevention Program across the state, and also actively supports provider education about these programs. Dr. Peters views the PaTH to Health: Diabetes study as an important part of understanding how health systems are addressing this widespread health problem. Specifically, Dr. Peters believes that the prevalence and outcomes are most important

Sadie Anthea Peters, MD,

Medical Director, Center for Chronic Disease Prevention and Control at the Maryland Department of Health (MDH) Dr. Peters received her medical degree from Howard University, and a Master in Health Science Degree in Health Education from Johns Hopkins Bloomberg School of Public Health.

She is Board Certified in Internal Medicine and an alumna of the General Internal Medicine Fellowship at Johns Hopkins.

SUMMER/FALL 2019 EDITION | 3

PATIENT PARTNER VOICE Many of you have already met Patient Partner, Julie Tice. Within the summer/fall 2016 newsletter [http://bit.ly/SumerFall2016] she took us on a tour of her ups and downs with type 2 diabetes. Now Julie is returning to share a very honest and firsthand assessment of how things have gone since then….exactly five years post bariatric surgery.

“After I had [bariatric] surgery I worked so hard to lose weight and keep it off – and life finally returned to normal. I could eat any way that I wanted to again but it got increasingly harder to manage. I know I don’t want to be back where I was.” Julie’s triumphant success with weight loss in the first few years after surgery didn’t come without hard work and perseverance. She adopted a healthier lifestyle by being more mindful of what she was eating and she committed to a rigid workout routine. Julie started to increase her walks to jogs and later to runs. Signing up for 5K races turned into 10K races which later turned into halfmarathons. Her progress was inspiring! She was free of diabetes and the weight of it, both literally and figuratively.

But then life got in the way. Julie’s dad suffered from chronic illness and was nearing the end.

Things were put on hold to care for him. A few months later, Julie suffered an injury during a halfmarathon. Julie had to start all over again, similar to resetting a clock. She couldn’t run, not even jog.

It was back to square one until she rehabilitated from her injury. These setbacks led to a vicious thought cycle for Julie. “It was an emotionally intense time. I would get down on myself for not doing what I knew I needed to do but couldn’t do at the time.” The weight crept up again. Julie feared she would be back up to the weight that she was at prior to bariatric surgery. “I understand the difficulty and the struggles when you’re trying to keep it at bay. It always has to be on my mind or I’m 4 | SUMMER/FALL 2019 EDITION

“It [her weight] always has to be on my mind or I’m likely to get diabetes back.

Genetics are against me. Both my parents and grandparents had diabetes. I don’t want to be diabetic.

I need to turn this ship around - NOW.”

likely to get diabetes back. Genetics are against me.

Both my parents and grandparents had diabetes. I don’t want to be diabetic. I need to turn this ship around - NOW.” Julie tries to avoid the negative self-talk. It’s defeating and she knows that it will get her nowhere. She is trying to take one day at a time, sometimes one hour at a time, to get back to where she was. “You need to take care of yourself short-term to avoid suffering long-term.” With her glass half-full mentality, she often thinks, “What’s my work around?” If she can’t run, at least she can walk. She is slowly but surely getting back into a more rigorous workout routine and hopes to soon join races again. She practices mindful living by recognizing the importance of accepting where she is at versus where she aspires to be. As a houseparent to 12 teenage girls, some of whom also deal with weight issues, Julie has openly shared her struggles with them. The girls are frustrated with their weight, just like she is. They have setbacks too. “There’s times when it’s really hard. Having them see me go through it makes them feel like they are not alone.”

Julie’s story does not end here. She continues to work hard every day and ride out the storms that come her way. We applaud Julie for sharing this raw side of her weight-loss journey that so many of us face but cast to the shadows.

“We must pass through the darkness to reach the light.”

– Albert Pike

Clinician

MESSAGE “Stress can increase your blood sugars and be harmful for your overall health and well-being. Mindfulness-based stress reduction (MBSR) decreases stress, and may also decrease fasting blood sugar (Raja-Khan, et al, 2017). You can start practicing mindfulness now by using the brief S.T.O.P. strategy described here: http://bit.ly/STOPstrategy”

STOP

For more resources visit the following websites: http://bit.ly/MindfulnessBloodSugar http://bit.ly/ManageStressAndDiabetes http://bit.ly/MindfulnessCenter

– Nazia Raja-Khan, MD, MS, Associate Professor of Medicine and Obstetrics and Gynecology, Division of Endocrinology, Diabetes and Metabolism, Penn State College of Medicine

► Recent Trends in Diabetes Management

Study Finds Low Rates of Eye Exams in Diabetes Patients “Alarmingly low” was the term used by authors of a new study published in Diabetes Care that reported on the frequency of eye exams by people with diabetes.

The researchers studied insurance companies and employers that supplied data from 2010 to 2014 to IBM Watson Health. The researchers identified nearly 300,000 patients who had Type 2 diabetes and did not have diabetic retinopathy. They determined that 48.1 percent of these patients did not have an eye exam during the study period. Perhaps even more disturbing, only 15.3 percent had met the recommendations of the American Diabetes Association (ADA) for an eye exam every one or two years. When it came to the nearly 3,000 patients with Type 1 diabetes and no diabetic retinopathy, 33.6 percent had no eye exams during the study period and only 26.3 percent met the ADA guidelines.

And what about those diabetes patients who did have eye exams? The researchers discovered that 24.4 percent of the Type 2 diabetes patients actually did have diabetic retinopathy, with 8.3 percent having visionthreatening retinopathy. Among the Type 1 diabetes patients, 54.0 percent had retinopathy and 24.3 percent had vision-threatening retinopathy. In other words, it’s apparent that there’s a lot of undetected diabetic retinopathy among people with diabetes. It’s no wonder that the researchers were alarmed.

The authors reasonably concluded that “systemic changes in healthcare may be needed to detect and prevent vision-threatening eye disease among people with diabetes.” “Until that happens,” they went on to say, diabetic retinopathy” will likely remain the leading cause of blindness among workingage adults.”

Full article: http://bit.ly/LowEyeExamRate

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SUMMER/FALL 2019 EDITION | 5

RECIPE CORNER

Chicken with Porcini Mushrooms Makes: 4 servings Serving Size: 3 to 4 oz. chicken, about 1/4 cup mushroom sauce Preparation Time: 10 minutes Cooking Time: 45 minutes Ingredients: 1 oz. dried porcini mushrooms or other dried wild mushroom (3/4 cup) 1 cup hot water 1 lb. boneless, skinless chicken thighs ¾ tsp. kosher salt Freshly ground black pepper 1 ¹/₂ Tbsp. olive oil 1 large onion, diced (1 ¹/₂ cups) 1 garlic clove, finely minced (1 tsp.) ½ cup dry white wine 2 Tbsp. tomato paste ¼ cup minced fresh Italian parsley From www.diabetesforecast.org, Recipe by Robyn Webb, MS, LN; Photograph by Greg Scheidemann; Styling by Jill Lust

Directions

Original source: http://bit.ly/ChickenWithPorciniMushrooms

1

Place the porcini mushrooms in a heatproof bowl. Pour enough hot water to cover the mushrooms and set aside.

2

Pat the chicken thighs dry. Sprinkle the thighs with the salt and black pepper to taste.

3 4

In a large skillet, heat the olive oil over medium-high heat. Add the chicken and sauté for 4 to 5 minutes. Flip the thighs and sauté for another 4 to 5 minutes until golden brown. Remove the thighs from the skillet and set aside.

Add the onion to the skillet, scraping up any browned bits. Lower the heat to medium, and sauté the onion for 6 to 7 minutes. Add the garlic and sauté for 2 minutes.

5

Drain the mushrooms, reserving the mushroom liquid. Coarsely chop the mushrooms, and add them to the skillet. Sauté the mushrooms for 1 minute. Add the wine, tomato paste, and mushroom liquid, bringing the sauce to boiling.

6

Lower the heat to simmer. Return the cooked chicken to the skillet. Cover and simmer for 15 to 20 minutes until the chicken is cooked through. Using a slotted spoon, remove the chicken from the skillet and put it on a serving platter. Cover the chicken with foil to keep it warm.

7

Raise the heat to high and boil the sauce, stirring occasionally, until it has thickened and is reduced by half. Pour the sauce over the chicken, garnish with fresh parsley, and serve.

6 | SUMMER/FALL 2019 EDITION

Baked Egg with Avocado, Tomato and Citrus Salad

RECIPE CORNER

Makes: 2 servings Serving Size: 1 egg and about 1 cup salad Preparation Time: 15 minutes Cooking Time: 5 minutes Ingredients: 2 eggs 2 tsp. canola oil, divided 2 Tbsp. lime juice ¼ tsp. kosher salt ½ tsp. cracked black pepper 2 ½ oz. peeled and cubed avocado (about ½ of a medium fruit) 1 large tomato, thinly sliced 2 oz. red onion, peeled and thinly sliced (generous 1/3 cup) ¼ cup finely chopped cilantro Original source: http://bit.ly/BakedEggWithAvocado Recipe by Ronaldo Linares, Photograph by Eric Hinders/Mittera Recipe adapted from Chef Ronaldo’s Sabores De Cuba: Diabetes-Friendly Traditional and Nuevo Cubano Cuisine by Ronaldo Linares (American Diabetes Association, 2016). Order online at shopdiabetes.org or by calling 800-232-6733

Directions

1

Preheat the oven to 400° F.

2

Crack each egg into a separate bowl without breaking the yolks. Set aside.

3

Looking for additional diabetic-friendly recipes?

4

In a small bowl, add the remaining 1 tsp canola oil, the lime juice, salt, and pepper; whisk the ingredients to create the dressing. Add the avocado, tomato, onion, and cilantro to the dressing, and toss.

5

Remove the eggs from the oven. Plate half the salad for each serving and add an egg.

http://bit.ly/diabetic-friendly courtesy of

Preheat a small ovenproof pan and add 1 tsp of the canola oil. Gently add the eggs to the pan.

Immediately place the pan in the oven. Cook at least 5 minutes, until both the white and yolk are firm. (Infants, young children, older adults, pregnant women, and people with weakened immune systems, including those with diabetes and other chronic illnesses, are particularly vulnerable to foodborne illnesses from bacteria found in undercooked or raw eggs.)

SUMMER/FALL 2019 EDITION | 7

Building HOPE Helps

Put a POSITIVE

SPIN

on Having Diabetes

Virginia Valentine, APRN, BC-ADM, CDE, FAADE, named the American Diabetes Association’s 2019 Outstanding Educator in Diabetes, knows firsthand what it’s like to experience the struggle that comes with having diabetes. She has had type 2 diabetes (T2D) for 39 years, so she’s used to the reactions she gets when meeting someone new for the first time.

“There is often a huge amount of shame and blame,” Ms. Valentine says about those who do not really understand the condition. “There is a stigma attached to having type 2 diabetes because many people assume that you have diabetes simply because you are overweight. Case in point— I once overheard a woman who had type 1 diabetes telling her friend that she had the kind of diabetes that she didn’t cause herself.”

As a health professional with one of the most common diseases among adults in the United States, Ms. Valentine’s personal experience informed the theme for her presentation upon accepting her award at the American Dietetic Association 79th Scientific Sessions in San Francisco, California.

Shifting Focus of Diabetes to Caring and Away from Shaming

The topic of her presentation comes from personal and professional appreciation of the struggle faced by some many people with type 2 diabetes. Ms. Valentine’s address: “The Most Important Thing We Give to People Is Hope—Overcoming Stigma in Diabetes and Obesity,” was selected to recognize how important it is to help people reframe this condition “because the stigma gets in the way of caring for people with diabetes.”

First off, she says, it’s important to have a health care professional who acknowledges that having type 2 diabetes is not your fault. “There are now studies with the zillions of genes that have an impact on insulin resistance,” she says. “So, knowing that is important because it’s not that I am looking to give individuals with type 2 diabetes, including myself, a pass. I say, rather, this is not your fault, but it is your responsibility.”

Changing the way we think of ourselves is an important an necessary step forward, Ms. Valentine says. “Taking ‘diabetic’ out of the language helps, too,” she says. “I am not a diabetic. I am a person with diabetes; It’s not about being ‘diabetic’ or having a ‘diabetic foot.’”

Written by Rosemary Black An exclusive interview with Virginia Valentine, APRN, CDE

Ms. Valentine, who just turned 70 years of age, is currently a certified diabetes educator and advanced practice nurse at Sage Specialty Care in Albuquerque, New Mexico, where she holds a faculty appointment with the University of New Mexico. In addition, she is co-author of Diabetes, the New Type 2—Your Complete Handbook to Living Healthfully with Diabetes Type 2.

Read full story here: http://bit.ly/BuildingHopeHelps

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PATIENT

Resources

Recently diagnosed with type 2 diabetes and don’t know where to begin? Start here: http://bit.ly/DiabetesJourney Learn about your risk for pre-diabetes, type 2 diabetes and heart disease: http://bit.ly/pre-diabetes_risks

Learn all about blood glucose: http://bit.ly/BloodGlucose Interested in joining a team of peers, clinicians, and healthy champions as you work towards your diabetes management goals?

Visit: www.teamingupfordiabetes.com For several resources related to diabetes: www.diabetesforecast.org Meal planning is part of healthy eating and maintaining a healthy weight. Get tips on how you can plan healthy meals at home, at work and on the go. http://bit.ly/1etYyA6 Learn more about the benefits of walking, and how you can add walking to your daily routine. http://bit.ly/2kBcjEE

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SUMMER/FALL 2019 EDITION | 9

COMMUNITY EVENTS

Penn State Annual Diabetes Fair DATE: Saturday, November 2, 2019 TIME: 9 AM – Noon LOCATION: University Conference Center at Penn State Hershey Campus

Type 2 Diabetes Support Group Whether you’re newly diagnosed or have had type 2 diabetes for many years, our support group can help you live well with type 2 diabetes. Meet others who face the same challenges and learn new healthy lifestyle habits.

REGISTER: Call 717-531-4540 for more information.

Penn State Extension Dining with Diabetes

Dining with Diabetes program helps people with type 2 diabetes identify and understand important information about managing and preventing this disease. There are five workshops are at a beginner skill level.

DATE: 5 sessions, dates vary TIME: times vary LOCATION: 13 location options COST: Reduced program rates of $5/Individual and $10/ Family are reflected on events with funding provided by local, state, and/or national grants. Click Register and see Cost tab for individual site rates (discount will be reflected).

REGISTER: http://bit.ly/DiningWithDiabetesProgram

10 | SUMMER/FALL 2019 EDITION

Diabetes Education One-on-one session is offered with diabetes nurse educator: Individual one-hour session with diabetes nurse educator; review of how to treat high or low blood sugar, sick-day guidelines, etc. Please obtain a referral from your physician's office and an authorization from your insurance company to ensure insurance coverage. Our program is recognized by the American Diabetes Association. http://bit.ly/2JMakK6 Diabetes Support Groups (children and parents) LOCATION: Hershey Medical Center REGISTER: For more information, please contact: 717-531-7795 Insulin Pump Support Group Specifically for people already using insulin pumps.

REGISTER: For more information, please contact: 717-531-4220

A Touch of Sugar Diabetes Support Caregivers, family members and friends are welcomed.

DATE: meets the second Monday of each month TIME: 5:30 – 6:30 PM LOCATION: Weis Markets, 4525 Valley Road, Enola COST: FREE REGISTER: For information, please call 717-763-2466.

Diabetes Prevention Program Trained lifestyle coaches will help participants lose weight, increase physical activity, and make healthy lifestyle choices that can prevent or delay the onset of type 2 diabetes. Must be 18 years of age or older and have pre-diabetes or be at risk for developing diabetes.

DATE: every Wednesday TIME: 9:30 – 10:30 AM LOCATION: Dillsburg Senior Center, 1 N. 2nd St., Dillsburg REGISTER: Call 866-415-7138

COMMUNITY EVENTS Diabetes Educational Series The Clinical Nutrition/Diabetes Services team at Geisinger Holy Spirit is hosting a series of four diabetes education classes in August and September. Topics for each week are listed below.

• August 6: Diabetes and medication • August 20: Healthy eating • August 27: Exercise and monitoring • September 3: Problem solving and reducing risks

DATE: Tuesdays in August and September TIME: 2 – 4 PM LOCATION: Geisinger Holy Spirit Diabetes Services/ Clinical Nutrition office, 890 Poplar Church Road, Suite 506, Camp Hill, PA 17011 REGISTER: Contact Sheila Thomas at 717-763-2466 or visit, http://bit.ly/2GqyYy1

Diabetes Prevention Program This program is intended for individuals who are pre-diabetic and it is held in a classroom setting, by a trained lifestyle coach who will facilitate a small group of participants in learning about healthier eating, physical activity and other behavior changes over 25 sessions. The year-long program consists of 16 weekly sessions for the first six months followed by two sessions per month in the second six months. The program’s goals are to lose 5–7% of your body weight and gradually increase your physical activity to 150 minutes per week.

REGISTER: Visit http://bit.ly/DiabetesPreventionApp to complete the registration form. A representative will contact you within two business days. If you have any questions, please call 215-707-7247.

Real World Diabetes Program Take charge of your diabetes with Temple’s Real World Diabetes Program’s classes that will help inspire you to make healthy lifestyle choices and get control of your diabetes.

The Real World Diabetes Program will teach you about your disease in a way that is easy to understand.

Before the program begins, you will meet one-on-one with a Temple Certified Diabetes Nurse Educator. The nurse educator will ask you about your medical history and make sure you are signed up for the classes you need.

REGISTER: 215-926-3780 or http://bit.ly/2JWXPdK

Diabetes Self-Management Education Program This group course is designed to cover all aspects of diabetes self-management. Learn about meal planning, physical activity, glucose monitoring, medicines, dining out, coping with stress and more. The content is based on American Diabetes Association Guidelines. The cost is covered by most insurance companies. Please contact your insurance company to confirm coverage of services prior to registering. A Physician Referral may be needed to enroll. For more information, visit http://bit.ly/UPMCEducationProgram or call the following: UPMC Altoona: 814-889-2731 UPMC Bedford: 814-624-4315 UPMC Hamot: 814-877-2123 UPMC Horizon: 724-983-7160 UPMC McKeesport: 412-664-3055 UPMC Mercy: 412-232-5908 UPMC Northwest: 814-676-7992 UPMC Passavant: 412-748-6398 UPMC St. Margaret: 412-784-5162; 412-784-4195

Class options listed on next page.

SUMMER/FALL 2019 EDITION | 11

COMMUNITY EVENTS Diabetes Self-Management Education Program

Continued from page 11.

DATE: 8/22/2019 - 8/29/2019 TIME: 5:00 PM - 9:00 PM INSTRUCTOR: Barbara Bucek LOCATION: UPMC St. Margaret, Nursing Education Classroom REGISTER: http://bit.ly/2Z8x7VB DATE: 10/19/2019 - 10/26/2019 TIME: 8:00 AM - Noon INSTRUCTOR: Barbara Bucek LOCATION: UPMC St. Margaret, Cafeteria A&B REGISTER: http://bit.ly/2Z8x7VB Diabetes Support Groups with UPMC Passavant DATE: 8/21/2019 - 8/21/2019 TIME: 6:00 PM - 7:00 PM INSTRUCTOR: Kelly Szelc LOCATION: UPMC Passavant McCandless, Assembly Hall REGISTER: Contact Kelley Szelc at 412-748-3681 or szelcka2@upmc.edu DATE: 9/18/2019 - 9/18/2019 TIME: 6:00 PM - 7:00 PM INSTRUCTOR: Kelly Szelc LOCATION: UPMC Passavant McCandless, Assembly Hall REGISTER: Contact Kelley Szelc at 412-748-3681 or szelcka2@upmc.edu Diabetes Support Groups with UPMC St. Margaret DATE: 9/19/2019 TIME: 6:00 PM - 7:30 PM INSTRUCTOR: Barbara Bucek LOCATION: UPMC St. Margaret Cafeteria A&B REGISTER: http://bit.ly/UPMCStMargaretSupportGroup DATE: 11/21/2019 TIME: 6:00 PM - 7:30 PM INSTRUCTOR: Barbara Bucek LOCATION: UPMC St. Margaret Cafeteria A&B REGISTER: http://bit.ly/UPMCStMargaretSupportGroup 12 | SUMMER/FALL 2019 EDITION

One-on-One Diabetes Instruction Diabetes counseling with one of our Certified Diabetes Educators in a personal setting. Learn about meal planning, physical activity, glucose monitoring, medicines, dining out, and coping with stress. The content is based on American Diabetes Association Guidelines. The cost is covered by most insurance companies. A Physician Referral is needed to enroll.

Questions? Visit http://bit.ly/OneOnOneClasses.

UPMC Hamot: 814-877-2123 UPMC Mercy: 412-232-5908 UPMC Northwest: 814-676-7992 UPMC Passavant: 412-748-6398 UPMC St. Margaret: 412-784-5162 or 412-784-4195

Comprehensive Diabetes Center Education Program

Patients are offered the opportunity to meet one-on-one with a nurse practitioner or dietitian certified diabetes educator, as well as group education programs. Group and individual sessions are geared for newly diagnosed diabetics, those who need education updates, and those interested in the latest tips to best manage diabetes.

REGISTER: To schedule please call 410-955-9270 or visit, http://bit.ly/2Hrs9ix

Sign up for

FREE

monthly diabetic-friendly recipes! American Diabetes Association's NEW Recipes for Healthy Living makes eating healthy easier for YOU. http://bit.ly/ADArecipe

COMMUNITY EVENTS

Comprehensive Diabetes Self Management Classes

The Diabetes Self -Management Class Series will be starting in August. These classes will require a referral (http://bit.ly/2ZdtNc8) from your provider and will equip with all the necessary skills to understand and manage diabetes.

• The importance of making the right food choices • Staying physically active • What your blood glucose numbers mean • Strategies to manage blood glucose levels • Medications to help manage Type 2 diabetes • Healthy coping skills The Johns Hopkins Program Schedule 2019 • August 19: On the Road to Better Managing your Diabetes, Diabetes and Healthy Eating • September 23: Diabetes and Healthy Eating (continued) and Monitoring Your Glucose • October 28: Continuing Your Journey with Diabetes • December 16: On the Road to Better Managing your Diabetes, Diabetes and Healthy Eating REGISTER: To schedule please call 410-955-9418 or visit, http://bit.ly/2Hrs9ix

Gestational Diabetes Class in Spanish and English The Utah Diabetes Center is accepting all patients. Those without insurance may be covered.

• Spanish Gestational Diabetes Class DATE, TIME: Every Wednesday 2:00 - 4:00 PM • English Gestational Diabetes Class DATE, TIME: 2nd and 4th Thursday of the month 9:30 11:30 AM Spanish Diabetes Classes DATE, TIME: Every 3rd Wednesday and Thursday of the month 4:00 - 6:00 PM

Type 2 Diabetes Prevention Program The program lasts for 12 months and covers sciencebased education and lifestyle changes. It will be offered every four to six months at University Of Utah locations.

The program will help you to: • Learn about healthy food choices.

• Build physical activity into your life.

• Lose weight.

• Decrease your risk of diabetes.

COST: The program is available for $50/Person for 12 months for University of Utah employees and community members. There is no charge for 12 months for residents on Medicaid or residents who meet WIC income guidelines. Call 801-213-8720 for clarification about the program cost for you. All participants must be 18 at the time of the first class.

REGISTER: Apply to join our program and take our Diabetes Risk Quiz (http://bit.ly/2SwrVIT ) to see if you are eligible for the program. Contact 801-213-8720 or email DPP@utah.edu to see if you qualify for a scholarship.

Diabetes One Day Education and Care Program This unique one-day program offers personalized care as well as diabetes education in a small group setting.

The interactive educational program helps you develop a personalized plan to achieve your diabetes goals.

The program is designed to support individuals who have a new diagnosis of diabetes and those who have had diabetes for many years. You will have access to follow-up with the team to promote ongoing success.

Some activities include: meet with a nurse practitioner or physician and diabetes educators to establish your diabetes treatment goals, review the latest diabetes medications and technology and receive exercise and nutrition education with personalized recommendations, and more. Breakfast, lunch, and snacks will be provided.

DATE, TIME: First and third Friday of month, 9AM to 5PM. LOCATION: Utah Diabetes & Endocrinology Center 615 Arapeen Drive, Suite 100, Salt Lake City, Utah 84108 REGISTER: Anyone with Type 1 or Type 2 diabetes can enroll in our program. Limited spots per session. We encourage you to bring a family member or friend along. http://bit.ly/2OoM8Se SUMMER/FALL 2019 EDITION | 13

COMMUNITY EVENTS

Diabetes Complications Program The program provides retinal and vascular testing to identify early stage eye and vascular complications.

Eye testing is completed using state of the art fundus photography. Vascular testing is completed using an ankle brachial index. Each test takes less than 15 minutes to complete. Early detection of diabetes complications can allow for early treatment, slowing the progression of diabetes complications and improving quality of life.

DATE, TIME: First and third Friday of every month, 9AM to 5PM. LOCATION: Utah Diabetes & Endocrinology Center 615 Arapeen Drive, Suite 100, Salt Lake City, Utah 84108 REGISTER: Anyone with Type 1 or Type 2 diabetes can be tested if they meet certain criteria. To see if you qualify for testing, please contact Julie Neuberger at julie.neuberger@hsc.utah.edu or call 801-587-3914.

Diabetes Support Group Session where you can exchange information, feelings and ideas. Groups offer discussion, question and answer sessions, and other activities. FREE and open to ALL adults in the community, 18 years and older.

Spouses and support members are encouraged to also attend.

• Education at Community Clinics (for the newly diagnosed patient): Redwood Center (1525 W. 2100 S., SLC) • Education at Utah Diabetes Center (for the newly diagnosed or returning patient) DATE: Every fourth Tuesday of the month, 6:00 7:30PM LOCATION: 615 Arapeen Drive, Suite 100, Salt Lake City, Utah REGISTER: For dates, times and registration, please call 801- 587-3913. Registration is required for group classes and individual consults.

14 | SUMMER/FALL 2019 EDITION

Step Out: Washington, DC DATE: September 21, 2019 TIME: Registration Opens 8:00 AM; Walk Starts 9:30 AM LOCATION: Washington Monument Grounds REGISTER: Contact Sharon Keating at 202-331-8303 ext. 4532 or email SKeating@diabetes.org or visit http://bit.ly/2Y7JYGs Step Out: Baltimore DATE: October 6, 2019 LOCATION: Canton Waterfront, 1501 S. Clinton St. REGISTER: Contact Corey Proctor at 410-265-0075 or email cproctor@diabetes.org or visit http://bit.ly/2XZdWkT Step Out: Philadelphia DATE, TIME: November 2, 2019; 6 AM LOCATION: Philadelphia Museum of Art REGISTER: Contact Alyssa Laufer at 610-828-5003 ext. 4633 or email ALaufer@diabetes.org or visit http://bit.ly/30VKDN8

Tour de Cure Pittsburgh: South Side Riverfront Park RIDE: 63 MI, 30 MI, 12 MI, WALK: 5K, RUN: 5K DATE: September 14, 2019 LOCATION: South Shore Riverfront Park 2701 S Water St, Pittsburgh, PA 15203 REGISTRATION FEE: $20 for cyclists, no fee for walk/run; Fundraising Minimum: Riders $200 | Runners/Walkers $100 | Children Riding 12 and under $50 REGISTER: Contact Chelsea Schaffer at 412-824-1181 x4609 or email cschaffer@diabetes.org, or visit http://bit.ly/2JZH959.

PaTH to Health: Diabetes Study Newsletter Team

DESIGNER: Abbey Kinard CONTRIBUTORS: Lan Kong, Sadie Peters, Julie Tice EDITORS: Diane Bennett, Cynthia Bradley, Treva Alston, Mully Chea, Julie Tice, Angela Evans, Jennifer L. Kraschnewski, Erica Francis

EDITOR-IN-CHIEF: Jennifer M. Poger Need to get in touch with us?

Email: PATHtoHealth@pennstatehealth.psu.edu

WINTER/SPRING 2019 EDITION

“A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities”

Greetings from the PaTH to Health: Diabetes Research Team!

As Principal Investigator on this project, I’d like to welcome you to our most recent issue of our biannual research study newsletters. We worked closely with our patient partners and stakeholders, some of whom are featured in this issue, to develop the resources in this edition. Learn about our midway research study updates, read up on recent trends in diabetes management, try a new diabetes-friendly recipe, and sign up for a local diabetes related community event in your area. Happy reading!

Jennifer L. Kraschnewski, MD, MPH

Associate Professor of Medicine and Public Health Sciences Vice Chair of Clinical Research, Department of Medicine Director, Penn State Project ECHO® Penn State College of Medicine

HIGH FIVES A HIGH FIVE goes to patient partners, stakeholders and Penn State PRO Wellness’s marketing team for their efforts raising awareness for National Diabetes Month (November) and World Diabetes Day (November 14, 2018). Thanks to our successful marketing campaign, our study website, www.pathdiabetes.org, had an impressive increase of website views by nearly 400% between October and November. Great work, team!

Congratulations and a HIGH FIVE are in order for our patient partners that completed the fall Data Analysis Mini Series Training.

This two-part training provided a background on basic statistics and how it will be applied during the data analysis phase of our project.

Our PaTH to Health: Diabetes study began in 2016 and is funded through 2021. Congratulations to our entire team for making it to the halfway mark with many anticipated milestones on the horizon.

We look to the second half of the project with excitement as we move closer to sharing study results and disseminating them within our communities.

A HIGH FIVE goes to Patient Partner Angie, above at right, for attending Penn State Health’s Annual Diabetes Fair in November, 2018. This is the third year Angie has represented our study in the local diabetes community and she has been able to connect with other alike patients, share strategies for diabetes selfmanagement and distribute our study resources. Round of applause!

Research Study Overview & Update

For new readers (or returning readers) enjoy an overview about our current research study, “A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities” which is funded by the Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent, nonprofit organization that envisions a research world addressing questions and concerns most relevant to patients, while including them, their caregivers, clinicians and other stakeholders in the research process. We are thrilled to be working alongside our patient partners and stakeholders throughout each phase of our project. Our awesome community team consists of six patient partners, six primary care providers, and ten stakeholders who continue to contribute their ideas, expertise and lived experience to our project. They have been the driving force of key study decisions and are a constant reminder of why our research matters.

Patient Partners

Primary Care Providers

To give you some background on our PaTH to Health: Diabetes study, let’s take a brief look at the literature. You may be aware that obesity is a big issue in the US. In fact, it’s our number one health concern. Addressing obesity through lifestyle interventions (i.e. healthy eating and increased physical activity) decreases the risk of developing type 2 diabetes, a disease that affects over 29 million people (9.3% of the US population). Diabetes is associated with serious complications, including heart disease, blindness, renal failure and lower extremity amputation. Although complications are preventable with proper medical and lifestyle management, including weight loss, nearly half of diabetic patients do not have adequate glycemic control.

Recent policy changes and health insurance expansion have resulted in coverage for obesity counseling by Centers for Medicare and Medicaid to improve weight loss for adults either with or at high risk of type 2 diabetes. Obese beneficiaries are eligible for up to 20 face-toface visits for weight counseling in the primary care setting. However, it is unknown whether or not this benefit has helped patients lose weight and better control their diabetes.

This is where the PaTH to Health: Diabetes study comes into play. We are looking at Electronic Health Record (EHR) and claims data across three states to see if obesity counseling has improved weight and diabetes outcomes. For patients with or at risk of developing type 2 diabetes, are they receiving obesity counseling? If so, is it leading to weight loss and better blood sugar control? These are questions we hope to answer by analyzing the data. We are utilizing the PaTH network, an integrated research collaboration between Maryland, Pennsylvania and Utah, to pull EHR data on over two million patients with or at risk of type 2 diabetes.

This project began in early 2016 and is set to continue until the year 2021. We have finished extracting EHR data from each of the universities collaborating in this research: Penn State Health, University of Pittsburgh, Temple University, Geisinger Health System, Johns Hopkins University and University of Utah. During the process of “cleaning” up the dataset, we’ve come across some missing data challenges. After further review, we’ve found a high percentage of patients that are missing HbA1c values within their health record. This is often due to patients receiving treatment at a particular health center for an isolated incident, but receiving ongoing diabetes care elsewhere. At this time, we are developing ways to better identify true diabetes patients. We will then be able to analyze the data to help shed light on how policy changes impact diabetes. If we are able to identify practice sites that have successfully implemented intensive obesity counseling and they have improved diabetes outcomes, we will disseminate their approach strategies to help other providers implement.

Stay tuned for updates.

2 | WINTER/SPRING 2019 EDITION

Stakeholders Each individual engages in key research activities, strengthening our project through their perspective and experience.

Style Guide for Internal Audiences

Table of Contents •

Introduction and Purpose

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Using Pitt Public Health in Writing

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The Pitt Public Health Graphic Mark

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Using the Graphic Mark

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Departments, Centers, Programs, and Other Entities

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The University Seal and Signature

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Typefaces, Colors

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Spacing, Size, Design Tips

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Tools, Templates, and Training

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updated: July 21, 2016

SPOTLIGHT: Team Member Hsin-Chieh “Jessica” Yeh, PhD, Site Principal Investigator for PaTH to Health: Diabetes study Johns Hopkins University

Meet Dr. Hsin-Chieh "Jessica" Yeh! Dr. Hsin-Chieh "Jessica" Yeh serves as site Principal Investigator for the PaTH to Health: Diabetes study at Johns Hopkins University. In this role, Dr. Yeh provides expertise on diabetes research and data analysis, and facilitates data acquisition at Johns Hopkins. She is also an Associate Professor of Medicine, Epidemiology, and Oncology at Johns Hopkins Medicine; Director of the Baltimore Diabetes Research Center (DRC) Healthcare and Population Science Core; and the Associate Director of the Welch Center for Prevention, Epidemiology, and Clinical Research. Her research focuses on clinical trials and cohort studies of diabetes, obesity and cancer. Recently, she was appointed by the American Diabetes Association to chair the Public Health and Epidemiology Interest Group, a forum with over 1,200 professional members.

Dr. Yeh received a bachelor’s degree from the National Taiwan University and

a PhD in Epidemiology from Johns Hopkins School of Public Health before joining the Johns Hopkins faculty. In her free time, Dr. Yeh enjoys travel, movies and music.

► Meet Dr. Linda Siminerio, one of our PaTH to Health: Diabetes study stakeholders! research program and former Chair of the IDF Diabetes World Congress.

Dr. Siminerio's research focuses on the translation of evidence based practice into clinical and community settings with a concentration on improving access and quality to diabetes self-management and care in underserved populations. As a leader in diabetes research and treatment, we are thrilled to have Dr. Siminerio serve as a stakeholder in the PaTH to Health: Diabetes study. We are grateful for her assistance in supporting the dissemination and potential implementation of our results within her network.

Cool Connections

Linda Siminerio, RN, PhD, CDE is a Professor of Medicine at the University of Pittsburgh Schools of Medicine and Nursing.

She is a national advocate for diabetes care, education and funding, and currently serves as the Executive Director of the University of Pittsburgh Diabetes Institute. Additionally, she served as Chair of the National Diabetes Education Program, a program sponsored by the U.S. Department of Health and Human Services’ National Institutes of Health and the Centers for Disease Control and Prevention. Internationally, Dr. Siminerio served as Chair of the International Diabetes Federation (IDF) translation

Linda Siminerio, RN, PhD, CDE,

Professor of Medicine at the University of Pittsburgh Schools of Medicine and Nursing; Executive Director, University of Pittsburgh Diabetes Institute

Dr. Siminerio received her BSN from Pennsylvania State University, MS in Health Sciences at the University of Pittsburgh

and earned her PhD from the Pennsylvania State University. She is also a Certified Diabetes Educator.

WINTER/SPRING 2019 EDITION | 3

PATIENT PARTNER VOICE

“Know your numbers. You can guess all day but

Meet Diane, a mother of four, grandmother of ten, and great grandmother of five! She’s also a minister, a motivational speaker, an author, and a playwright.... the impressive list goes on.

Ironically, it wasn’t until her type 2 diabetes diagnosis a few decades ago that Diane was able to discover some of her many talents.

“When I couldn’t do one thing, I could do another.” She turned gloom into a blessing and transformed into the best version of herself because she knew her life was worth fighting for.

Diabetes runs in Diane’s family. She recalls having to give her father insulin, and later in life, both her brothers and her sister also received their diagnoses. Childhood visions of people having limbs removed haunted her. “Am I next?” Diane was able to dodge it for quite some time but then her knee pain started. It progressed and impacted her ability to work.

She ultimately had to leave her job and ran out of insurance. Gratefully, she connected with a wonderful doctor from a spiritual charities group who immediately tested her A1C level – 10.9. Diane thought, “This is it.” But then he asked her something that would resonate – “Do you want to live your best life?” She knew what she needed to do in order to back up off the cliff. She immediately committed to taking medication, checking her blood sugar levels, eating better, and exercising - even simple chair exercises. She was participating in her health and there was still hope for her. “As days went on those words rang out – every time I didn’t want to exercise I heard those words – do I want to live my best life?” She started feeling better and getting her self-esteem back. After 4 | WINTER/SPRING 2019 EDITION

feelings aren’t facts. The only accurate way to find out about your body is through tests.”

her double knee replacement surgery, she was introduced to another doctor who also deeply cared about people living their best lives.

“When you have a doctor that really cares, their encouragement goes a long way.” Every time she goes to her doctor, she gets closer to where she wants to be with her weight and blood sugar control. She has certainly backed up off the cliff.

How does Diane do it?

“Being a part of such a large family, I’ve always taken care of everyone except ME. Yet, I’ve learned what we learn when we board a plane - oxygen mask first! So now I make sure that I take the time to take care of myself so that I can help my family and others.” Diane’s piece of advice: “Know your numbers. You can guess all day but feelings aren’t facts. The only accurate way to find out about your body is through tests.” On a family trip a few years ago, Diane’s daily routine of checking her sugar levels prompted her other family members to check theirs. A few of them had high levels but Diane was able to use her knowledge and empower her family to take charge of their health. There’s no longer an elephant in the room. Many are now seeing a doctor, managing their own diabetes, and are also on their way to living their best lives.

Clinician

MESSAGE

“With regard to advice I give patients about diet and health, I often recommend that they watch In Defense of Food, on Netflix. I think that people should adopt a healthy way of eating that they can continue for life. I find this video rather inspiring.”

– Lorraine Szczesny, MD, University of Utah and PaTH to Health: Diabetes study clinician stakeholder

To learn more about the film visit http://bit.ly/DefenseofFood.

► Recent Trends in Diabetes Management

Insulin is a lifesaving medication for people with diabetes. However, its cost has nearly tripled in the past fifteen years making it difficult for many patients to afford this medication and effectively manage their disease. This has put patient safety in jeopardy as patients opt to ration their insulin or forgo other medical care. Research indicates that a lack of transparency in the drug supply chain has made it challenging to identify the root cause of price increases. This position statement from the Endocrine Society will identify barriers to accessing affordable insulin and potential policy solutions that could address this growing problem.

Increasing Insulin

Affordability

Full article: http://bit.ly/IncreasingInsulinAffordability

Designed by Freepik

WINTER/SPRING 2019 EDITION | 5

Tuscan Chicken Soup

RECIPE CORNER

Makes: 10 servings Serving Size: 1 cup Preparation Time: 5 minutes Cooking Time: 30 minutes Ingredients: 1 lb. boneless, skinless chicken breast 1 Tbsp. extra-virgin olive oil 1 cup chopped onion (about 1 large onion) 1 Tbsp. minced garlic (3 medium cloves) 1 cup sliced carrots (2 medium carrots) 1 cup sliced celery (about 2 stalks) 2 cups sliced zucchini (1 medium zucchini) 1 cup grape tomatoes 2 (15-oz) cans cannellini beans, drained and rinsed 1 Tbsp. chopped fresh rosemary ¹/₄ cup fresh basil leaves, torn 1 tsp. fine sea salt ¹/₂ tsp. freshly ground black pepper 48 oz. low-sodium, low-fat chicken stock

Directions

Original source: http://bit.ly/TuscanChickenSoupRecipe

1

Cut the chicken breast into bite-sized pieces.

2

Place the olive oil, onion, garlic, and chicken pieces in a 6- or 8-quart soup pot over medium-high heat.

PER SERVING Calories

170

Fat

4g

Saturated Fat

0.9 g

Trans Fat

0g

3

Sauté until the onions become translucent. Add the carrots, celery, zucchini, and tomatoes, and cook for 5 minutes.

Carbohydrate

16 g

Fiber

4g

4

Add the beans, herbs, salt, pepper, and stock.

Bring to boiling, then reduce heat to just below a boil and cook, covered, for 20 minutes.

Sugars

3g

Recipe adapted from Complete Month of Meals Collection: Hundreds of Diabetes-Friendly Recipes and Nearly Limitless Meal Combinations.

Available at shopdiabetes.org, 800-232-6733, or bookstores nationwide.

From www.diabetesforecast.org, photography by Terry Doran; styling by Nick Sellers; food styling by Annie Whyte

Cholesterol

25 mg

Sodium

390 mg

Potassium

580 mg

Protein

Phosphorus

18 g 175 mg

Choices: Starch 0.5, Nonstarchy Vegetable 1, Lean Protein 21

6 | WINTER/SPRING 2019 EDITION

Moroccan-Style Grilled Tuna With Carrot, Date, and Orange Salad

RECIPE CORNER

Makes: 2 servings Serving Size: 3 oz fish and 1 cup salad Preparation Time: 15 minutes Cooking Time: 10 minutes Marinating Time: 1 hour Ingredients: Chermoula Sauce 2 Tbsp. finely chopped cilantro 2 Tbsp. finely chopped parsley 3 cloves garlic, minced ¹/₂ tsp. unrefined sea salt 1 lemon, juiced and zested 1 Tbsp. extra-virgin olive oil 4 (3-oz) tuna steaks Salad 2 cups chopped romaine lettuce ¹/₂ med. carrot, peeled and grated ¹/₂ orange, peeled and cut into segments 2 pitted dates, chopped Juice of ¹/₂ orange 1 Tbsp. extra-virgin olive oil Freshly ground black pepper, to taste 4 Tbsp. chopped almonds 6 tsp. julienne or matchstick carrots 2 scallions, thinly sliced Original source: http://bit.ly/MoroccanStyleGrilledTuna, Recipe by Amy Riolo; photography by Todd Hanson/Mittera

Visit Pinterest for more diabetic-friendly recipes courtesy of

http://bit.ly/diabetic-friendly

Directions

1

In a medium bowl, mix the cilantro, parsley, garlic, salt, and lemon juice and zest together.

Whisk in 1 Tbsp olive oil.

2

Place the fish in a glass baking dish and pour half of the chermoula sauce over the fish. Cover with plastic wrap and refrigerate for 1 hour.

3

Preheat the grill to medium-high heat.

4

Meanwhile, make the salad by arranging the romaine lettuce on the bottom of a large serving dish. Scatter the carrots on top of the lettuce.

Arrange the orange slices on top of the carrots.

Arrange the dates on top.

5 6

Make the dressing by whisking the orange juice, olive oil, and black pepper together in a small bowl.

Pour over the salad and toss to combine. Top with the chopped almonds.

Grill the fish for 6 to 8 minutes, turning once, until firm. Spread the remaining chermoula sauce evenly over the tuna, and let stand for 5 minutes to absorb the flavors. If you prefer to make this dish in the oven, simply place the fish in a greased baking dish, top with half of the chermoula, cover with aluminum foil, and bake at 425° F for 20 to 25 minutes, or until cooked through. Serve two of the steaks and save two of the steaks.*

*Place in a tightly sealed container and refrigerate for use in Grilled Tuna Tacos.

WINTER/SPRING 2019 EDITION | 7

ADA-Funded Researcher Designs Community Program to

TACKLE Diabetes

„Patient Resources Learn all about blood glucose: http://bit.ly/BloodGlucose Learn about your risk for pre-diabetes, type 2 diabetes and heart disease: http://bit.ly/pre-diabetes_risks Recently diagnosed with type 2 diabetes and don’t know where to begin? Start here: http://bit.ly/DiabetesJourney For several resources related to diabetes: www.diabetesforecast.org

h Interested in joining a team of peers, clinicians, and healthy champions as you work towards your diabetes management goals? To learn more visit: https://www.teamingupfordiabetes.com/ h Meal planning is part of healthy eating and maintaining a healthy weight. Get tips on how you can plan healthy meals at home, at work and on the go. http://bit.ly/1etYyA6 h Learn more about the benefits of walking, walkable communities, and how you can add walking to your daily routine with these helpful resources. http://bit.ly/2kBcjEE

„

Diabetes self-management and support programs are important adjuncts to traditional physician directed treatment. These community-based programs aim to give people with diabetes the knowledge and skills necessary to effectively self-manage their condition. While several clinical trials have demonstrated the value of diabetes self-management programs in terms of improving glucose control and reducing health-care costs, whether this also occurs in implemented programs outside a controlled setting is unclear, particularly in socially and economically disadvantaged groups.

Lack of infrastructure and manpower are often cited as barriers to implementation of these programs in socioeconomically disadvantaged communities. ADA-funded researcher Dr. Briana Mezuk addressed this challenge in a study recently published in The Diabetes Educator. Dr. Mezuk partnered with the YMCA to evaluate the impact of the Diabetes Control Program in Richmond, Virginia. This community-academic partnership enabled both implementation and evaluation of the Diabetes Control Program in socially disadvantaged communities, who are at higher risk for developing diabetes and the complications that accompany it.

Dr. Mezuk had two primary research questions: (1) What is the geographic and demographic reach of the program? and (2) Is the program effective at improving diabetes management and health outcomes in participants? Over a 12-week study period, Dr. Mezuk found that there was broad geographic and demographic participation in the program. The program had participants from urban, suburban and rural areas, most of which came from lower-income zip codes. HbA1C, mental health and self-management behaviors all improved in people taking part in the Greater Richmond Diabetes Control Program.

Results from this study demonstrate the value of diabetes selfmanagement programs and their potential to broadly improve health outcomes in socioeconomically diverse communities.

Potential exists for community-based programs to address the widespread issue of outcome disparities related to diabetes.

Access the journal article at: http://bit.ly/ADA-FundedResearcher

Designed by Freepik

COMMUNITY EVENTS

Diabetes Prevention Program This program is intended for individuals who are pre-diabetic and it is held in a classroom setting, by a trained lifestyle coach who will facilitate a small group of participants in learning about healthier eating, physical activity and other behavior changes over 25 sessions. The year-long program consists of 16 weekly sessions for the first six months followed by two sessions per month in the second six months. The program’s goals are to lose 5–7% of your body weight and gradually increase your physical activity to 150 minutes per week.

REGISTER: Visit http://bit.ly/DiabetesPreventionApp to complete the registration form. A representative will contact you within two business days. If you have any questions, please call 215-707-7247.

Type 2 Diabetes Support Group Whether you’re newly diagnosed or have had type 2 diabetes for many years, our support group can help you live well with type 2 diabetes. Meet others who face the same challenges and learn new healthy lifestyle habits.

REGISTER: Call 717-531-4540 for more information.

A Touch of Sugar Diabetes Support Join for a free educational session focusing on living well with diabetes or pre-diabetes. Presenters will address sick day guidelines and attendees are encouraged to ask questions. Caregivers also encouraged to attend.

DATE: February 11 TIME: 5:30 – 6:30 PM LOCATION: Pub Cafe Room at Weis Markets, 4525 Valley Rd., Enola COST: FREE REGISTER: For information, please call 717-763-2466.

No registration required.

Penn State Extension Dining with Diabetes

Dining with Diabetes program helps people with type 2 diabetes identify and understand important information about managing and preventing this disease. There are five workshops are at a beginner skill level.

DATE: 5 sessions, dates vary TIME: times vary LOCATION: 13 location options COST: Reduced program rates of $5/Individual and $10/ Family are reflected on events with funding provided by local, state, and/or national grants. Click Register and see Cost tab for individual site rates (discount will be reflected).

REGISTER: http://bit.ly/DiningWithDiabetesProgram

Seed to Farmacy Seed to Farmacy is a garden-themed evening featuring dinner, entertainment and a silent auction. The event will benefit the Fresh Food Farmacy soon to be open in Lewistown. Piloted with great success in Northumberland County, the Fresh Food Farmacy uses food as medicine in the treatment of diabetes.

DATE: June 6, 2019 TIME: 6 – 11 PM LOCATION: The Nittany Lion Inn, 200 West Park Ave., State College, PA 16803 COST: $125.00 REGISTER: For more information, please contact: GeisingerEvents@geisinger.edu or call 570-214-0300.

WINTER/SPRING 2019 EDITION | 9

COMMUNITY EVENTS

Diabetes Support Group LOCATION FOR ALL LISTED CLASSES: 615 Arapeen Drive, Suite 100, Salt Lake City, Utah REGISTER: Please call 801-587-3913, for more information visit http://bit.ly/2My7oRi Session where you can exchange information, feelings and ideas. Groups offer discussion, question and answer sessions, and other activities.

DATE, TIME: Every 4th Tuesday of the month, 6 - 7:30 PM COST: FREE and adults 18 years and older. Spouses and support members are encouraged to also attend.

Gestational Diabetes Class in Spanish and English The Utah Diabetes Center is accepting all patients. Those without insurance may be covered.

• Spanish Gestational Diabetes Class DATE, TIME: Every Wednesday 2:00 - 4:00 PM • English Gestational Diabetes Class DATE, TIME: 2nd and 4th Thursday of the month 9:30 11:30 AM Spanish Diabetes Classes DATE, TIME: Every 3rd Wednesday and Thursday of the month 4:00 pm - 6:00 pm Hill Air Force Base Diabetes Classes Topics include: Podiatry (foot health); What Is Diabetes?; Dental; Nutrition; Optometry (eye health); Pharmacy (medicine); Psychological Aspects & Stress; Exercise.

People with diabetes, families, and significant others are all welcome.

DATE: First and third Tuesday of every month LOCATION: Family Medicine Clinic, 75th Medical Group at Hill AFB. Hill Air Force Base Diabetes Refresher Course Bring your water and join a new and interesting interactive presentation.

DATE: Second Tuesday of every month.

LOCATION: Family Medicine Clinic, 75th Medical Group at Hill AFB. 10 | WINTER/SPRING 2019 EDITION

Free Introduction to Diabetes class Neal Catalano, RPh, CDE presents the introduction to diabetes class offered for free and opened to all the public. To help give people additional tools to manage their diabetes.

DATE: Starting the first Thursday in January and the first Thursday of each month thereafter.

TIME: 5:30 -6:30 PM LOCATION: Granger Professional Pharmacy in the Granger Medical Center, 3725 W 4100 S West Valley City, UT 84124 REGISTER: Email Diabetes101@ymail.com or call 1-801-965-3639.

Individual Sessions Individual sessions for those who are interested in having 1-on-1 education time.

Future for-fee classes in the series will be: • Your Diabetes Medications • Insulin 101 • Exercising and Diabetes • How to manage your blood glucose • Continuing to have success with Diabetes DATE: Starting the first Thursday in February TIME: 7:00 - 8:00 PM COST: fee (most insurances can be billed) REGISTER: Email Diabetes101@ymail.com or call 1-801-965-3639.

Davis County Support Group The Diabetes Care Centers of Utah at Davis Hospital in Layton Utah sponsors a Diabetes Support Group.

A speaker discusses a topic that the participants have indicated they would like to learn about. Other sessions will have various physicians and specialists come and discuss eye care, foot care, basic diabetes care etc. Anyone is welcome to attend.

DATE, TIME: 7-8 PM on the 4th Thursday of the month LOCATION: The Robert F. Bitner Medical Office Building (located just west of the Davis Hospital Emergency Room); 2132 North 1700 West ste. B150 (basement level), Layton, Utah 84041 COST: Free REGISTER: Call 801-807-7360

COMMUNITY EVENTS Tongan and Samoan Diabetes Education Classes Sponsored by the National Tongan American Society.

Please call 801-467-8712 for more information before attending to verify times and locations.

The Tour de Cure

The Tour de Cure is an event where no matter what road you take, you will be joining thousands of people from around the country who have the same passion as you to fight diabetes and its burdens.

Tour de Cure Maryland DATE: Sunday, June 2, 2019 LOCATION: Goucher College, 1021 Dulaney Valley Rd, Baltimore, MD 21204 REGISTER: http://bit.ly/MDTourDeCure Tour de Cure Greater Philadelphia DATE: Saturday, June 15, 2019 TIME: 6:00 AM - 2:00 PM LOCATION: Delaware Valley University, 700 E. Butler Avenue, Doylestown, PA 18901 REGISTER: http://bit.ly/PhillyTourDeCure2019 Tour de Cure Pittsburgh: South Side Riverfront Park DATE: Saturday, September 14, 2019 TIME: 6:00 AM - 2:00 PM LOCATION: South Water Street, Pittsburgh, PA 15203 REGISTER: http://bit.ly/SouthSideWorksTour

Diabetes Education

Patients are offered the opportunity to meet oneon-one with a nurse practitioner or dietitian certified diabetes educator, as well as group education programs. Group and individual sessions are geared for newly diagnosed diabetics, those who need education updates, and those interested in the latest tips to best manage diabetes. Family members or a support person are invited to join. Space is limited.

LOCATION: Harrison Library & Education Center, Johns Hopkins Bayview campus TIME: 5:30 to 6:30 PM REGISTER: Call 410-550-5669 or 410-550-KNOW. Call 410-955-9270 to schedule an appointment with a Nurse Practitioner or Registered Dietitian http://bit.ly/2Hrs9ix

Tongan Classes: All senior citizens welcome, transportation and lunch provided.

DATE, TIME: Tuesdays, 11-noon LOCATION: Harman Senior Center, 4090 South 3600 West, West Valley City, UT DATE, TIME: Thursdays, 1-2 PM LOCATION: Sunday Anderson Westside Senior Center, 868 West 900 South, SLC, UT

Samoan Classes: All senior citizens welcome, transportation and lunch provided.

DATE, TIME: Tuesdays, 11-noon LOCATION: Harman Senior Center, 4090 South 3600 West, West Valley City, UT All ages welcome DATE, TIME: Thursdays, 7-8 PM LOCATION: Hunter Library, 4740 West 4100 South, West Valley City, UT

Sign up for

FREE

monthly diabetic-friendly recipes! American Diabetes Association's NEW Recipes for Healthy Living makes eating healthy easier for YOU. http://bit.ly/ADArecipe WINTER/SPRING 2019 EDITION | 11

COMMUNITY EVENTS Diabetes Support Group with UPMC St. Margaret

The Diabetes Support Group provides informal information sessions on various aspects of living with diabetes.

DATE: • March 21, 2019 • May 16, 2019 • September 19, 2019 • November 21, 2019 TIME: 6:00 – 7:30 PM LOCATION: UPMC St. Margaret, Cafeteria A&B COST: FREE REGISTER: For questions call 412-784-5162 or 412-784-4195 or visit http://bit.ly/UPMCStMargaretSupportGroup

Diabetes Self-Management Education Program This group course is designed to cover all aspects of diabetes self-management. Learn about meal planning, physical activity, glucose monitoring, medicines, dining out, coping with stress and more. The content is based on American Diabetes Association Guidelines. The cost is covered by most insurance companies. Please contact your insurance company to confirm coverage of services prior to registering. A Physician Referral may be needed to enroll. For more information, visit http://bit.ly/UPMCEducationProgram or call the following: UPMC Altoona: 814-889-2731 UPMC Bedford: 814-624-4315 UPMC Horizon: 724-983-7160 UPMC McKeesport: 412-664-3055 UPMC Mercy: 412-232-5908 UPMC Northwest: 814-676-7992 UPMC Passavant: 412-748-6398 UPMC St. Margaret: 412-784-5162; 412-784-4195 12 | WINTER/SPRING 2019 EDITION

One-on-One Diabetes Instruction Learn about meal planning, physical activity, glucose monitoring, medicines, dining out, and coping with stress from a Certified Diabetes Educator. The cost is covered by most insurance companies. A physician referral is needed. Questions? Call 412-784-5162 or 412-784-4195 or visit http://bit.ly/OneOnOneClasses.

PaTH Network ADAPTABLE study Cardiovascular Disease (CVD) & Diabetes campaign The CVD/Diabetes Campaign was launched through the efforts of patient partners (ADAPTORS) on the PaTH network ADAPTABLE study (to learn more visit http://bit.ly/PaTHResearch) to help increase awareness, education, and research about the link between heart disease and diabetes. The campaign link features videos and helpful resources from patient partners, heart/stroke survivors, actress Angela Bassett, as well as medical experts from UCLA and Duke. Help be the change you want to see in the world of Heart Health: • Take the "Heart You" Quiz at www.foryoursweetheart.com.

• Register to learn more about diabetes and heart disease at www.foryoursweetheart.com/register.

• Additional resources: http://bit.ly/DiabetesResource

PaTH to Health: Diabetes Study Newsletter Team

DESIGNER: Abbey Kinard CONTRIBUTORS: Diane Bennett, Hsin-Chieh Yeh, Linda Siminerio, Lorraine Szczesny EDITORS: Treva Alston, Diane Bennett, Cynthia Bradley, Mully Chea, Angela Evans, Erica Francis, Jennifer L. Kraschnewski, Julie Tice

EDITOR-IN-CHIEF: Jennifer M. Poger Need to get in touch with us?

Email: PATHtoHealth@pennstatehealth.psu.edu

SUMMER/FALL 2018 EDITION

“A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities”

Greetings from the PaTH to Health: Diabetes Research Team!

As Principal Investigator on this project, I’d like to welcome you to our most recent issue of our biannual research study newsletters. We’ve worked closely with our talented patient partners and stakeholders to develop the resources contained in this newsletter. Learn about our research study updates, read up on recent trends in diabetes management, try new healthy recipes we’ve included, and look into participating in a community event in your area. Happy reading!

Jennifer L. Kraschnewski, MD, MPH

Executive Director, Penn State PRO Wellness Associate Professor of Medicine, Pediatrics and Public Health Sciences Penn State College of Medicine

HIGH FIVES We would like to give a HIGH FIVE to one of our clinician stakeholders, Dr. Rebecca Mancoll, for her efforts in recruiting our newest patient partner, Diane Bennett from Pittsburgh! We are so glad to have you on the team, Diane!

We would also like to give a HIVE FIVE to our patient partners and stakeholders for engaging in our study website brainstorming sessions!

Our patient partners were integrally involved in developing the website structure and drafting content. We applaud their efforts and are excited to see our patient-centered study website come to life! Help us spread the word and check it out here: www.PaTHDiabetes.org We extend another HIGH FIVE to all study stakeholders and patient partners who completed their Year 2 Engagement Evaluations. These yearly surveys offer an opportunity to share how engagement activities are going thus far, identify areas for improvement and provide direction on future engagement activities that interest our diverse stakeholder body.

We appreciate all of the submitted evaluation responses!

UPCOMING TRAININGS As our study continues to extract health data via the PaTH network, interested patient partners and stakeholders will have the opportunity to learn about what we do with the data once it’s collected. Get your calculators ready as we crunch some numbers in a brief training on data analysis coming this fall 2018! Stay tuned for more details.

Research Study Overview & Update

For new readers (or returning readers) enjoy an overview about our current research study, “A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities” which is funded by the Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent, nonprofit organization that envisions a research world addressing questions and concerns most relevant to patients, while including them, their caregivers, clinicians and other stakeholders in the research process. We are thrilled to be working alongside our patient partners and stakeholders throughout each phase of our project. We have added some new talent to our project team since the last newsletter edition, updating our roster to include 6 patient partners, 6 primary care providers, and 10 stakeholders who continue to contribute their ideas, expertise and lived experience to our project. They have been the driving force of key study decisions and are a constant reminder of why our research matters.

To give you some background on our study, let’s take a brief look at the literature. You may be aware that obesity is a big issue in the US. In fact, it’s our number one health concern.

Addressing obesity through lifestyle interventions (i.e. healthy eating and increased physical activity) decreases the risk of developing type 2 diabetes, a disease that affects over 29 million people (9.3% of the US population). Diabetes is associated with serious complications, including heart disease, blindness, renal failure and lower extremity amputation. Although complications are preventable with proper medical and lifestyle management, including weight loss, nearly half of diabetic patients do not have adequate glycemic control.

Recent policy changes and health insurance expansion have resulted in coverage for obesity counseling by Centers for Medicare and Medicaid to improve weight loss for adults either with or at high risk of type 2 diabetes. Obese beneficiaries are eligible for up to 20 face-toface visits for weight counseling in the primary care setting. However, it is unknown whether or not this benefit has helped patients lose weight and better control their diabetes.

This is where the PaTH to Health: Diabetes study comes into play. We are looking at Electronic Health Record (EHR) and claims data across 3 states to see if obesity counseling has improved weight and diabetes outcomes. For patients with or at risk of developing type 2 diabetes, are they receiving obesity counseling? If so, is it leading to weight loss and better blood sugar control? These are questions we hope to answer by analyzing the data. We are utilizing the PaTH network, an integrated research collaboration between Maryland, Pennsylvania and Utah, to pull EHR data on over 2 million patients with or at risk of type 2 diabetes.

This project began in early 2016 and is set to continue until the year 2021. We have finished extracting EHR data from each of the universities collaborating in this research: Penn State Health, University of Pittsburgh, Temple University, Geisinger Health System, Johns Hopkins University and University of Utah. We are currently in the process of standardizing the EHR data to ensure all sites are “speaking the same language.” This clean dataset will then be ready to analyze to shed light on how policy changes impact diabetes. We are also trying to better identify patients with diabetes who are truly seen at one of our partnering health institutions and not just referred for an isolated treatment. This will help us increase our sample size of patients with diabetes. Stay tuned for more updates!

2 | SUMMER/FALL 2018 EDITION

Patient Partners

Primary Care Providers

Stakeholders Each individual engages in key research activities, strengthening our project through their perspective and experience.

Style Guide for Internal Audiences

Table of Contents •

Introduction and Purpose

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Using Pitt Public Health in Writing

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The Pitt Public Health Graphic Mark

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Using the Graphic Mark

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Departments, Centers, Programs, and Other Entities

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The University Seal and Signature

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Typefaces, Colors

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Spacing, Size, Design Tips

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Sample Applications

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Tools, Templates, and Training

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Contacts

Pitt Public Health Style Guide

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updated: July 21, 2016

SPOTLIGHT: Team Member H. Lester Kirchner, Ph.D.,

Co-Investigator for PaTH to Health: Diabetes study Geisinger Health System

Dr. H. Lester Kirchner serves as Co-Investigator for the PaTH to Health: Diabetes study at Geisinger. In this role, he works with Geisinger IT analysts on the data extraction process. Dr. Kirchner is also the site PI for the PaTH network. He is a professor in the Department of Biomedical and Translational Informatics, senior biostatistician in the Medicine Institute at Geisinger, and directs the Biostatistics Core. At the institutional level, Dr. Kirchner Co-Chairs the Geisinger IRB. Key responsibilities include support of research projects across several departments and mentoring of fellows, residents and junior faculty. Dr. Kirchner’s particular interests reside with understanding long-term outcomes of chronic kidney disease and the genetics of obstructive sleep apnea.

Dr. Kirchner holds a Ph.D. in Biostatistics from the University of Iowa. In his

free time, he enjoys traveling with his family and going for leisurely drives in his 1978 Chevy C10 truck.

new nutrition and physical activity standards for Pennsylvania schools.

► Meet Professor Everette James, one of our PaTH to Health: Diabetes study stakeholders!

Professor James research interests center around his state and federal public policy experience in health law and regulation, costeffectiveness and translational health services research. He recognizes the tremendous potential in utilizing the PaTH network to assemble electronic health information for a vast, communitybased cohort of relevant patients and examine the real-world impact of health insurance expansion.

As a stakeholder in the PaTH to Health: Diabetes study, Professor James provides valuable insight A. Everette James, III, JD, MBA, into the policy and practice Director, Health Policy Institute implications of the study and (HPI); Professor, Health Policy and will be key dissemination partner Management; Associate Vice Chancellor for our findings.

Cool Connections

A. Everette James, III, JD, MBA, Director, Health Policy Institute (HPI); Professor, Health Policy and Management and Associate Vice Chancellor for Health Policy and Planning, University of Pittsburgh Schools of the Health Science.

He oversees HPI’s six research centers – the Comparative Effectiveness Research Center, the Medicaid Research Center, the Center for Pharmaceutical Policy and Prescribing, the Center for Interprofessional Practice and Education, the Center for Research on Media Technology and Health and the new Center for Caregiving Research, Education and Policy.

Before joining Pitt, Professor James served as the 25th Pennsylvania Secretary of Health and oversaw the regulation of all of the hospitals, nursing homes and managed care plans in the Commonwealth.

As Secretary, he negotiated and implemented important public health legislation, including the state’s first Clean Indoor Air Act, regulations expanding health professionals’ scope of practice and

Meet Dr. H. Lester Kirchner!

Professor James received a JD from Illinois Institute of Technology, Chicago Kent College of Law and an MBA from Illinois Institute of Technology, Stuart School of Business.

for Health Policy and Planning, University of Pittsburgh Schools of the Health Science

SUMMER/FALL 2018 EDITION | 3

PATIENT PARTNER VOICE

“Be willing to reach out for help.

Don’t be afraid to

Meet Mully. She is a vibrant and motivated professional in Healthcare Information Technology, and also a caregiver to friends and family who have, or are at risk of, type 2 diabetes. Within her Southeast Asian culture, diabetes is one of the leading causes of death.

This bleak statistic drove her at an early age to become knowledgeable in nutrition education in order to help her relatives and close friends better manage their diabetes.

ask questions. In healthcare, ask your questions and find someone who will hear you.”

resources. She was able to extend what she was learning through her practicum experience to her own community back in Cambodia.

Is being a caregiver an easy job? Not always.

As a first generation American with parents back in Cambodia who had very little formal education, Mully was determined to pursue a Bachelor’s Degree in Public Health and a Master's Degree in Health Informatics. As part of her undergraduate degree requirements at Temple University, Mully participated in a health literacy initiative through the AmeriCorps Project Shine Health Literacy program, affiliated with Temple University.

This community-based learning project provided a unique opportunity to engage a Southeast Asian community within the greater Philadelphia area on healthy eating practices. Over the course of nine months, Mully incorporated demonstrations and many hands-on experiences at weekly one-hour sessions to help improve the community’s literacy of nutrition. By introducing ways to substitute unhealthy food choices for healthier options, she effectively provided her class with the knowledge to alter their eating habits to better promote an overall healthier lifestyle.

This experience was where Mully developed her love of teaching and helping others, and it allowed her to give back to the community.

During this same time, many of her friends and family members were receiving a diabetes diagnosis and looked to Mully for advice and 4 | SUMMER/FALL 2018 EDITION

Since, Mully has worked in healthcare throughout her career, her friends and family look to her as a valued resource for their diabetes care, which can feel like a lot of pressure at times. After having experienced some of her own health issues during graduate school, her advice to others resonated within herself. “Oxygen mask first.” Mully knew that she could not help others without first taking care of herself. This is a powerful message to all caregivers, who often fall victim to putting other’s needs before their own. She now tries to stay more conscious of her own health by packing healthy snacks to get her through busy days and running with friends in the evenings to keep her motivated and accountable.

Since many caregivers are often managing the day-to-day challenges of chronic disease self-management alongside the patient, it’s important to bring their voice to the diabetes conversation. We are so fortunate to have Mully’s caregiver perspective brought to our PaTH to Health: Diabetes study team! Mully’s recommendation for the growing list of family and friends she looks after: “Be willing to reach out for help. Don’t be afraid to ask questions.

In healthcare, ask your questions and find someone who will hear you.”

registered dietitian

M

MESSAGE

10

tips

M Choos

utrition

“Start by avoiding foods that have sugars added to them such as soda, lemonade, sweet tea and dessert. Once you have made a good habit of eliminating added sugars, then try to follow MyPlate to cut back portion sizes. If your plate is filled with ¼ whole grains, ¼ fruit, ¼ protein and ¼ non-starchy vegetables, you will naturally keep your carbohydrate intake under control. If you need to cheat, make sure you add a protein to ‘cheat snacks’, to prevent a spike in blood sugar.”

ation Series

– Kara Shifler Bowers, RD, LDN, project manager at Penn State PRO Wellness

To learn more visit www.choosemyplate.gov.

► Recent Trends in Diabetes Management MyPlate to build your healthy eating style an Lifestylesure Intervention each MyPlate food group. Make yourforchoi Type 2 Diabetes with small changes to make healthier choices y The National Institutes of Health (NIH) has awarded $8 million to Wake Forest Baptist Medical Center to study cognitive decline and impairment in older adults with type 2 diabetes who are overweight or obese. “It is critical to understand the role of lifestyle intervention for the treatment of type 2 diabetes and obesity,” said one of the study’s principal investigators, Mark Espeland, Ph.D., professor of public health sciences at Wake Forest Baptist. “Together, these two conditions nearly double one’s risk for Alzheimer’s disease and related dementias.”

intensive lifestyle intervention – reduced caloric intake and increased physical activity – did not appear to extend to those with the greatest levels of obesity. For these, paradoxically, the intensive lifestyle intervention appeared to increase rather than to decrease rates of cognitive impairment, Espeland said.

Find your healthy eating style

This new study will collect the additional data needed Creating a healthy style eating The four-year study, part of the NIH’s Action for Health means to confirm theregularly earlier findings and to determine the a in Diabetes, will be led by Espeland, Kathleen Hayden, mechanisms of action behind any benefits or risks.

Ph.D., associate professor of public health sciences Participants will be enrolled at 16 calories sites across the Unitedyou variety of foods to get the nutrients and at Wake Forest Baptist, and Jose Luchsinger, M.D., States. “Funding for this additional research provides associate professor of epidemiology and medicine the unprecedented and timely opportunity to assess the MyPlate’s tips help you create your own healthy at Columbia University.

The study will build on legacy that a successful, sustained and well-documented earlier findings that intensive lifestyle intervention in lifestyle intervention has on cognitive resilience and overweight older adults with diabetes was associated g solutions—“MyWins.” the risk of Alzheimer’s disease, related dementia and with a 30 percent decrease in cognitive impairment.

However, this potential benefit was not firmly established, necessitating additional research. The previous study showed that cognitive benefits from the

mild cognitive impairment in a large and diverse cohort drawn from across the country,” Espeland said.

Full article: http://bit.ly/LifestyleIntervention SUMMER/FALL 2018 EDITION | 5

Grilled Eggplant “Steak”

RECIPE CORNER

Makes: 2 servings Serving Size: 2 eggplant “steaks” Preparation Time: 10 minutes Cooking Time: 12 minutes Ingredients: 1 large eggplant, cut lengthwise into 4 thick slices (about 6 oz. per slice) 2 ¹/₂ tsp. extra-virgin olive oil ¹/₂ tsp. freshly ground black pepper, or to taste ¹/₄ tsp. sea salt, or to taste Pinch ground cinnamon 2 tsp. pine nuts, toasted 1 tbsp. small fresh mint leaves 2 lemon wedges From www.diabetesforecast.org, photography by Terry Doran; food styling by Annie Whyte; styled by Mary Hayes.

PER SERVING

Directions

Original source: http://bit.ly/GrilledEggplantSteak

Calories

160

Fat

8g

Saturated Fat

1g

Trans Fat

0g

2

Grill over direct medium-high heat, about 6 minutes per side, until the eggplant is fully cooked through and rich grill marks form.

Carbohydrate

22 g

Fiber

10 g

3

Transfer the eggplant to serving plates and sprinkle with the pine nuts and mint. Serve with a lemon wedge on each dish.

Sugars

11 g

Cholesterol

0 mg

1

Prepare an outdoor or indoor grill. Lightly brush the eggplant with the oil using a silicone brush. Sprinkle with the pepper, salt, and cinnamon.

With Beef: Heat 2 tsp. extra-virgin olive oil in a large, nonstick skillet over medium heat. Add 1 cup finely chopped red onion and 3 oz. lean, ground beef sirloin, and sauté until the beef is cooked through and the onion is softened, about 5 minutes. Add 1 cup low-sodium vegetable broth, ¹/₂ cup marinara sauce of choice, and ¹/₄ tsp. ground cinnamon, and bring to boiling over high heat. Reduce heat to low and simmer, uncovered, for 8 to 10 minutes. Ladle the beef mixture over the eggplant in step 3 and sprinkle with the pine nuts and mint. This dish is higher in sodium than the American Diabetes Association guideline of 480 mg. for a combo main dish.

6 | SUMMER/FALL 2018 EDITION

Sodium

300 mg

Potassium

820 mg

Protein

Phosphorus

4g 100 mg

Choices: Nonstarchy Vegetable 4, Fat 1.5

Chicken Lettuce Wraps

RECIPE CORNER

Makes: 6 servings Serving Size: 1 wrap Ingredients: 6 large lettuce leaves, Boston or Bibb lettuce work well 6 oz. grilled chicken, finely chopped 6 tsp. Asian peanut sauce 6 tsp. julienne or matchstick carrots 2 scallions, thinly sliced

PER SERVING Calories

65

Fat

2.5 g

Saturated Fat

0.6 g

Trans Fat

0g

Cholesterol

25 mg

Sodium

95 mg

Potassium

125 mg

Protein

Phosphorus

9g 65 mg

Choices: Lean Meat 1, Fat ¹/₂

Visit Pinterest for more diabetic-friendly recipes courtesy of

Directions

1

Place all ingredients in separate bowls.

2

Begin by laying a piece of lettuce on a plate. Top with chicken, peanut sauce, carrots, and scallions.

Roll to enclose filling.

Original source: http://bit.ly/ChickenLettuceWrap, Adapted from the Stress Free Diabetes Kitchen by Barbara Seelig-Brown.

From www.diabetesforecast.org, photography by Chef’d

Sign up for

FREE

monthly diabetic-friendly recipes! American Diabetes Association's NEW Recipes for Healthy Living makes eating healthy easier for YOU.

http://bit.ly/diabetic-friendly

http://bit.ly/ADArecipe

SUMMER/FALL 2018 EDITION | 7

OUTCOMES & ECONOMIC BENEFITS of Dining with Diabetes Program Patient Resources Learn all about blood glucose: http://bit.ly/BloodGlucose Learn about your risk for pre-diabetes, type 2 diabetes and heart disease: http://bit.ly/pre-diabetes_risks Recently diagnosed with type 2 diabetes and don’t know where to begin? Start here: http://bit.ly/DiabetesJourney For several resources related to diabetes: www.diabetesforecast.org

Many diabetes education programs address the problem of diabetes, but little attention is given to the economic impact of such programs.

Dr. Griffie et al. sought to assess the effectiveness of a community-based education program in improving diabetes-related lifestyle behaviors and biomarkers and ascertain the economic benefits of the program for adults aged 18 years or older with type 2 diabetes, prediabetes or no diagnosis of diabetes in Pennsylvania.

From October 2012 through June 2015, Pennsylvania State University Extension’s Dining with Diabetes program collected data on 2,738 adults with type 2 diabetes or prediabetes and adult family members without diabetes. The program consisted of four weekly two-hour classes and a follow-up class conducted three months after the fourth two-hour class. In the initial class and the follow-up class, participants completed a lifestyle questionnaire and their hemoglobin A1c and blood pressure were measured. Economic benefit was calculated as the medical expenditure cost savings resulting from program participation.

At the three-month follow-up, a significant number of participants had improved their lifestyle behaviors (diet and physical activity), and they had reduced their hemoglobin A1c and blood pressure, and improved their diabetes status. The Dining with Diabetes program had a five-year benefit–cost ratio of 2.49 to 3.35.

Participants who completed the Dining with Diabetes program had significant improvements in diabetes-related biomarkers and lifestyle behaviors.

If the Dining with Diabetes program were extended to half of the 1.3 million people living with diabetes in Pennsylvania and if they had similar improvements, the one-year benefit to the state would be approximately $195 million, assuming a conservative 15% decrease in direct medical costs.

To find a Dining with Diabetes program in your area, please visit: http://bit.ly/DiningWithDiabetesProgram.

Photo Credit MediaLoot.com; Designed by Freepik

Access the journal article at: http://bit.ly/DiningWithDiabetesProgramOutcomes

COMMUNITY EVENTS

Diabetes Prevention Program This program is intended for individuals who are pre-diabetic and it is held in a classroom setting, by a trained lifestyle coach who will facilitate a small group of participants in learning about healthier eating, physical activity and other behavior changes over 25 sessions. The year-long program consists of 16 weekly sessions for the first six months followed by two sessions per month in the second six months. The program’s goals are to lose 5–7% of your body weight and gradually increase your physical activity to 150 minutes per week.

REGISTER: Visit http://bit.ly/DiabetesPreventionApp to complete the registration form. A representative will contact you within two business days. If you have any questions, please call 215-707-7247.

Penn State Extension Dining with Diabetes

Dining with Diabetes program helps people with type 2 diabetes identify and understand important information about managing and preventing this disease. There are five workshops are at a beginner skill level.

DATE: 19 session options, dates vary TIME: times vary LOCATION: 19 location options COST: Starting at free. Select individual site to view rates.

Reduced program rates of $5/Individual and $10/Family are reflected on events with funding provided by local, state, and/or national grants.

REGISTER: http://bit.ly/DiningWithDiabetesProgram

Pre-Diabetes Class Join for an interactive, healthy living class to help you prevent type 2 diabetes. The class is free and open to our patients, including family or friends.

Class goals and focus: losing weight, being active, understanding food labels, managing stress, coping with triggers, staying motivated, tracking and managing food intake.

DATE: August 22, 2018 TIME: 9:00 – 11:00 AM LOCATION: Penn State Neuroscience Institute, 30 Hope Drive, Hershey, PA 17033 – Entrance B, Room 2005 COST: FREE REGISTER: Space is limited. Please call Michelle Whitman, LPN, at 717-531-4540 to reserve your seat.

Type 2 Diabetes Support Group Whether you’re newly diagnosed or have had type 2 diabetes for many years, our support group can help you live well with type 2 diabetes. Meet others who face the same challenges and learn new healthy lifestyle habits.

DATE: August 22, 2018 TIME: 1:00 – 2:30 PM LOCATION: Mohler Senior Center, 25 Hope Drive, Hershey, PA 17033 REGISTER: Call 717-531-4540 for more information.

Annual Diabetes Fair at Penn State Milton S. Hershey Medical Center DATE: Saturday, November 3, 2018 TIME: 9:00 AM – 12:00 PM LOCATION: Penn State Hershey Medical Center University Conference Center SUMMER/FALL 2018 EDITION | 9

COMMUNITY EVENTS

The Tour de Cure

Diabetes Prevention Program Have you been thinking about making a change today for a healthier tomorrow? Geisinger is offering a program for individuals living with prediabetes or at risk for developing diabetes. Learn how to improve their health by making healthy lifestyle changes.

Caregivers, friends and family are welcome to attend.

DATE: Every Wednesday from July 25, 2018 through January 2, 2019 TIME: 9:30 – 10:30 AM LOCATION: Dillsburg Senior Center, 1 North 2nd St., Dillsburg, PA 17019 COST: FREE, Participants 18 years or older REGISTER: Call the Geisinger wellness department at 866-415-7138.

A Touch of Sugar Diabetes Support Join for a free educational session focusing on living well with diabetes or pre-diabetes. Presenters will address various topics and attendees are encouraged to ask questions. Caregivers also encouraged to attend.

DATE: Every second Monday of every month • August 13: Mindful Eating • September 10: When to Call 911 • October 8: Exercise During the Winter TIME: 6:00 – 7:00 PM LOCATION: Wegman's, 6416 Carlisle Pike, Mechanicsburg, PA 17050, conference room in rear of dining area COST: FREE REGISTER: For information, please call 717-763-2466.

No registration required.

10 | SUMMER/FALL 2018 EDITION

The Tour de Cure is an event where no matter what road you take, you will be joining thousands of people from around the country who have the same passion as you to fight diabetes and its burdens.

Tour de Cure Pittsburgh: South Side Riverfront Park DATE: Saturday, September 15, 2018 TIME: 6:00 AM - 2:00 PM LOCATION: South Water Street, Pittsburgh, PA 15203 REGISTER: http://bit.ly/SouthSideWorksTour Tour de Cure Utah County DATE: Saturday, September 15, 2018 TIME: 6:00 AM - 2:00 PM LOCATION: 986 West Atheron Drive, Suite 220, Taylorsville, UT 84123 REGISTER: http://bit.ly/TourUtahCounty The Step Out Walk to Stop Diabetes The Step Out Walk to Stop Diabetes gives everyone in your community a chance to gather together to raise funds for diabetes research, advocacy and education.

You will hear inspirational speakers whose lives have been affected by diabetes and you will be surrounded by people from our community who share the same passion as you – to fight diabetes. What a great opportunity to show solidarity! After the walk, enjoy a festival of wellness exhibits, refreshments and entertainment. Register today for a location near you.

Baltimore Canton Waterfront DATE: Sunday, October 7, 2018 TIME: 7:00 AM - 12:00 PM LOCATION: 3001 Boston Street, Baltimore, MD 21224 REGISTER: http://bit.ly/BMOREStepOut Philadelphia Museum of Art DATE: Saturday, November 3, 2018 TIME: 7:00 AM - 12:00 PM LOCATION: 2600 Benjamin Franklin Parkway, Philadelphia, PA 19130 REGISTER: Visit www.diabetes.org/stepoutphilly

COMMUNITY EVENTS

Diabetes Support Group with UPMC St. Margaret

The Diabetes Support Group provides informal information sessions on various aspects of living with diabetes.

DATE: • Thursday, September 20, 2018 • Thursday, November 15, 2018 TIME: 6:00 – 7:30 PM LOCATION: UPMC St. Margaret, Cafeteria A&B COST: FREE REGISTER: For questions call 412-784-5162 or 412-784-4195 or visit http://bit.ly/UPMCStMargaretSupportGroup

Diabetes Self-Management Education Program This group course is designed to cover all aspects of diabetes self-management. Learn about meal planning, physical activity, glucose monitoring, medicines, dining out, coping with stress and more. The content is based on American Diabetes Association Guidelines. The cost is covered by most insurance companies. Please contact your insurance company to confirm coverage of services prior to registering. A Physician Referral may be needed to enroll. For more information, visit http://bit.ly/UPMCEducationProgram or call the following: UPMC Altoona: 814-889-2731 UPMC Bedford: 814-624-4315 UPMC Horizon: 724-983-7160 UPMC McKeesport: 412-664-3055 UPMC Mercy: 412-232-5908 UPMC Northwest: 814-676-7992 UPMC Passavant: 412-748-6398 UPMC St. Margaret: 412-784-5162; 412-784-4195

One-on-One Diabetes Instruction Learn about meal planning, physical activity, glucose monitoring, medicines, dining out, and coping with stress from a Certified Diabetes Educator. The cost is covered by most insurance companies. A physician referral is needed. Questions? Call 412-784-5162 or 412-784-4195 or visit http://bit.ly/OneOnOneClasses.

PaTH Network ADAPTABLE study Cardiovascular Disease (CVD) & Diabetes campaign The CVD/Diabetes Campaign was launched through the efforts of patient partners (ADAPTORS) on the PaTH network ADAPTABLE study (to learn more visit http://bit.ly/PaTHResearch) to help increase awareness, education, and research about the link between heart disease and diabetes. The campaign link features videos and helpful resources from patient partners, heart/stroke survivors, actress Angela Bassett, as well as medical experts from UCLA and Duke. Help be the change you want to see in the world of Heart Health: • Take the "Heart You" Quiz at www.foryoursweetheart.com.

• Register to learn more about diabetes and heart disease at www.foryoursweetheart.com/register.

• Additional resources: http://bit.ly/DiabetesResource

PaTH to Health: Diabetes Study Newsletter Team

DESIGNER: Abbey Kinard CONTRIBUTORS: Mully Chea, A. Everette James, H. Lester Kirchner EDITORS: Treva Alston, Diane Bennett, Cynthia Bradley, Mully Chea, Angela Evans, Erica Francis, Jennifer L. Kraschnewski, Julie Tice

EDITOR-IN-CHIEF: Jennifer M. Poger Need to get in touch with us?

Email: PATHtoHealth@pennstatehealth.psu.edu SUMMER/FALL 2018 EDITION | 11

WINTER/SPRING 2018 EDITION

“A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities”

Greetings from the PaTH to Health: Diabetes Research Team!

As Principal Investigator on this project, I’d like to welcome you to our most recent issue of our biannual research study newsletters. We’ve worked closely with our talented patient partners and stakeholders to develop the resources contained in this newsletter. Learn about our research study updates, read up on some recent trends in diabetes management, try new healthy recipes we’ve included, and look into participating in a community event in your area. Happy reading!

Jennifer L. Kraschnewski, MD, MPH

Executive Director, Penn State PRO Wellness Associate Professor of Medicine, Pediatrics and Public Health Sciences Penn State College of Medicine

HIGH FIVES We would like to give a HIGH FIVE to our patient partners for completing our Patient-Reported Outcomes (PRO) Inventory! Over the past several monthly meetings, our patient partners have worked through an extensive list of PRO’s and provided feedback on which outcomes they feel are most relevant to our study aims based on their lived experience. We are excited to be prioritizing our secondary data analyses based on their responses!

We would also like to give a HIVE FIVE to our patient partners and stakeholders for engaging in our study website brainstorming sessions!

Our patient partners were also integrally involved in developing the website structure and drafting content so we applaud their efforts and are excited to see our patient-centered study website come to life!

Check it out here: www.PaTHDiabetes.org Turn the heat up in the kitchen with diabetic-friendly recipes on page 6, and sign up for FREE monthly recipes on page 7!

UPCOMING TRAININGS As our study continues to extract health data via the PaTH network, interested patient partners and stakeholders will have the opportunity to learn about what we do with the data once it’s collected. Get your calculators ready as we crunch some numbers in a brief training on data analysis! Stay tuned for more details.

Research Study Overview & Update

For new readers (or returning readers) enjoy an overview about our current research study, “A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities” which is funded by the Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent, nonprofit organization that envisions a research world addressing questions and concerns most relevant to patients, while including them, their caregivers, clinicians, and other stakeholders in the research process. We are thrilled to be working alongside our patient partners and stakeholders throughout each phase of our project. We have added some new talent to our project team since the last newsletter edition, updating our roster to include 5 patient partners, 6 primary care providers, and 10 stakeholders who continue to contribute their ideas, expertise and lived experience to our project. They have been the driving force of key study decisions and are a constant reminder of why our research matters. We also look forward to recruiting additional patient partners over this next project period.

To give you some background on our study, let’s take a brief look at the literature. You may be aware that obesity is a big issue in the US. In fact, it’s our number one health concern.

Addressing obesity through lifestyle interventions (i.e. healthy eating and increased physical activity) decreases the risk of developing type 2 diabetes, a disease that affects over 29 million people (9.3% of the US population). Diabetes is associated with serious complications, including heart disease, blindness, renal failure, and lower extremity amputation. Although complications are preventable with proper medical and lifestyle management, including weight loss, nearly half of diabetic patients do not have adequate glycemic control.

Recent policy changes and health insurance expansion have resulted in coverage for obesity counseling by Centers for Medicare and Medicaid to improve weight loss for adults either with or at high risk of type 2 diabetes. Obese beneficiaries are eligible for up to 20 face-toface visits for weight counseling in the primary care setting. However, it is unknown whether or not this benefit has helped patients lose weight and better control their diabetes.

This is where the PaTH to Health: Diabetes study comes into play. We are looking at Electronic Health Record (EHR) and claims data across 3 states to see if obesity counseling has improved weight and diabetes outcomes. For patients with or at risk of developing type 2 diabetes, are they receiving obesity counseling? If so, is it leading to weight loss and better blood sugar control? These are questions we hope to answer by analyzing the data. We are utilizing the PaTH network, an integrated research collaboration between Maryland, Pennsylvania, and Utah, to pull EHR data on over 2 million patients with or at risk of type 2 diabetes.

This project began in early 2016 and is set to continue until the year 2021. Data extraction is in full swing across each of the universities collaborating in this research: Penn State Health, University of Pittsburgh, Temple University, Geisinger Health System, Johns Hopkins University, & University of Utah. We are currently in the process of standardizing the EHR data to ensure all sites are “speaking the same language.” This clean dataset will then be ready to analyze to shed light on how policy changes impact diabetes. We will also be integrating insurance claims data, patient-reported outcomes, and sociodemographic characteristics into our analyses to understand how these secondary outcomes may also affect diabetes and weight. We look forward to keeping you posted on how things are going!

Patient Partners

Primary Care Providers

Stakeholders Each individual engages in key research activities, strengthening our project through their perspective and experience.

Style Guide for Internal Audiences

Table of Contents •

Introduction and Purpose

•

Using Pitt Public Health in Writing

•

The Pitt Public Health Graphic Mark

•

Using the Graphic Mark

•

Departments, Centers, Programs, and Other Entities

•

The University Seal and Signature

•

Typefaces, Colors

•

Spacing, Size, Design Tips

•

Sample Applications

•

Tools, Templates, and Training

•

Contacts

Pitt Public Health Style Guide

2 | WINTER/SPRING 2018 EDITION

p. 1/10

updated: July 21, 2016

SPOTLIGHT: Team Member Barbara Postol, Ph.D.,

PaTH Network Project Manager, University of Pittsburgh

Dr. Barbara Postol is the PaTH Network Project Manager. In her role, Dr. Postol ensures that PaTH Network studies are running smoothly by providing oversight of the ongoing PaTH-affiliated research projects.

This includes keeping study milestones on track; working closely with the Information Technology team, Institutional Review Board, and Grants and Contracts at the University of Pittsburgh; as well as study investigators.

Additionally, Dr. Postol coordinates the PaTH Future Research Topics (FRT) working group, which welcomes investigators who wish to collaborate with the PaTH Network.

Dr. Postol holds a PhD in Healthcare Ethics from Duquesne University in

Pittsburgh, PA. In addition to her role as Network Project Manager at the University of Pittsburgh, Dr. Postol is a consulting ethicist at UPMC Mercy Hospital, adjunct faculty at Carlow University, and an ethics committee member of LIFE Pittsburgh (Living Independently for the Elderly.) In her free time, she enjoys spending time with her dogs and being outdoors.

in federally qualified health centers, allowing her to additionally advise our project in the area of health disparities in diabetes.

Dr. Carroll has a Doctorate of Medicine from the University of Connecticut School Medicine, as well as a Masters of Public Health from the University of Rochester, where she also completed her residency. She has clinical certifications in Integrative and Holistic Medicine and Exercise Prescription and Programming.

Dr. Carroll is committed, and well-positioned, to assist in the dissemination and potential implementation of our results upon the study’s completion. We look forward to the opportunity to also work with her to improve our understanding of health policies effects on patient-centered diabetes outcomes for our patients.

► Meet Dr. Carroll, one of our PaTH to Health: Diabetes study stakeholders!

Cool Connections

Dr. Jennifer K. Carroll is an Associate Professor of Family Medicine at the University of Colorado School of Medicine and serves as the Director of the American Academy of Family Physicians (AAFP) National Research Network. The AAFP formed the Network in 1999 with the goal of conducting, supporting, promoting, and advocating for primary care research in practicebased settings. Under Dr. Carroll’s leadership, the network assists in realizing overall strategies for achieving improved primary care for the nation, uniquely positioning her to serve as a Stakeholder in our PaTH to Health: Diabetes study. As primary care is responsible for the vast majority of care for patients with diabetes, Dr. Carroll is eager to come to the table to ensure the primary care physician’s voice is heard. Her clinical work, research, and community service have focused on underserved populations

Meet Dr. Barbara Postol!

Jennifer K. Carroll, MD, MPH,

Associate Professor of Family Medicine at the University of Colorado School of Medicine; Director of American Academy of Family Physicians National Research Network

WINTER/SPRING 2018 EDITION | 3

PATIENT PARTNER VOICE

“Take care of yourself now to avoid complications down the road. If you don’t address

Meet Angie. A loving mother and grandmother with a contagious smile. She’s been able to maintain a 'glass half full' perspective even after her type 2 diabetes diagnosis in her 20s and Multiple Sclerosis (MS) diagnosis in her 30s. Having experienced the ups and downs of chronic disease, Angie has learned over the last several decades how to take better care of herself and stay in control of her health.

Angie comes from a solid family history of diabetes – her grandmother, mother, brother, and sister all were affected by type 2 diabetes and her other sister and brother had type 1, requiring insulin treatment. Angie struggled with weight issues even at a young age. “I knew that if I didn’t get that under control, I would eventually become a diabetic,” as family history and weight issues coupled together can drastically increase type 2 diabetes rates. The day came when Angie received her own diabetes diagnosis. “I immediately became more mindful of what I ate and started to exercise.” This helped for a while and things were going well. Unfortunately, ten years later Angie found out she also had MS, an auto-immune disorder that attacks an individual’s central nervous system and causes vision, mobility, and sensation complications. The MS diagnosis threw things off for her. “I needed to find a new balance.”

At first, it was quite challenging. Angie was prescribed different types of medication to manage her MS, many of which were steroids, causing her blood glucose levels to soar. She was only able to remain on steroids for a short period of time and then had to take insulin until her blood glucose levels were back at a good level.

After trial and error with different MS medications, Angie found what worked well for both conditions. She needed to take an ACTIVE role in her health and she needed specialists with whom she could have an open dialogue about what was working and what wasn’t.

“You need a good physician who listens to you. I always had to make sure I brought my list of medications to all appointments so this could be communicated to each specialist I had to see for diabetes or MS. I would also read up on side effects to make sure there were no contraindications.” It was hard to figure out how to 4 | WINTER/SPRING 2018 EDITION

diabetes early on, it can get worse. However, it’s not a death sentence. It’s a disease you can live with if you do the right things.”

manage the varying symptoms both diseases brought.

While many symptoms are similar (neuropathy, loss of balance, vision issues), MS exacerbations come in waves and can be intense whereas diabetes symptoms are more predictable and in some cases avoidable with proper diet and exercise. Angie was able to improve both conditions by becoming educated and discovering what worked best for her.

Angie has juggled both of her conditions for years, but has some reprieve when her MS goes into remission.

Periods of stress can cause exacerbations and disrupts her diabetes but she works to keep her blood glucose levels under control through healthy eating, exercise, and plenty of rest. “I try to find types of exercise that work, such as bands and hand weights.” Through her insurance she is able to participate in the Silver Sneakers program, which provides her access to several facilities/gyms. “What I’ve found over the years was the more I take care of my diabetes, the more it helps with my MS.” Angie’s MS is currently in remission and her diabetes is under control. “Overall I am good health-wise, although I never know what the day may bring. I know if I get up and have some MS symptoms, I take it slower. I take what life deals me and keep going because I enjoy life.” Her 3 grandchildren keep her motivated. She also actively participates in research studies related to her conditions and is currently serving as a patient co-Investigator on the PaTH to Health: Diabetes study to help educate others. Angie’s advice to patients dealing with diabetes and other health conditions: “Be mindful of your body – if it doesn’t feel right, don’t hesitate to let your doctor know. Take care of yourself now to avoid complications down the road. If you don’t address diabetes early on, it can get worse. However, it’s not a death sentence. It’s a disease you can live with if you do the right things.”

Clinician

MESSAGE

“I usually advise my patients with diabetes to get some exercise in—not only does it give them all the benefits we think about for everyone (improves heart health, mood, blood pressure, weight maintenance), it helps with glucose control in two ways: using up some of the glucose circulating, and making their muscles more sensitive to insulin (helping with glucose levels for hours after they stop exercising).”

– Rebecca Mancoll, Clinical Assistant Professor of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine and and PaTH to Health: Diabetes study stakeholder

Check out the American Diabetes Association website to learn more about different types of exercise that may be right for you: http://bit.ly/TypesOfActivity. ► Recent Trends in Diabetes Management The American Diabetes Association (ADA)'s 2018 update to its Standards of Medical Care in Diabetes makes several notable recommendations, including a target blood pressure below 140/90 mm Hg for most patients with hypertension, integration of continuous glucose monitoring into care, and routine screening for type 2 diabetes in high-risk youth.

Important changes and updates for patients with diabetes and cardiovascular disease include: • A new recommendation for adults with type 2 diabetes and heart disease that after lifestyle management and metformin, a medication proven to improve heart health should be added.

• Most adults with diabetes and hypertension should have a target blood pressure below 140/90 mm Hg, and risk-based individualization to lower targets, such as 130/80 mm Hg, may be appropriate for some patients, as summarized and outlined in a new table of four major, randomized controlled trials.

• A new algorithm illustrates the recommended antihypertensive treatment approach for adults

ADA UPDATES: Standards of Diabetes Care with diabetes and confirmed hypertension, defined as blood pressure of 140/90 mm Hg or greater.

The algorithm suggests selecting specific classes in certain clinical situations.

• All hypertensive patients with diabetes should monitor their blood pressure at home to help identify potential discrepancies between office and home blood pressure and to improve their medication-taking behavior.

The standards also include new recommendations highlighting the importance of individualizing pharmacologic therapy for older adults with diabetes and a guideline recommending consideration of daily low-dose aspirin starting at the end of the first trimester in all pregnant women with preexisting type 1 or type 2 diabetes to reduce the risk of pre-eclampsia.

Full article: http://bit.ly/ADADiabetesUpdates WINTER/SPRING 2018 EDITION | 5

Winter Salad with Citrus

RECIPE CORNER

Makes: 8 servings Ingredients: Salad 6 cups mixed greens 1 cup grapefruit sections 1 cup orange sections 1 cup thinly sliced red onion 1/4 cup coarsely chopped toasted walnuts From The Family Classics Cookbook by American Diabetes Association, photo credit www.diabetes.org

Salads aren't just for summer, they're for winter too especially when you can throw in some citrus fruits, which are in season for the winter!

Directions 1

Combine the dressing ingredients in a bowl.

2

Combine the greens, grapefruit, oranges, onion and walnuts. Add dressing and toss to coat.

RECIPE CORNER

Dressing 2 tablespoons raspberry vinegar 1 tablespoon orange juice 1 tablespoon balsamic vinegar 1 tablespoon olive oil 1/2 teaspoon sugar 1/4 teaspoon pepper 1/2 teaspoon soy sauce 1/4 teaspoon dry mustard 1/8 teaspoon salt

Spaghetti Squash with Light Marinara Sauce Makes:6 servings Ingredients: Spaghetti Squash: 1 medium (2-lb) spaghetti squash, washed 1 Tbsp extra virgin olive oil 1 Tbsp finely grated Parmigiano-Reggiano cheese Marinara: 14 plum tomatoes, chopped 2 cloves garlic, chopped 1 shallot, minced

1 Tbsp extra virgin olive oil Freshly ground pepper 1/2 tsp fine sea salt 1 cup fresh basil leaves

From The Stress-Free Diabetes Kitchen by Barbara Seelig-Brown, photo credit www.diabetes.org

1. Pierce spaghetti squash with a fork in several places and place in microwave on high until skin is soft, approximately 10-15 minutes. Let cool.

2. While squash is cooking, combine all marinara ingredients in a medium-sized bowl except basil leaves.

3. Tear basil leaves and add to tomato mixture.

4. Cut squash in half and make “spaghetti.”

6 | WINTER/SPRING 2018 EDITION

Using a fork, pull out individual strands of “spaghetti.”

Toss spaghetti squash with olive oil and ParmigianoReggiano cheese.

5. Place squash in a pie plate. Top with light marinara and a sprinkling of Parmigiano-Reggiano cheese.

6. Serve over cooked spaghetti squash.

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monthly diabetic-friendly recipes! American Diabetes Association's NEW Recipes for

Type 2

Healthy Living makes eating

DIABETES

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IS forNOT Life

for YOU. http://bit.ly/ADArecipe

Almost half of the patients with Type 2 diabetes supported by their General Practitioners (GPs) on a weight loss program were able to reverse their diabetes in a year, a study has found. The first year results, which are published in The Lancet, also revealed that almost nine out of 10 people (86%) who lost 15kg or more put their Type 2 diabetes into remission. The study led by Professor Roy Taylor, from Newcastle University, and Professor Mike lean from Glasgow University, found that 45.6% of those who were put on a low calorie diet for three to five months and were able to stop their Type 2 diabetes medications.

Importantly, long-term support by routine General Practice staff was given to help the participants maintain their weight loss. The trial, called DiRECT (Diabetes Remission Clinical Trial) and funded by Diabetes UK, recruited 298 people between the Newcastle and Glasgow University and builds on Professor Taylor's earlier pilot work.

Patient Resources Learn all about blood glucose: http://bit.ly/BloodGlucose Learn about your risk for pre-diabetes, type 2 diabetes and heart disease: http://bit.ly/pre-diabetes_risks Recently diagnosed with type 2 diabetes and don’t know where to begin? Start here: http://bit.ly/DiabetesJourney

Professor Taylor, lead researcher of the DiRECT trial, said: "These findings are very exciting. They could revolutionize the way Type 2 diabetes is treated. The study builds on the work into the underlying cause of the condition, so that we can target management effectively. Substantial weight loss results in reduced fat inside the liver and pancreas, allowing these organs to return to normal function. What we're seeing from DiRECT is that losing weight isn't just linked to better management of Type 2 diabetes: significant weight loss could actually result in lasting remission."

For several resources related to diabetes: www.diabetesforecast.org

Photo Credit MediaLoot.com Article Source: http://bit.ly/NotForLife

Access the full journal article here: http://bit.ly/TheLancetArticle WINTER/SPRING 2018 EDITION | 7

COMMUNITY EVENTS

The Tour de Cure

Healthy Heart, Healthy You! Join for the annual cardiovascular disease awareness day event at Geisinger Holy Spirit.

Attendees can participate in health lectures (topics: Cardiomyopathy; Arrhythmia; Hypercholesterolemia; heart-healthy cooking demonstration with samples), free health screenings, information booths and door prize raffles. Health screenings offered include body mass index, blood pressure, cardiovascular risk assessment, and glucose and cholesterol tests.

DATE: Saturday, February 17, 2018 TIME: 8:30 AM - 12:00 PM COST: FREE, Pre-registration is not required, but is appreciated as space is limited. Light refreshments provided.

REGISTER: Call 717-972-4149 or email HSGACommEdWeb@geisinger.edu

Diabetes Prevention Program Have you been thinking about making a change today for a healthier tomorrow? Geisinger is offering a program for individuals living with prediabetes or at risk for developing diabetes. Learn how to improve their health by making healthy lifestyle changes.

Caregivers, friends and family are welcome to attend.

DATE: Every Friday from February 9, 2018 to May 25, 2018 TIME: 9:00 – 10:00 AM LOCATION: Altoona Library, 1600 5th Ave., Altoona, PA 16602 COST: FREE, Participants 18 years or older REGISTER: Call the Geisinger wellness department at 866-415-7138.

8 | WINTER/SPRING 2018 EDITION

The Tour de Cure is an event where no matter what road you take, you will be joining thousands of people from around the country who have the same passion as you to fight diabetes and its burdens.

Tour de Cure Maryland: Goucher College DATE: Sunday, June 3, 2018 TIME: 6:00 - 2:00 PM LOCATION: 1021 Dulaney Valley Road, Baltimore, MD 21204 REGISTER: http://bit.ly/TourGoucherCollege Tour de Cure Greater Philadelphia: Temple University - Ambler Campus DATE: Saturday, June 16, 2018 TIME: 6:00 AM - 2:00 PM LOCATION: 580 Meetinghouse Road, Ambler, PA 19002 REGISTER: http://bit.ly/TourAmblerCampus Tour de Cure Pittsburgh: South Side Riverfront Park DATE: Saturday, September 15, 2018 TIME: 6:00 AM - 2:00 PM LOCATION: South Water Street, Pittsburgh, PA 15203 REGISTER: http://bit.ly/SouthSideWorksTour Tour de Cure Utah County DATE: Saturday, September 15, 2018 TIME: 6:00 AM - 2:00 PM LOCATION: 986 West Atheron Drive, Suite 220, Taylorsville, UT 84123 REGISTER: http://bit.ly/TourUtahCounty

One-on-One Diabetes Instruction Learn about meal planning, physical activity, glucose monitoring, medicines, dining out, and coping with stress from a Certified Diabetes Educator. The cost is covered by most insurance companies. A physician referral is needed. Call 1-866-334-5227 to schedule.

Questions? Call 412-784-5162 or 412-784-4195.

DATE, TIME, LOCATION: TBD

COMMUNITY EVENTS Diabetes Self-Management Education Program This group course is designed to cover all aspects of diabetes self-management. Learn about meal planning, physical activity, glucose monitoring, medicines, dining out, coping with stress and more. The content is based on American Diabetes Association Guidelines. The cost is covered by most insurance companies. Please contact your insurance company to confirm coverage of services prior to registering. A Physician Referral may be needed to enroll. For more information, please call the following: UPMC Altoona: 814-889-2731 UPMC Bedford: 814-624-4315 UPMC Horizon: 724-983-7160 UPMC McKeesport: 412-664-3055 UPMC Mercy: 412-232-5908 UPMC Northwest: 814-676-7992 UPMC Passavant: 412-748-6398 UPMC St. Margaret: 412-784-5162; 412-784-4195

PaTH Network ADAPTABLE study Cardiovascular Disease (CVD) & Diabetes campaign The CVD/Diabetes Campaign was launched through the efforts of patient partners (ADAPTORS) on the PaTH network ADAPTABLE study (http://bit.ly/ PaTHResearch) to help increase awareness, education, and research about the link between heart disease and diabetes. The campaign link features videos and helpful resources from patient partners, heart/stroke survivors, actress Angela Bassett, as well as medical experts from UCLA and Duke. Help be the change you want to see in the world of Heart Health: • Take the "Heart You" Quiz at www.foryoursweetheart.com.

• Register to learn more about diabetes and heart disease at www.foryoursweetheart.com/register.

• Additional resources: http://bit.ly/DiabetesResource

Diabetes Support Group with UPMC St. Margaret The Diabetes Support Group provides informal information sessions on various aspects of living with diabetes.

DATE: Thursday, March 15, 2018 Thursday, May 17, 2018 Thursday, September 20, 2018 Thursday, November 15, 2018 TIME: 6:15 – 7:30 PM LOCATION: UPMC St. Margaret, Cafeteria A&B COST: FREE REGISTER: For questions call 412-784-5162 or 412-784-4195 or visit http://bit.ly/UPMCStMargaretSupportGroup

PaTH to Health: Diabetes Study Newsletter Team

DESIGNER: Abbey Kinard CONTRIBUTORS: Jennifer Carroll, Angela Evans, Rebecca Mancoll, Barbara Postol EDITORS: Treva Alston, Cynthia Bradley, Mully Chea, Angela Evans, Erica Francis, Brianna Hoglen, Jennifer L. Kraschnewski, Julie Tice

EDITOR-IN-CHIEF: Jennifer M. Poger Need to get in touch with us?

Email: PATHtoHealth@pennstatehealth.psu.edu WINTER/SPRING 2018 EDITION | 9

SUMMER/FALL 2017 EDITION

“A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities”

Greetings from the PaTH to Health: Diabetes Research Team!

As Principal Investigator on this project, I’d like to welcome you to the most recent issue of our biannual research study newsletters. We’ve worked closely with our talented patient partners and stakeholders to develop the resources contained in this newsletter, which includes study updates and features from some of the key players involved, recent trends in diabetes management, recipes, community events, and other diabetes-related information for you and your loved ones. Happy reading!

Jennifer L. Kraschnewski, MD, MPH

Executive Director, Penn State PRO Wellness Associate Professor of Medicine, Pediatrics and Public Health Sciences Penn State College of Medicine

HIGH FIVES We would like to give a HIGH FIVE to our PaTH to Health: Diabetes investigative and patient partner/stakeholder team at Penn State College of Medicine for receiving the “Outstanding Collaborative Research Award,” given by the Office of the Vice Dean for Research and Graduate Studies and the Unified Campus Research Team in May 2017. This award represents the collaborative efforts of ALL involved in our study and we thank each of you for your commitment to this important work.

HIGH FIVE to patient partners and stakeholders who have completed our Year 1 Engagement Evaluation. This short survey lets us know how things have gone for you over the past project year. We want to make sure you are meeting your goals of engagement in the study and your feedback helps improve processes moving forward.

Finally, HIVE FIVE to our stakeholders, patient partners, and investigative team for attending our annual in-person conference in June 2017 and for joining us on quarterly stakeholder calls. The decisions we make during these meetings continue to steer our work in the right direction and we are grateful for all of your ideas and expertise.

UPCOMING TRAININGS As our study continues to extract health data via the PaTH network, interested patient partners and stakeholders will have the opportunity to learn a little bit about what we actually do with the data once it’s collected – get your calculators ready as we crunch some numbers in a brief training on data analysis! Stay tuned for more details.

Research Study Overview & Update

We’d like to provide an overview of our study for any new readers (and also a recap for returning readers). Our current research study, “A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities” is funded by the Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent, nonprofit organization that envisions a research world addressing questions and concerns most relevant to patients, while including them, their caregivers, clinicians and other stakeholders in the research process. We are thrilled to be working alongside our patient partners and stakeholders throughout each phase of our project. We have added new talent to our project team since our last newsletter, updating our roster to include 5 patient partners, 5 primary care providers, and 11 stakeholders who continue to contribute their ideas, expertise and lived experience to our project. They are the driving force of key study decisions and are a constant reminder of why our research matters.

Patient Partners

Primary Care Providers

To give you some background on our study, let’s take a brief look at the literature. You may be aware that obesity is a big issue in the US. In fact, it’s our number one health concern.

Addressing obesity through lifestyle interventions (i.e. healthy eating and increased physical activity) decreases the risk of developing type 2 diabetes, a disease that affects over 29 million people (9.3% of the US population). Diabetes is associated with serious complications, including heart disease, blindness, renal failure, and lower extremity amputation. Although complications are preventable with proper medical and lifestyle management, including weight loss, nearly half of diabetic patients do not have adequate glycemic control.

Recent policy changes and health insurance expansion have resulted in coverage for obesity counseling by Centers for Medicare and Medicaid to improve weight loss for adults either with or at high risk of type 2 diabetes. Obese beneficiaries are eligible for up to 20 face-toface visits for weight counseling in the primary care setting. However, it is unknown whether or not this benefit has helped patients lose weight and better control their diabetes.

This is where the PaTH to Health: Diabetes study comes into play. We are looking at Electronic Health Record (EHR) and claims data across 3 states to see if obesity counseling has improved weight and diabetes outcomes. For patients with or at risk of developing type 2 diabetes, are they receiving obesity counseling? If so, is it leading to weight loss and better blood sugar control? These are questions we hope to answer by analyzing the data. We are utilizing the PaTH network, an integrated research collaboration between Maryland, Pennsylvania, and Utah, to pull EHR data on over 2 million patients with or at risk of type 2 diabetes.

This project began in early 2016 and will continue until 2021. Data extraction is in full swing across each of the universities collaborating in this research: Penn State Health, University of Pittsburgh, Temple University, Geisinger Health System, Johns Hopkins University, and University of Utah. Being the first PaTH study to utilize this research infrastructure to its highest capability, it’s no surprise that we’ve experienced a few challenges and delays as we pioneer this effort. However, we’re ironing out the kinks and are in the process of standardizing the EHR data to ensure all sites are “speaking the same language.” This clean dataset will then be ready to analyze to shed light on how policy changes impact diabetes. We will also be integrating insurance claims data, patient-reported outcomes, and sociodemographic characteristics into our analyses to understand how these secondary outcomes may also affect diabetes and weight.

2 | SUMMER/FALL 2017 EDITION

Stakeholders Each individual will engage in key research activities, strengthening our project through their perspective and experience.

Style Guide for Internal Audiences

Table of Contents •

Introduction and Purpose

•

Using Pitt Public Health in Writing

•

The Pitt Public Health Graphic Mark

•

Using the Graphic Mark

•

Departments, Centers, Programs, and Other Entities

•

The University Seal and Signature

•

Typefaces, Colors

•

Spacing, Size, Design Tips

•

Sample Applications

•

Tools, Templates, and Training

•

Contacts

Pitt Public Health Style Guide

p. 1/10

updated: July 21, 2016

SPOTLIGHT: Team Member Cindy L. Bryce, Ph.D.,

Co-Investigator and Site PI, University of Pittsburgh

Meet Cindy Bryce!

Dr. Bryce serves as a site Principal Investigator for our PaTH to Health: Diabetes study at the University of Pittsburgh. In this role she engages in ongoing communication with the study team, including regular conference calls and annual inperson stakeholder meetings. Dr. Bryce also maintains communication with the PaTH/Pittsburgh team responsible for assembling data from University of Pittsburgh Medical Center patients that is consistent with the data structure across all PaTH sites. Additional

responsibilities include ensuring IRB status at the University of Pittsburgh throughout the project period, reviewing and discussing data findings and data analyses, helping to disseminate findings with both abstracts and manuscripts, and assisting with all interim and final reports.

Dr. Bryce holds a Ph.D. in Policy Analysis from Carnegie Mellon University and completed a postdoctoral fellowship with the Center for Health Services Research, VA Medical Center in Durham, NC.

Dr. Bryce works predominantly on projects related to organ allocation and organ transplantation policy as well as diabetes

prevention and management. Additionally, she serves as the Associate Dean for Student Affairs at the University of Pittsburgh Graduate School of Public Health. In her free time, Dr. Bryce might be taking a walk, reading a good book, or spending time with her husband and two children.

Serina has a passion for public health and improving the lives of others,

as evident in her leadership and advisory roles within the community.

As past Director of Nutrition and Physical Activity for the Pennsylvania Department of Health (2006-2015), she worked to develop, implement, and evaluate health promotion programs around obesity, diabetes, and asthma.

She has also served on the Penn State PRO Wellness, Bridge of Hope, and Capital Region American Heart Association advisory committees. Serina has a Master of Education degree with a concentration in Health from Pennsylvania State University and is a Certified Health Education Specialist (C.H.E.S).

Serina hopes to play an important role in our PaTH to Health: Diabetes by helping to disseminate our research findings to inform practice. We feel confident that her applicable professional experiences and extensive ties to the community will broaden our reach to those affected by diabetes and obesity.

► Meet Serina Gaston one of our PaTH to Health: Diabetes study stakeholders!

Cool Connections

As the Director of Strategic Initiatives and Corporate Compliance at the Pennsylvania Association of Community Health Centers (PACHC), Serina is responsible for developing and formalizing the company’s human resource policies and procedures, providing education and technical assistance to community health centers around social determinants of health, and promoting awareness of the Diabetes Prevention Program throughout the network of community health centers. PACHC is the state’s primary care association, representing and supporting the largest network of primary health care providers in the Commonwealth. PACHC services have supported health centers in their mission to improve access to affordable, quality primary care for more than 700,000 people at more than 300 sites in underserved rural and urban areas throughout Pennsylvania.

Serina Gaston, M.Ed.,

Director of Strategic Initiatives and Corporate Compliance, Pennsylvania Association of Community Health Centers

SUMMER/FALL 2017 EDITION | 3

PATIENT PARTNER VOICE

As an African American, the odds were stacked against Cynthia. Her father’s

Meet Cynthia. A committed single mom who for several years juggled working two (sometimes three) jobs, attending classes to earn a bachelor’s degree, raising her daughter, and caring for their home, all the while trying to maintain her sanity. It was no easy feat and stress had taken its toll. “Did I take care of that bill?...

Am I going to get approved for this school grant?...

Is my daughter safe on campus?” These questions haunted her at night and further compounded her weight issues. She had little to no time for self-care and was running on empty without realizing it. However, a diabetes diagnosis was the wake-up call Cynthia needed to find a new balance in her life, one that put herself on the list of priorities and would ultimately lead to a healthier, less stressful lifestyle.

The life changing moment occurred during a day like all the others, filled with the hustle and bustle that was the norm for Cynthia. She attended a health fair offered for employees where she worked at Mercy Hospital in Philadelphia, PA. What was usually a quick and routine screening rapidly escalated to an emergency room visit after the staff nurse measured a dangerously high blood pressure reading, putting her at risk for a heart attack or stroke. It was later discovered that Cynthia also had high A1C values and the diabetes diagnosis shortly followed. It was a whirlwind of flurry, shock, and sting…but she felt the weight of it immediately. As an African American, the odds were stacked against her. Her father’s side was severely diabetic, with her grandmother on insulin for as long as she could recall.

There was a lot at stake and getting her health back on track for her daughter became a new priority. “You can’t crawl up in a ball and say it’s over, because it’s not over.”

The same unwavering perseverance that pushed Cynthia through previous hardships prevailed once again. She first sought out mental health, where she learned to get a grip with her diagnosis. “If you’re in denial, you’re not going to do anything about it.”

After wrapping her head around it, she reached out to others in a similar situation, finding solace in others fighting the same fight. “I’ve had angels surrounding me throughout my life” and these new friends became 4 | SUMMER/FALL 2017 EDITION

side was severely diabetic, her grandmother was on insulin for as long as she could recall. A diabetes diagnosis was the wake-up call Cynthia needed to find a new balance in her life, one that would lead to a healthier, less stressful lifestyle.

her rock. “Together, we could breath,” she reflects.

Cynthia learned through this support system how to cook healthier, flavor food with natural ingredients, and incorporate more fruits and vegetables while reducing sugar and salt intake. She followed up on doctor’s appointments and took necessary medications.

Downsizing her residence came next and proved to be a huge stress reducer. It not only alleviated a financial burden but also freed up more time for her to join the fitness center located within her apartment complex. With lowered cost of living expenses, she was able to cut out one job, dedicating more time to her coursework. Like a domino effect, one smart decision putting her needs first led to a series of healthier choices that ultimately rescued her from the crippling cycle of stress she was stuck in.

Cynthia turned trouble into triumph and is currently maintaining her weight and diabetes. It’s something she works at every day. While life stressors still pop up, she is now better equipped to deal with them.

She knows when she has too much on her plate, both literally and figuratively. With a completed bachelor’s degree and some coursework under her belt as she obtains her Masters in Health Administration, Cynthia has hope. “You don’t know what you’re capable of until you get there.” Her message to patients who receive a diabetes diagnosis: “Embrace it. You can control it.” She hopes to inspire others through her role as a patient partner and plans to use her degrees to serve as a patient advocate for those navigating through insurance coverage issues. She encourages younger generations to “pace yourself but still reach for your dreams,” — she certainly still is.

Clinician

MESSAGE

"Diabetes management and stress management go hand in hand.

The body releases a hormone called cortisol when under stress, which is designed to increase blood sugar. This mechanism is in place as part of the "fight or flight" response for humans in imminent danger. However, continuous exposure to cortisol worsens blood glucose control, so stress management is crucial for proper diabetes management."

– Regina Jacob, MD, MSCE, Assistant Professor, Section of General Internal Medicine,

Lewis Katz School of Medicine at Temple University and PaTH to Health: Diabetes study stakeholder

Check out the American Diabetes Association website to learn more about symptoms of stress and how to better manage it and diabetes visit http://bit.ly/ManageStressDiabetes. Interested in the connection between stress and type 2 diabetes? Visit http://bit.ly/StressType2Diabetes. ► Recent Trends in Diabetes Management Heart disease, a leading cause of death worldwide, can worsen when coupled with diabetes. However, most diabetes treatment regimens focus solely on blood glucose control, leaving patients at risk for heart attack and stroke. Results from four recent randomized clinical trials now suggest that using medications that offer glucose control while reducing the risk for cardiovascular disease could improve patient outcomes.

"Strong evidence provided by the four recent trials published within the past 1.5 to 2 years in the New England Journal of Medicine has shown that some of the modern available therapeutic agents that control blood glucose also help reduce the risk for cardiovascular disease," said Faramarz Ismail-Beigi, MD, PhD, Professor of Medicine at Case Western Reserve University and Endocrinologist at University Hospitals Cleveland Medical Center and Louis Stokes Cleveland VA Medical Center. "Based on this evidence, we propose that we must shift from our previous paradigm with its monocular focus on control of blood glucose and hemoglobin A1C, to one of control of blood glucose plus preventing

Link Between DISEASE and

HEART Diabetes Management cardiovascular disease and death from cardiovascular causes." Hemoglobin A1C is a common test used to determine a patient's average blood sugar levels over the previous 2-3 months.

"For the first time we have seen glucose-lowering medications that can improve cardiovascular outcomes," Ismail-Beigi said. The new trial results could help address a major dilemma for clinicians looking for ways to control heart disease and reduce mortality, while simultaneously managing blood glucose in patients with type 2 diabetes.

Read the full article here: http://bit.ly/ParadigmShiftPlan

Learn more about the CVD/Diabetes Campaign on page 9 and www.foryoursweetheart.com.

SUMMER/FALL 2017 EDITION | 5

Green Smoothie Breakfast Bowl

RECIPE CORNER

Smoothies topped with some crunch and nuts make for a complete breakfast in a bowl! The extra ingredients make this thick fruit-and-veggie blend more filling than a drinkable smoothie.

Recipe by www.diabetes.org; Photo credit www.spoonfulofflavor.com

Directions 1

2

Combine all ingredients except KIND bar in a blender.

Purée until smooth and thick, stopping to stir mixture in between blending at times. (Add a little more almond milk if needed.)

Pour smoothie mixture into 2 bowls. Top each bowl with half of the crumbled KIND bar.

RECIPE CORNER

Makes: 2 servings Preparation Time: 5 minutes Cooking Time: 0 minutes Ingredients: 3/4 cup original almond milk, unsweetened 4 oz nonfat plain Greek yogurt 1 cup frozen mixed fruit 2 cups baby spinach 1 medium sliced, frozen banana 1 (1.4-oz) KIND Maple Glazed Pecan & Sea Salt bar, crumbled Dietitian Tip: No KIND bar? Try topping with a sprinkle of toasted almonds and coconut.

Vegetable with or without Meat Stir-Fry Ingredients: Mrs. Dash Garlic and Herb Seasoning 1/2 cup of Oyster Sauce 1/2 cup of Stir Fry Soy Sauce 3 ounces of Broccoli 3 ounces Baby Corn 3 ounces Mushrooms 2 cloves of minced/chopped Garlic Your Choice of Meats: 1 cup of Shrimp; 1 cup of Pork; or 1 cup of Chicken Your Choice of Carbs (6.8 ounces): Jasmine Rice; Basmati Rice; Brown Rice; or Lo-Mein

Recipe by patient partner Mully Chea; Photo credit www.lowcarblab.com

1.

2.

3.

4.

5.

Clean/Prepare/Cut all of the vegetables Pour canola oil or olive oil into a stir-frying pan Pour a pinch of minced garlic Add your preferred meat and stir with minced garlic Make sure meat is semi-cooked so that the seasoning will flavor the meats 6. Add the seasoning (soybean sauce, stir fry soy sauce) and mix all together 6 | SUMMER/FALL 2017 EDITION

7. Make sure the meat is fully cooked before adding vegetables 8. Pour vegetables and stir everything together 9. The meal is complete with your choice of carbs (jasmine, basmati, brown rice or lo-mein) 10. Make sure to measure the correct amount of carbs with your entrée 11. You’re ready to enjoy the delicious meal

Treating Prediabetes like

DIABETES:

Prevent Complications, Yield Better Outcomes?

Designed by xb100 / Freepik

Ralph DeFronzo, MD, endocrinologist and chief of the Diabetes Division at the University of Texas Health Science Center, wants to redefine prediabetes. While A1C values between 5.7-6.5 are currently diagnosed

Patient Resources

as prediabetes, Dr. DeFronzo argues that it’s not a

Learn all about blood glucose: http://bit.ly/BloodGlucose

separate illness. “The development of type 2 is a gradual

Learn about your risk for pre-diabetes, type 2 diabetes and heart disease: http://bit.ly/pre-diabetes_risks

prediabetes, in my opinion, have diabetes—they just

Recently diagnosed with type 2 diabetes and don’t know where to begin? Start here: http://bit.ly/DiabetesJourney

optimal treatment plan for patients at risk, most fail

process that occurs over years,” he says. “People with don’t meet the cutoff points set by the ADA yet.”

While physical activity and healthy eating are the to lose weight and stick with an exercise program. He argues that treating with an effective pharmaceutical will yield better outcomes and ward off microvascular

For several resources related to diabetes: www.diabetesforecast.org

complications later on (i.e. eye, kidney, nerve problems).

However, which drug will yield the best outcomes is understudied.

His current research is exploring how people with prediabetes respond to a random assignment to four possible drug treatments: metformin, dapagliflozin, pioglitazone, and saxagliptin.

Photo Credit MediaLoot.com

Read the full article here: http://bit.ly/TreatingPrediabetes SUMMER/FALL 2017 EDITION | 7

COMMUNITY EVENTS

"A Touch of Sugar" Diabetes Support Groups DATE: Monday, September 11, 2017 TIME: 6:00-7:00 PM LOCATION: Wegman's, 6416 Carlisle Pike, Mechanicsburg, PA 17050 TOPIC: Diabetes and Hearing Loss: Did you know that people with diabetes are twice as likely to experience hearing loss? Listen close as we teach you about hearing loss.

DATE: Monday, October 9, 2017 TIME: 6:00-7:00 PM LOCATION: Wegman's, 6416 Carlisle Pike, Mechanicsburg, PA 17050 TOPIC: Diabetes and Family dynamics: Diabetes not only affects the person diagnosed with it, but also the family and friends involved. Learn how to get your loved ones involved and help you on this diabetes journey.

Join for a monthly support group hosted by the Diabetes Services team at Geisinger. Sessions are held on the second Monday of each month, and offer information to help those living with diabetes or pre-diabetes, or for anyone wanting to learn how to live a healthier lifestyle. You do not have to be diagnosed diabetes to attend. Meetings are held in the conference room located in the back of the dining area at Wegman's. The sessions are free and no registration is necessary.

For more information, please call 717-763-2466.

The Step Out Walk to Stop Diabetes The Step Out Walk to Stop Diabetes gives everyone in your community a chance to gather together to raise funds for diabetes research, advocacy and education. You will hear inspirational speakers whose lives have been affected by diabetes and you will be surrounded by people from our community who share the same passion as you – to fight diabetes. What a great opportunity to show solidarity! After the walk, enjoy a festival of wellness exhibits, refreshments and entertainment. Register today for a location near you.

Baltimore, MD DATE: Saturday, October 1, 2017 TIME: 8:00 AM - 12:00 PM LOCATION: Canton Waterfront Park, 3001 Boston St., Baltimore, MD 21224 CONTACT: Rachel Guzman at rguzman@diabetes.org or 410-265-0075, ext.4671.

Pittsburgh, PA DATE: Saturday, October 7, 2017 TIME: 8:00 AM - 12:00 PM LOCATION: North Shore, Art Rooney Ave, Pittsburgh, PA 15212 CONTACT: Your Pittsburgh Step Out Team at PittsburghStepOut@diabetes.org or 412-824-1181 ext.

4520.

Frederick, MD DATE: Sunday, October 8, 2017 TIME: 8:00 AM - 12:00 PM LOCATION: Baker Park, 121 N. Bentz St, Frederick, MD 21701 CONTACT: Katie Audy at kaudy@diabetes.org or 410-265-0075, ext.4670.

Philadelphia, PA presented by Merck DATE: Saturday, November 4, 2017 TIME: 8:00 AM - 12:00 PM LOCATION: Philadelphia Museum of Art, 2600 Benjamin Franklin Parkway, Philadelphia, PA 19130 REGISTER: Visit www.diabetes.org/stepoutphilly.

8 | SUMMER/FALL 2017 EDITION

Pennsylvania Department of Health and Health Promotion Council statewide Diabetes/Obesity Campaign To inspire Pennsylvanians to fight diabetes and obesity, a statewide marketing campaign was created to promote healthy living, physical activity and weight management to individuals across the Commonwealth called "Make A Choice." The campaign is designed to encourage Pennsylvanians to take a stand for their health, and to make the immediate choice to live a healthier lifestyle.

Make A Choice will provide current and relevant information about how to enroll in educational programs that specifically address constituents’ health issues (i.e. prevent and manage prediabetes and type 2 diabetes) and offer helpful tips and tools that will support them through their wellness journeys using the web portal at the heart of the initiative, www.makeachoice.org. The campaign will run August 2017 through National Diabetes Awareness Month in November 2017. Join us at one of the Make a Choice events below!

Pittsburgh, PA DATE: Thursday, November 2, 2017 TIME: 5:00 – 8:00 PM LOCATION: David Lawrence Convention Center Philadelphia, PA DATE: Saturday, November 4, 2017 TIME: 11:00 AM – 2:00 PM LOCATION: Pennsylvania Convention Center

COMMUNITY EVENTS Diabetes Educational Courses Check out diabetes educational courses offered this fall through the University of Pittsburgh Medical Center: • • • • • • •

Diabetes Self-Management Education Program Diabetes Support Group with UPMC Passavant Diabetes Support Group with UPMC St. Margaret Group Lifestyle Balance Weight Loss Program Nutrition and Weight Management in Diabetes Nutrition Counseling (Medical Nutrition Therapy) One-on-One Diabetes Instruction

Visit http://bit.ly/EducationalCourses for details.

PaTH Network ADAPTABLE study Cardiovascular Disease (CVD) & Diabetes campaign feature: For Your SweetHeart The campaign was launched in 2016 by Boehringer Ingelheim and Eli Lilly and Company and continues in 2017 with supporting efforts from one of the members of patient partners (ADAPTORS) on the PaTH network ADAPTABLE study (http://bit.ly/PaTHResearch) to help increase awareness, education, and research about the link between heart disease and type 2 diabetes. The campaign link features videos and resources from patient partners, heart disease/stroke survivors, actress Angela Bassett, 11 patient and professional organizations as well as six healthcare providers, including medical experts from UCLA and Duke.

• Take the "Heart You" Quiz at www.foryoursweetheart.com.

• Register to learn more about diabetes and heart disease at www.foryoursweetheart.com/register.

• Additional resources: http://bit.ly/DiabetesResource

Annual Diabetes Fair at Penn State Milton S. Hershey Medical Center DATE: Saturday, November 4, 2017 TIME: 9:00 AM – 12:00 PM LOCATION: Penn State Hershey Medical Center University Conference Center

PaTH to Health: Diabetes Study Newsletter Team

DESIGNER: Abbey Kinard CONTRIBUTORS: Cynthia Bradley, Cindy L. Bryce, Mully Chea, Serina Gaston, Regina Jacob EDITORS: Treva Alston, Cynthia Bradley, Mully Chea, Angela Evans, Erica Francis, Brianna Hoglen, Jennifer L. Kraschnewski, Julie Tice

EDITOR-IN-CHIEF: Jennifer M. Poger SUMMER/FALL 2017 EDITION | 9

WINTER/SPRING 2017 EDITION

“A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities”

Greetings from the PaTH to Health: Diabetes Research Team!

As Principal Investigator on this project, I’d like to welcome you to our latest issue of our biannual research study newsletters. Inside you’ll find progress updates on our research study, introductions from some of the key players that help make this research possible, and resources as well as community event information for you and your loved ones. Happy reading!

Jennifer L. Kraschnewski, MD, MPH

Executive Director, Penn State PRO Wellness Associate Professor of Medicine, Pediatrics and Public Health Sciences Penn State College of Medicine

HIGH FIVES We would like to give a HIGH FIVE to our patient partners for completing the Community Partner Research Ethics Training course in August 2016. Our study was the first at Penn State College of Medicine to utilize this training and certification program adapted from the University of Pittsburgh. This training will enhance patient-centeredness in research by having our patient partners educated in human participants research and the ethical guidelines that embody best practices. Congratulations, patient partners, for making history by becoming the first Patient Co-Investigators on a research study at our institution!

Another HIGH FIVE goes to our patient partners for completing our data extraction training, “De-coding the PaTH of EHR data: How it’s collected, how it’s protected” in fall 2016.

A final HIVE FIVE to our stakeholders, patient partners, and investigative team for attending our annual in-person meeting and quarterly stakeholder calls. Your commitment is greatly appreciated!

UPCOMING TRAININGS Project stakeholders will have the opportunity to attend a voluntary Just-InTime mini training session on the data extraction process via the PaTH network in winter 2017. The training will help optimize engagement in discussions and work surrounding the research phase of our secondary data analysis study. Stay tuned for details regarding the new learning management system, Litmos, that will provide the training.

Research Study Overview & Update

Our research study, “A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities” is funded by the Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent, nonprofit organization that envisions a research world that addresses the questions and concerns most relevant to patients, while including them, their caregivers, clinicians and other stakeholders in the research process. We are thrilled to be working alongside our patient partners and stakeholders throughout each phase of the project. We have added new talent to the project team since the last newsletter edition, updating our roster to include 4 primary care providers, 5 patient partners, and 10 stakeholders who will be engaged in research activities, strengthening our project through their perspective and experience.

Primary Care Providers

Patient Partners

As literature shows, overweight and obesity are a big issue in the U.S. In fact, it’s the number one health concern. Addressing obesity through lifestyle interventions (i.e. healthy eating and increased physical activity) decreases the risk of developing type 2 diabetes, a disease which affects over 29 million people (9.3% of the U.S. population).

Diabetes is associated with serious complications, including heart disease, blindness, renal failure and lower extremity amputation. Although complications are preventable with proper medical and lifestyle management, including weight loss, nearly half of patients with diabetes do not have adequate glycemic control.

Recent policy changes and health insurance expansion have resulted in coverage for obesity counseling by Centers for Medicare and Medicaid to improve weight loss for adults either with or at high risk of type 2 diabetes. Beneficiaries whom are obesity are eligible for up to 20 face-to-face visits for weight counseling in the primary care setting.

However, whether or not this new benefit has actually helped patients lose weight and better control their diabetes is unknown.

In the PaTH to Health: Diabetes study, we are looking at Electronic Health Record (EHR) and claims data across three states to see if obesity counseling has improved weight and diabetes outcomes. For patients with or at risk of developing type 2 diabetes, are they receiving obesity counseling? If so, is it leading to weight loss and better blood sugar control? We hope to answer these questions by analyzing data. We’ll be utilizing the PaTH network, which is an integrated research collaboration between Maryland, Pennsylvania, and Utah, to pull EHR data on over 2 million patients with or at risk of type 2 diabetes.

This project began in early 2016 and will continue until 2021. In fall 2016, we obtained Institutional Review Board approval (IRB) across the universities collaborating in the research: Penn State College of Medicine, University of Pittsburgh, Temple University, Geisinger Health System, Johns Hopkins University, and University of Utah. Our first data extraction has been completed and the data is being “cleaned” in order to analyze.

Additionally, we are in the process of collecting Patient-Reported Outcomes (PRO’s) from each partnering institution, including physical activity levels, fruit and vegetable consumption, social support, and other variables of interest that will help us better understand diabetes and associated risks.

2 | WINTER/SPRING 2017 EDITION

Stakeholders Each individual will engage in key research activities, strengthening our project through their perspective and experience.

Style Guide for Internal Audiences

Table of Contents •

Introduction and Purpose

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Using Pitt Public Health in Writing

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The Pitt Public Health Graphic Mark

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Using the Graphic Mark

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Departments, Centers, Programs, and Other Entities

•

The University Seal and Signature

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Typefaces, Colors

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Spacing, Size, Design Tips

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Sample Applications

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Tools, Templates, and Training

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Contacts

Pitt Public Health Style Guide

p. 1/10

updated: July 21, 2016

SPOTLIGHT: Team Member Brianna Hoglen, BS

Meet Brianna Hoglen!

Brianna is currently a project coordinator for Penn State PRO Wellness at Penn State College of Medicine.

Brianna organizes meetings, maintains communication between patient co-investigators and study staff, and coordinates project documentation and deliverables for Path to Health: Diabetes. She meets with project management to ensure milestones are met along with team action items. Additionally, she communicates with patient partners and stakeholders about upcoming meetings, events, or other opportunities

to become involved in the project, to ensure their engagement over the course of the study.

In addition to this role, Brianna also works on a variety of projects within PRO Wellness, including obesity prevention work with the Boy Scouts of America, serves as a reviewer for LiveHealthyPA website with the PA Department of Health, and assists the community health improvement team for Better Together Lebanon County. Brianna has a passion for public health in the areas of nutrition, obesity, and preventative medicine.

„Brianna holds a Bachelor of Science in Psychology/Neuroscience from Pennsylvania State University and is currently a full

time student in the Master of Public Health program at Penn State Hershey College of Medicine. In her free time, Brianna enjoys working out, painting, and traveling with friends and family.

Dr. Turer received her medical degree from Johns Hopkins School of Medicine, and completed combined

Internal Medicine/Pediatrics residency training, a Fellowship in Health Services Research in Primary Care, and a Masters in Clinical Research at Duke University Medical Center. She joined the faculty at UT Southwestern in 2010. Her research focuses on primary-care weight management in children and adults. Her goal is to identify specific ways that primarycare providers can improve the weight status and health of patients with overweight and obesity. Her publications address complications of and treatments for pediatric and adult overweight and obesity.

Dr. Turer is well-versed in challenges faced by practicing clinicians in treating obesity in the clinic, as well as bridging the related worlds of research and clinical practice. As The Obesity Society is committed to keeping the medical community and public informed of new advances, Dr. Turer will play an important role in the dissemination of our research results.

â–ş Meet Dr. Christy Boling Turer, one of our PaTH to Health: Diabetes study stakeholders!

Cool Connections

As a past chair (2013-2014) of the Clinical Management of Obesity Section of The Obesity Society, Dr. Turer is positioned to serve as a voice for clinicians who treat patients with obesity. The Obesity Society is the leading professional society dedicated to better understanding, preventing and treating obesity. The Clinical Management of Obesity Section has greater than 900 members. The purpose of this section is to form a collective group of practicing clinicians to improve our presence with the medical community, to help with common problems faced by practicing clinicians, and to promote good ethical treatment of the overweight patient by all practicing clinicians. Dr. Turer has extended her experience and expertise working with The Obesity Society to the research team to help inform our project.

Christy Boling Turer, MD, MHS,

Assistant Professor of Pediatrics, Department of Clinical Science, & Internal Medicine at UT Southwestern Medical Center

WINTER/SPRING 2017 EDITION | 3

PATIENT PARTNER VOICE

Meet Treva, a retired government employee of 34 years, who held positions at the Food & Drug Administration (FDA), Department of Defense (DOD), and Environmental Protection Agency (EPA). With a Bachelors of Science degree in Chemistry and a Masters degree in Environmental Management, Treva understands the science behind healthy eating. “You don’t have to tell me about carbohydrates,” she states knowingly. Yet, Treva represents one of 86 million Americans who are pre-diabetic. Diabetes runs in the family; her grandfather became blind from having type 2 diabetes, her aunt was on dialysis, and her mother was insulin-dependent.

Given her genetic predisposition to developing diabetes, increased incidence among African Americans, and her personal weight struggles, Treva is well aware that a diabetes diagnosis is within arms reach. “It’s one of the things I’m supposed to get. It’s on my DNA according to the stats.”

Yet, like the other one-third of the U.S. population, Treva is in a position to take control of her health. She has not yet received the official diagnosis. Although her A1c has been elevated in recent years, she hasn’t experienced the cardinal signs, such as increased thirst, frequent urination, or blurred vision, all typical symptoms of diabetes. While the “whistle hasn’t been blown,” Treva realizes it’s up to her to make sure it never is.

So how does she do it? For starters, Treva is well aware that losing weight will help decrease her chances of developing diabetes and also improve her overall health.

Therefore, she is starting to make healthier food choices.

Admittedly she has a sweet tooth and realizes this points her in the direction of becoming diabetic so she knows she has to be careful. Although she frequently dines out, she can now go to a restaurant and avoid overeating.

She is becoming a smarter shopper too. “There was a time I wouldn’t go to the grocery store without getting at least of five Ocean Spray juices, ” she recalls. “One day I got smart and read the label and saw that it was loaded with sugar. Now I don’t even bring them in the house.”

Instead, she reminds herself to drink more water and be diligent with healither choices or the pendulum could swing in the wrong direction.

4 | WINTER/SPRING 2017 EDITION

“You have to be your own advocate for your health.

You have to be in control.”

Where Treva struggles, as do many of others who are at risk of developing type 2 diabetes, is with getting enough physical activity. “I’m not a lover of exercise. I got a D in college gym class because I wouldn’t change into my gym clothes!” She knows that she needs to exercise more to stay healthy and keep her A1c in check. Entering into the seventh decade of her life, Treva has already experienced a longer lifespan than her father. With every new year comes a boost in motivation, and Treva plans to use that as a springboard to exercise more. “The light bulb has come on. I know that I have to do this.” A big motivator for her is not wanting to be on medicine or become insulin dependent, like her mother was. “My biggest fear are the needles,” she admits.

Treva’s advice to patients at risk of developing type 2 diabetes: “You have to be your own advocate for your health. You have to be in control.” Seeing her doctor three to four times per year keeps Treva accountable. She also keeps abreast of the latest diabetes research and has recently taken on a more active role by participating as a patient partner for our PaTH to Health: Diabetes study, where her voice and perspective is shared throughout each phase of the study to inform the research and enhance patientcenteredness. Additionally, she serves as a member on both the Executive and Steering Committees of the PaTH network, an electronic health record (EHR)-based data infrastructure across three states (Maryland, Pennsylvania, and Utah) that allows for collaborative research.

In her spare time, Treva enjoys traveling, going to the theatre, and attending lectures. One of her pipedreams she plans to accomplish is to start a small baking business, and we look forward to seeing what diabeticfriendly delicacies will appear on the menu!

Clinician

MESSAGE

“In my practice I try to focus on telling patients what they should eat and drink as opposed to what they should not. For example, I always tell patients to make it their goal to eat five fruits and vegetables every day and to drink 64oz of water. I find that by simply making these two things their goals, they naturally eat and drink less carbs and sugars.”

– Tiffany Gonzalo, CRNP, Cocoa Family Medicine

Check out American Diabetes Association's website to learn how to make healthy food choices, understand carbohydrates, and receive food tips, visit http://bit.ly/WhatCanDiabeticEat. ► Recent Trends in Diabetes Management

Although diabetes affects over 9% of the U.S. population, your chances increase at an alarming rate if you are Hispanic or African American. While previous research has pointed to genetics as the culprit for the dim outlook among disparate populations, new research findings suggest that environmental factors may play an even more decisive role in the subsequent development of diabetes. Stress factors such as poverty and discrimination experienced by minorities increase their cortisol levels, or “fight or flight” response. This leads to higher insulin resistance because the body has to store extra blood glucose to provide more energy to deal with stressful situations. Over time, ongoing insulin resistance wears out insulin-producing beta cells, thus causing type 2 diabetes. Exercise physiologist Rebecca Hasson, PhD, director of the Childhood Disparities Research Laboratory at the University of Michigan, is working with 150 children with obesity between ages 14 and 18 to measure associations between stress, race, and type 2 diabetes risk. Preliminary findings reveal that African American and Latino children in the study do indeed have higher cortisol levels, warranting stress reduction interventions in these populations.

Read the full article here: http://bit.ly/StressType2

The Connection Between STRESS & Type 2 Diabetes

WINTER/SPRING 2017 EDITION | 5

RECIPE CORNER

Smoked Paprika–Roasted Chicken with Roasted Vegetables Makes: 6 servings Serving Size: 1/6 recipe Preparation Time: 20 minutes Cooking Time: 1 hour, 20 minutes Ingredients: 1 Tbsp. smoked paprika 1 Tbsp. chipotle powder 1 Tbsp. honey 1 Tbsp. fresh lemon juice 2 tsp. olive oil 2 garlic cloves, minced 1/2 tsp. salt 1 4-lb whole chicken 3 celery stalks, cut into 2-inch chunks 3 med. carrots, cut into 2-inch chunks 2 large white onions, quartered 1/4 cup reduced-sodium chicken broth

Recipe by Ingrid Hoffmann; photography by RenĂŠe Comet; Photo Credit www.diabetesforecast.org

Make Sunday dinner a cinch with this 255 calorie spin on a traditional roasted chicken.

Directions 1

Preheat the oven to 400 F. Spray a roasting pan with nonstick spray.

2

Combine the paprika, chipotle powder, honey, lemon juice, oil, garlic, and salt in a small bowl to make a paste.

3

Pat the chicken dry with paper towels. Gently loosen the skin from the breast and leg portions of the chicken by slipping your fingers under the skin.

Rub the paste evenly under the skin and on top of the skin. Tuck the wing tips behind the chicken's shoulders and tie the legs together with kitchen string.

4

Make a bed for the chicken with the celery and carrots in the bottom of the pan. Place the chicken, breast-side up, on top of the vegetables. Add the onions and broth to the pan. Roast the chicken until an instant-read thermometer inserted into the thigh

6 | WINTER/SPRING 2017 EDITION

(not touching the bone) registers 165 F, about 1 hour and 10 minutes. If the chicken is browning too fast, cover it with aluminum foil.

5

Transfer the chicken to a cutting board and let it stand for 10 minutes. Carve the chicken. Remove the chicken skin before eating. Serve the carved chicken with the roasted vegetables.

Quick, healthy and satisfying breakfast?

Start your day off right with a recipe from one of our patient partners, Angela Evans.

Ingredients: One hard boiled egg one Tbsp of real bacon pieces The bacon is 25 calories, 190mg sodium, 0 carbs, 5mg choles, 0.5mg sat fat.

New Insight into How Diabetes Leads to

BLINDNESS Diabetic retinopathy, occurring when high blood glucose levels form abnormal blood vessels of the eye, is the leading cause of vision impairment and blindness among the working age population. New research led by Michael D. Dennis, PhD, an American Diabetes Association Pathway to Stop Diabetes awardee, is exploring how diabetes changes the kinds of proteins that are made in the eye. These changes may lead to diabetic retinopathy, a debilitating complication of diabetes and leading cause of blindness. Dr. Dennis is hypothesizing that high blood glucose changes which genes get made into proteins in a manner that contributes to retinopathy. Through his research, he has identified a molecular switch that occurs during high blood glucose levels, causing the abnormal development of blood vessels in the retina. This discovery is allowing researchers to identify new targets for therapies that could delay or prevent the development of diabetic retinopathy.

Patient Resources Learn all about blood glucose: http://bit.ly/BloodGlucose Learn about your risk for pre-diabetes, type 2 diabetes and heart disease: http://bit.ly/pre-diabetes_risks Recently diagnosed with type 2 diabetes and don’t know where to begin? Start here: http://bit.ly/DiabetesJourney For several resources related to diabetes: www.diabetesforecast.org

Photo Credit MediaLoot.com

Read the full article here: http://bit.ly/BlindnessFromDiabetes WINTER/SPRING 2017 EDITION | 7

COMMUNITY EVENTS

Greater Philadelphia Tour de Cure DATE: Saturday, June 3, 2017 TIME: 6:00 AM - 12:00 AM LOCATION: Temple University - Ambler Campus, 580 Meetinghouse Road, Ambler, PA 19002 2017 DICK's Sporting Goods Pittsburgh Marathon DATE: May 6 – 7, 2017 LOCATION: Downtown Pittsburgh If current trends continue, one in three American adults will have diabetes by 2050. Please consider supporting the American Diabetes Association and helping the 400,000 Western Pennsylvanians with diabetes! Please note, registering as a fundraiser does not guarantee entry into the DICK's Sporting Goods Pittsburgh Marathon. There is no fundraising minimum but participating is easy!

Visit http://bit.ly/PittsburghMarathon17 to purchase race entry. Questions? Contact Kira Kellner: kkellner@ diabetes.org or call 412-824-1181 x4520

Northern Virginia Tour de Cure DATE: Saturday, May 13, 2017 TIME: 6:00 AM - 12:00 AM LOCATION: Reston Town Center, 11900 Market St., Reston, VA 20190 Join thousands of participants from around the country who come together to directly impact the lives of people facing the daily challenges of diabetes and their loved ones.

Visit http://bit.ly/VATourDeCure to learn more.

8 | WINTER/SPRING 2017 EDITION

Tour de Cure is more than just a cycling event.

A day full of fun and excitement where riders of all levels join forces in the fight to Stop Diabetes® and raise critical funds for diabetes research, education and advocacy in support of the American Diabetes Association. So take the Ride of Your Life and sign up today! http://bit.ly/PhillyTourDeCure

Tour de Cure Utah DATE: Saturday, June 10, 2017 TIME: 6:30 AM - 4:00 PM LOCATION: 1 N. Main Street, Brigham City, UT 84302 It’s more than just a cycling event, it's a lifechanging event. Get involved year-round in training rides, healthy living and team building.

We promise you the ride of your life by offering all the extras: breakfast & lunch menu, routes from 10 – 100 miles, safety & on-course support, rest stops stocked with top-shelf items, and a new finish line filled with high-energy heritage on Brigham’s Main Street. Whether you are an occasional rider or an experienced cyclist, there is a route designed just for you!

Learn more and register at www.diabetes.org/ utahtour

Give Back: Denim for Diabetes COMMUNITY EVENTS Want to make a difference at work? You're invited to participate in the American Diabetes Association's Campaign: Denim for Diabetes.

For a suggested donation of $5, Business Information employees & coworkers will receive a Denim for Diabetes sticker entitling themCompany to wear denim to Business Address work - and making them ambassadors for diabetes Ambassadors Needed! awareness in your company and in our community.

Contact Name/Title The American Diabetes Association has established To receive your kit, fill out and return the Denim Business Phone a program to train volunteers to implement for Diabetes registration form Business at http://bit.ly/ Fax diabetes/wellness education workshops in DenimForDiabetes, or contact E-mail Shannon Davis at Address the Washington DC Metro Area. The idea is to sdavis@diabetes.org give people who are passionate about health or 412-824-1181 ext. 4604. Dress Down Day Information promotion the resources they need to act by Approximate # of Participants leading workshops on diabetes/wellness in Do-It-Yourself Fundraising # of Posters Requested their communities. These workshops will help Are you interested in to setting up a fundraiser get the word out about prevention strategies to support the American Diabetes Association? # of Employees in Company and the dangers of uncontrolled diabetes. The There are many ways to do it! If you would like Association also hopes these workshops become assistance with creating a local event, please visit Date(s) Your Company Will Be Dressing Down:Davis at places community members can exchange ideas http://bit.ly/2jkdSpR or contact Shannon about what they are doing to stay healthy. The sdavis@diabetes.org or 412-824-1181 ext. 4604. ideal audience will be people that you know from Scan & Email Form To: sdavis@diabetes.org your communities. Ambassador volunteers have Fax Form To: 412-471-1315 the opportunity to motivate friends, family and members of the community to join the fight to Mail Form To: American Diabetes Association StopStation Diabetes!

Trainings to become 100 West Square Drive, Suite 1900 an American Pittsburgh, PA 15219 Diabetes Association Ambassador will be held ATTN: Shannon Davis every other month.

Registration Form

Volunteer Center Your involvement as an American Diabetes Association volunteer will help expand community outreach and impact, and inspire healthy living.

Visit http://bit.ly/VolunteerNearYou or http://bit. ly/VolunteerInPA to find volunteer opportunities in your area. „

If you, or someone you know, is interested in serving as an American Diabetes Association Ambassador, please contact Jackie DelAguila at 202-331-8303 ext. 4518 or jdelaguila@diabetes.org.

For more details visit Page 1 of 1 http://bit.ly/VATourDeCure.

PaTH to Health: Diabetes Study Newsletter Team

DESIGNER: Abbey Kinard CONTRIBUTORS: Treva Alston, Angela Evans, Tiffany Gonzalo, Brianna Hoglen, Christy Boling Turer

EDITORS: Treva Alston, Cynthia Bradley, Mully Chea, Angela Evans, Erica Francis, Brianna Hoglen, Jennifer L. Kraschnewski, Julie Tice

EDITOR-IN-CHIEF: Jennifer M. Poger WINTER/SPRING 2017 EDITION | 9

PCORI Diabetes PROJECT

SUMMER/FALL 2016 EDITION

“A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities”

Greetings from the PCORI Diabetes Research Team!

As Principal Investigator on this project, I’d like to welcome you to the first installment of our research study newsletters. In each issue, we’ll be including information about our research study and progress, feature some of the key players that help make this research possible, and provide you and your loved ones with resources and community event information.

Happy reading!

Jennifer L. Kraschnewski, MD, MPH

Executive Director, Penn State PRO Wellness Associate Professor of Medicine, Pediatrics and Public Health Sciences Penn State College of Medicine

HIGH FIVES We would like to give a HIGH FIVE to our patient partners for completing their first Patient Partner Training. This training session was conducted to provide patient partners with an overview of the PCORI diabetes project and their role in it, discuss ethical implications in research studies, and describe some behind the scenes efforts that make research possible. We look forward to future trainings with our patient partners!

Turn the heat up in the kitchen with healthy recipes on page 6-7.

UPCOMING TRAININGS We are very excited to announce our first ever Community Partner Research Ethics Training course to be offered in August 2016 for our patient partners on the project. This will be the first study at Penn State Health Milton S. Hershey Medical Center to utilize this training and certification program adapted from the University of Pittsburgh. We feel strongly that this training will enhance patient-centeredness in research by having our patient partners educated in human participants research and the ethical guidelines that embody best practices.

Looking to get up and out? Visit page 8-9 for community events that help combat diabetes.

Research Study Overview & Update

PCORI Diabetes PROJECT

Our current research study, “A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities” is funded by the Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent, nonprofit organization that envisions a research world that addresses the questions and concerns most relevant to patients, while including them, their caregivers, clinicians and other stakeholders in the research process. We are thrilled to be working alongside our patient partners and stakeholders throughout each phase of our project. To date, we have developed a roster of 9 stakeholders, 3 primary care providers, and 4 patient partners who will be engaged in key research activities, strengthening our project through their perspective and experience.

To give you some background on our PCORI Diabetes project, let’s take a brief look at the literature. You may be aware that overweight and obesity are a big issue in the US. In fact, it’s our number one health concern. Addressing obesity through lifestyle interventions (i.e. healthy eating and increased physical activity) decreases the risk of developing type 2 diabetes, a disease which affects over 29 million people (9.3% of the US population). You may also be aware that diabetes is associated with serious complications, including heart disease, blindness, renal failure and lower extremity amputation. Although complications are preventable with proper medical and lifestyle management, including weight loss, nearly half of patients with diabetes do not have adequate glycemic control.

Recent policy changes and health insurance expansion have resulted in coverage for obesity counseling by Centers for Medicare and Medicaid to improve weight loss for adults either with or at high risk of type 2 diabetes. Beneficiaries whom are obesity are eligible for up to 20 face-to-face visits for weight counseling in the primary care setting. However, whether or not this new benefit has actually helped patients lose weight and better control their diabetes is unknown.

This is where we come in. In our PCORI Diabetes Project, we are going to take a look at Electronic Health Record (EHR) and claims data across 3 states to see if obesity counseling has improved weight and diabetes outcomes. For patients with or at risk of developing type 2 diabetes, are they receiving obesity counseling? If so, is it leading to weight loss and better blood sugar control? These are questions we hope to answer by analyzing the data. We’ll be utilizing the PaTH network, which is an integrated research collaboration between Maryland, Pennsylvania, and Utah, to pull EHR data on over 2 million patients with or at risk of type 2 diabetes. That’s a lot of number crunching!

This project began in early 2016 and is set to continue until the year 2021. Currently, we are seeking out Institutional Review Board approval (IRB) across the universities collaborating in this research: Penn State Health, University of Pittsburgh, Temple University, Geisinger Health System, Johns Hopkins University, & University of Utah.

Our first data extraction is set to be accomplished by September 2016 once we achieve IRB approval. We look forward to keeping you posted on how things are going!

2 | PCORI SUMMER/FALL 2016 EDITION

Primary Care Providers

Patient Partners

Stakeholders Each individual will engage in key research activities, strengthening our project through their perspective and experience.

Style Guide for Internal Audiences

Table of Contents •

Introduction and Purpose

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Using Pitt Public Health in Writing

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The Pitt Public Health Graphic Mark

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Using the Graphic Mark

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Departments, Centers, Programs, and Other Entities

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The University Seal and Signature

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Typefaces, Colors

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Spacing, Size, Design Tips

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Sample Applications

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Tools, Templates, and Training

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Contacts

Pitt Public Health Style Guide

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updated: July 21, 2016

SPOTLIGHT: Team Member Erica Francis, MS

Meet Erica Francis! Erica is currently a senior Project Manager with the Penn State PRO Wellness Center. Her time on the PCORI Diabetes project is spent maintaining communication among all project sites, financial oversight, coordination of project documentation and analyses, and oversight of deliverable completion and reporting. She meets regularly with project management at PaTH to ensure deliverable completion and to help facilitate data extraction. In addition, she communicates with patient partners and stakeholders about upcoming meetings, trainings, or other opportunities for participation in project design to ensure engagement throughout the course of the project.

In addition to this role, Erica is also currently working on multiple community-focused projects, including a regional multi-tiered obesity prevention intervention with the Boy Scouts of America.

With a background in public health and an interest in health promotion, Erica has a passion for engaging communities in healthy lifestyle choices through education and programming.

Erica holds Bachelor of Science and Master of Science degrees in Biomedical Engineering from University of Maryland. In her

spare time, Erica enjoys traveling with her husband and three children.

As a stakeholder in the PCORI Diabetes research initiative, Dr. Hughes envisions an avenue to advance the work of the commonwealth’s Innovation team. For some time, obesity and the resulting health risks have been a dramatic and leading concern in the U.S. As Pennsylvania’s dedication to healthier lifestyles and preventive care increases, the benefits to this shift become more apparent. Specifically, enabling healthier lifestyle choices, encouraging increased activity, and implementing weight management services can all directly work to prevent diabetes and its related detrimental health risks. These elements, along with informed policy decisions and providers who responsibly care for their patients, will help to reverse this life-threatening trend of obesity and diminish the prevalence and likelihood of diabetes.

► Meet Dr. Lauren S. Hughes, one of our diabetes project stakeholders!

Cool Connections

Similarly to many other states, the Commonwealth of Pennsylvania is constantly exploring innovative approaches to transform health and health care delivery. The Commonwealth’s Health Innovation in Pennsylvania (HIP) plan is a comprehensive, multi-stakeholder statewide initiative to improve the health of all Pennsylvanians by redesigning the way we pay for, deliver, and coordinate health and health care services. With a team comprised of the Bureau of Managed Care, Bureau of Health Planning, Health Research Office, the newly-formed Pennsylvania Prescription Drug Monitoring Program (PA PDMP) Office, as well as the Innovation Center staff, the Deputate for Health Innovation is committed to ensuring a healthier Pennsylvania population.

Lauren S. Hughes, MD, MPH, MSc, FAAFP, Deputy Secretary for Health Innovation PCORI SUMMER/FALL 2016 EDITION | 3

PATIENT PARTNER VOICE Meet Julie. A daughter, wife, mother and houseparent to 12 high-school aged girls. Yes, that’s right – 12! Employed at Milton Hershey School for over 28 years and spending over a decade as a part time house parent, Julie and her husband decided 7 years ago to make it a full time gig to care for and guide teenagers who come from various backgrounds and hardships. It’s not a 9-5 job. It’s a commitment, it takes effort, it takes guts; the same qualities that have helped Julie conquer a personal battle with diabetes. Now that she’s on the other side, she shares her wisdom and honest account of what it’s like to fight and overcome.

Diabetes has been a part of Julie’s family history for decades. Both of her parents had Type 2 diabetes. Julie struggled with weight issues for most of her adult life and received her own diagnosis of Type 2 diabetes 12 years ago.

Much like the way her father dealt with diabetes, Julie, too, didn’t pay close attention to her diet or her blood sugar levels until she was in trouble. However, once her son was diagnosed with Type 1 juvenile diabetes, things changed.

“My son is watching what I’m doing.” Julie needed to be a role model for him. Although oral meds were able to control her A1c for some time, her condition worsened and she feared she would need to become insulin-dependent.

“When my blood sugar numbers inched up to the stroke range and there was evidence of adverse kidney issues, I knew I needed a big change.”

Referred to by her husband as the “poster child” for gastric bypass surgery, Julie pursued this intervention and was on her path toward a lifelong healthier lifestyle...one that would take commitment and perseverance. “If you’re at a point where you’re ready to make the change, I highly recommend the surgery. It resets your entire body. You lose a lot of weight really quickly so it’s good emotionally to see results. But you have to be disciplined for the commitment.

There’s no turning back.”

The results were striking – 157 lbs. were shed. “I’m about half of the size I was two years ago. Everything in my life changed. My A1c at time of surgery was 8.2. Now it’s around 5.1.” The surgery was a jumpstart to Julie’s new lifestyle, one filled with healthy eating and exercise. “I have so much energy now. I’m much more capable of doing things now that I couldn’t do before.” Like run 5 miles per day. Did this happen overnight? No. Small steps. “Two years ago I could barely walk to the end of my driveway without getting winded.” Julie started by taking short walks. But soon walks 4 | PCORI SUMMER/FALL 2016 EDITION

Julie's gastric bypass surgery results were striking – 157 lbs. were shed. “Everything in my life changed.

My A1c at time of surgery was 8.2.

Now it’s around 5.1.” turned into jogs and now she has completed 5K and 10K races. Her son has picked up on her healthy eating and exercise. They’ve even run in races together. And the 12 high school girls that Julie looks after? They’ve watched Julie’s transformation over the past two years, many of them struggling with their own weight issues, so this has been an inspiration to them as well. Julie cooks healthy foods for the household and models good habits by starting her day every morning with a 5 mile run. She has even run in some races with the girls. “You’re 25 years younger than me - if I can do it so can you!”

Julie recounts that glorious moment at her primary care provider’s office visit when her diabetes diagnosis was removed. “It was a great day. Not having to worry about that now is a whole different life. No more sleep apnea, no blood pressure meds…I don’t want to ever go back there; the headaches, highs and lows.” But she cautions that she has to work at this every day for the rest of her life. “It’s a lifelong commitment. Gastric bypass is a tool but it only works if you know how to use it and what you need to do to make it work. Watching what you eat, getting exercise.

Otherwise I could end up right back where I was.” Tracking what she eats and how much she exercises in a day keeps her accountable. Blood draws every 6 months keep her accountable. Helping her son with his highs and lows with Type 1 keeps her accountable. Creating a positive home environment for 12 impressionable teenaged girls keeps her accountable.

Julie’s advice for the summer months: “Take advantage of the weather! Get outside for a walk, in the evening when it’s not so hot. Find something that will keep you interested and motivated. Try some healthy recipes for the grill. Don’t try to get 20 years of bad habits rectified in one day. Little changes lead to bigger changes in your health.”

As for Julie, she will keep on running. Running with diabetes far behind her. Running with a healthier, more fulfilling life in front of her. Running towards her next challenge... the Hershey half marathon perhaps?

DOCTOR

MESSAGE

Hemoglobin A1c is a blood test that measures diabetes control.

Typical goals for patients with diabetes are for a hemoglobin A1c of less than 7. However, Dr. Pozefsky, one of our primary care physician partners on our study, warns: “Pushing therapy to [hemoglobin A1c less than 7] in older patients can be dangerous in terms of hypoglycemia.” Your doctor will know the right goal for you!

For more information, check out this recent publication in the Journal of the American Medical Association: Diabetes in Older People Kasia J. Lipska, MD JAMA. 2016;316(3):362 doi:10.1001/jama.2016.2087

► Recent Trends in Diabetes Management

As you may know, sugary drinks are not good for you. Not only can they raise blood glucose in people with type 1 diabetes, they can also contribute to obesity, type 2 diabetes, and heart disease. According to a national survey of 157,668 US adults, nearly one in three Americans still drink at least one sugarsweetened beverage (not including 100 percent fruit juice) per day. People between the ages of 18 and 24, men, African American adults, the unemployed, and those with less than a high school education were most likely to consume the sugary drinks. In this summer heat, opt for water instead!

Source: Morbidity and Mortality Weekly Report, published online Feb. 26, 2016

p

Pass the Water, Please.

Drink this!

Not that.

l

Soda, No Way!

PCORI SUMMER/FALL 2016 EDITION | 5

RECIPE CORNER

Grilled Trout with Fresh Herbs and Lemon Slices Makes: 4 servings Serving Size: 1 trout Preparation Time: 12 minutes Cooking Time: 8 minutes Ingredients 2 Tbsp. fresh mint, finely chopped 2 Tbsp. fresh rosemary, finely chopped 2 lemons 4 whole trout (about 7 oz.), cleaned, gutted, and heads removed (the fishmonger can do this for you) 1 Tbsp. extra virgin olive oil 1/2 tsp. kosher salt 1/4 tsp. black pepper

Recipe by Aviva Goldfarb; photography by RenĂŠe Comet; Photo Credit www.diabetesforecast.org

Summer is here. Let’s Get Grilling! Make dinner easy tonight with this diabetes-friendly grilled trout recipe from Diabetes Forecast (a great resource for healthy recipes!). Visit http://bit.ly/2axjllq for additional details.

Directions Preheat the grill to medium and oil the grates to prevent the fish from sticking. In a small bowl, combine the chopped herbs, the zest of 1 1/2 lemons, and the juice of one lemon. Cut the other lemon into thin slices.

Using a spatula, carefully transfer the trout to a plate to serve. Garnish the plate with a few fresh mint leaves and sprigs of rosemary, if desired.

2

Start the rice and broccoli now, if you are serving them.

Flavor Booster: Season the fish with freshly ground black pepper or lemon-pepper seasoning at the table.

3

Lay the trout on a cutting board, skin-side up, and brush the skin with olive oil to coat it. Flip the fish and rub the lemon-herb mixture over the flesh of the trout. Season the trout with the salt and pepper, and lay the lemon slices on top of one half of each trout.

Close the trout around the herbs and lemon slices, and transfer the fish to the grill.

Tip: Trout has similar health benefits to those of salmon. It is rich in omega-3s, which help to reduce inflammation, decreasing your risk for heart disease, and may also help to decrease sore muscles after exercising.

1

4

Grill the fish with the lid closed, without flipping, for 8 minutes, or until the flesh is opaque and flaky.

6 | PCORI SUMMER/FALL 2016 EDITION

Do Ahead or Delegate: Zest and juice the lemons.

*Try pairing this dish with a delicious Cucumber and Onion Salad recommended by one of our patient partners, Angela Evans. View the recipe on the following page.

RECIPE CORNER

Cucumber and Onion Salad Recommended by one of our patient partners, Angela Evans.

Ingredients: Sliced cucumber

Olive oil

Sliced onion

Drop of Italian dressing

Feta cheese Picture and recipe courtesy of Angela Evans.

Patient Resources Learn all about blood glucose: http://bit.ly/2aDNPDa Learn about your risk for pre-diabetes, type 2 diabetes and heart disease: http://bit.ly/2ax9DBp

Late to NEVER Too CHANGE

For several resources related to diabetes: www.diabetesforecast.org

Photo Credit MediaLoot.com

Endocrinologist Dennis T. Villareal, MD, a researcher at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston, argues that old habits don’t die hard. He is instead finding through his research that older adults are willing and motivated to make lifestyle changes for better diabetes control.

He has coupled intense counseling and education with exercise programs specifically designed for older adults with type 2 diabetes and is finding promising results; older adults are very motivated to replace old habits with healthier ones to improve their diabetes control and overall well-being. “We find that they are very motivated to change lifelong habits. They demonstrated significant weight loss and successful compliance,” says Villareal. Implications of these findings in the community setting are explored.

Read the full article here: http://bit.ly/2aRdprN PCORI SUMMER/FALL 2016 EDITION | 7

COMMUNITY EVENTS What’s Your Type?

Diabetes Meet and Greet Picnic Sunday, June 5, 2016 Lakeview Shelter, North Park 10:00 am—2:00 pm

Come meet other people living with diabetes and take advantage of the great resources the American Diabetes Association has to offer!   

Talk to medical professionals from the Pittsburgh area Representatives from major pharmaceutical companies

Hike and bike ride sponsored by the Pittsburgh Step Out: Walk to Stop Diabetes and Tour de Cure 

Meet other people living with diabetes! 

Food, drinks, music, and more!

RSVP to Shannon at sdavis@diabetes.org or by calling 412-824-1181

What’s Your Type?

Diabetes Meet and Greet Picnic

2016 Baltimore Step Out Walk to Stop Diabetes DATE: Sunday, October 2, 2016 TIME: 8:00 AM - 4:00 PM LOCATION: Canton Waterfront Park, 3001 Boston St., Baltimore, MD 21224 Step Out to do your part to Stop Diabetes® and take steps to improve your health! To register visit www.diabetes.org/stepoutbaltimore. This event does not require an RSVP.

Sunday, June 5, 2016

What’s Your Type?

Diabetes & Greet Picnic Lakeview Shelter,Meet North Park 10:00 am—2:00 DATE: Sunday, August 21, 2016 pm Come meet other people living with TIME: 10:00 AM - 2:00 PMdiabetes and take advantage of the great resources the American Diabetes Association has to offer!

LOCATION: North Park - Lakeview Shelter, Talk to medical professionals from the Pittsburgh area Northridge Representatives Drive, Allison Park, PA 15101 from major pharmaceutical companies 





Hike and bike ride sponsored by the Pittsburgh Step Out: Walk to Stop Diabetes and Tour de Cure

Meet others living with diabetes and take advantage Meet other people living with diabetes!

Food, drinks, music, and more! of the resources the American Diabetes Association to Shannon at sdavis@diabetes.org or by calling 412-824-1181 has toRSVP offer.

Talk to medical professionals from the Pittsburgh area and representatives from major pharmaceutical companies. Enjoy a hike, bike ride, food, drinks, music and more. For more information or to RSVP - email Shannon at sdavis@diabetes.org or call 412-824-1181. 



2016 Pittsburgh Step Out Walk to Stop Diabetes DATE: Saturday, October 1, 2016 TIME: 9:00 AM - 12:00 PM LOCATION: South Side Works, 412 S. 27th St., Pittsburgh, PA 15203 Celebrate the 25th Anniversary of the Step Out: Walk to Stop Diabetes. Help take steps towards improving health and changing the future for those affected by diabetes. For more information call 412-824-1181 or visit: www.diabetes.org/pittsburghstepout or www.facebook.com/stepoutpittsburgh.

8 | PCORI SUMMER/FALL 2016 EDITION

CEOs Stopping Diabetes DATE: Thursday, November 3, 2016 TIME: 8:00 AM - 12:00 PM LOCATION: Four Seasons Baltimore, 200 International Drive, Baltimore, MD 21202 For the past two years American Diabetes Association (ADA) has partnered with Greater Baltimore Committee (GBC) to combat diabetes in the workplace with our CEOs Stopping Diabetes Initiative. The ADA’s CEOs Stopping Diabetes Initiative is the first step in an ongoing effort to engage CEOs actively in promoting workforce wellness. CEOs Stopping Diabetes will engage leaders closely in strategies to enhance workforce wellness that are specifically geared to reducing the incidence of diabetes in the workforce. The program provides a simple leadership strategy and resources to inspire healthy behaviors in the workplace and to reward these behaviors both internally and externally. Each leader who signs on to participate in this program will, in effect, declare his or her personal commitment to stop the rising incidence of diabetes. For more information on contact David McShea at dmchsea@diabetes.org or 410-265-0075 ext 4675 To register or for free tools, resources and communications to combat diabetes in your workforce visit http://bit.ly/2ayXlGU.

COMMUNITY EVENTS

2016 Philadelphia Step Out Walk to Stop Diabetes DATE: Saturday, November 5, 2016 TIME: 8:00 AM - 12:00 PM LOCATION: Philadelphia Museum of Art, 2600 Benjamin Franklin Parkway, Philadelphia, PA 19130 Step Out: Walk to Stop Diabetes - Philadelphia presented by Merck is one of the American Diabetes Association’s signature fundraising events, to help raise money to find a cure for nearly 29 million Americans living with diabetes and to help improve their lives. Meet us at the steps at of the Philadelphia Museum of Art to participate in a fun 5K walk. New this year is our official timed 5K run! Participants register and recruit co-workers, friends and family members to walk and raise money. The day of the event is a party to celebrate the fundraising accomplishments of our teams and individual participants as well as an opportunity to promote awareness about diabetes in the local community.

To register for the walk or for more information, visit www.diabetes.org/stepoutphilly. This event does not require an RSVP.

2016 Bridge to Wellness Expo DATE: Saturday, November 5, 2016 TIME: 9:00 AM - 3:00 PM LOCATION: David L. Lawrence Convention Center, Halls D&E, 1000 Fort Duquesne Blvd., Pittsburgh, PA 15222 The 2nd Annual Bridge to Wellness (BTW) Expo will focus on wellness information, health resources and interactive experiences. Bridge to Wellness provides a forum for intensive exchange of questions and answers about health issues, proactive measures, wellness and where necessary, disease-state prevention and management. Focus areas for Bridge to Wellness include: Diabetes: Prevention, Managements, Eyes, Feet, Kidneys, and Heart Health; Active Lifestyles; Back Care; Respiratory Issues; Cancer Prevention; Dental and Oral Health; Stress Management; First Aid & Emergency Preparedness; Substance Abuse; Tobacco Cessation; Recreational Safety; Humor & Health Benefits; Women’s/Men’s Health Issues.

Explore your community, wellness lives here.

Visit www.diabetes.org for more events.

EVENT CALENDAR

RECIPES

WELLNESS

FITNESS

PCORI SUMMER/FALL 2016 EDITION | 9