Saving Lives by Training the Public Health Workforce in Diabetes Prevention

December 10, 2021

A Look at Emory’s Diabetes Training and Technical Assistance Center

By Kayleigh Jones

Ten years ago, Linelle Blais, PhD, and her team at Emory University's Diabetes Training and Technical Assistance Center (DTTAC) held its first lifestyle coach training, preparing 15 people to deliver the Centers for Disease Control and Prevention (CDC)-recognized lifestyle change program. The lifestyle change program is a key feature of the National Diabetes Prevention Program (National DPP), a partnership of public and private organizations working to prevent or delay type 2 diabetes. The partners work to make it easier for people with prediabetes or at risk for type 2 diabetes to participate in evidence-based, affordable, and high-quality lifestyle change programs to reduce their risk of type 2 diabetes and improve their overall health. The lifestyle change program is a research-based program focusing on healthy eating and physical activity which demonstrated that people with prediabetes who take part in a structured program with a lifestyle coach can cut their risk of developing type 2 diabetes by 58 percent (71 percent for people over 60 years old).

Lifestyle coaches implement the lifestyle change program with a CDC-approved curriculum and provide support and guidance to participants in the program. While lifestyle coaches may have credentials (e.g., registered dietitians, registered nurses, pharmacists, certified diabetes care and education specialists), a health care background is not required. Lifestyle coaches are able to lead a lifestyle change program after completing a quality-assured lifestyle coach training, like the one offered by DTTAC.

Inaugural Partners

DTTAC is one of four centers at the Emory Centers for Public Health Training and Technical Assistance (Emory Centers) at the Rollins School of Public Health. Emory Centers’ mission is to advance public health practice through capacity building of the public health workforce. Originally funded by the CDC to adapt their Tobacco Training and Technical Assistance Consortium (TTAC) to diabetes, DTTAC became an inaugural partner with CDC and the Y of the USA in training and amplifying a nationwide workforce to scale the National DPP. Specifically, from 2009 to 2011, DTTAC was a key partner in adapting the lifestyle change curriculum used in the original DPP study for group-based nationwide delivery. With the CDC’s official launch of the National DPP in 2012, DTTAC became the first national training entity to develop and deliver training for lifestyle coaches.

“That first lifestyle coach training was a momentous occasion, and we all knew it,” says Sarah Piper, MPH, CDCES, and center director of DTTAC. “We felt that we were a part of something important in public health and diabetes prevention. I was excited to be at the forefront of mobilizing a nationwide movement in type 2 diabetes prevention. I think it is safe to say that our DTTAC lifestyle coaches and DTTAC master trainers still feel that urgency and passion for the cause.”

Scaling Prevention & Expanding Reach to All

Since 2011, DTTAC has trained over 5,000 lifestyle coaches from all 50 states, Puerto Rico, the US Virgin Islands, and other countries like Canada, Mexico, India, and more. DTTAC-trained lifestyle coaches have continued to deliver the National DPP in over 2,000 unique organizations around the US, including health care systems, nonprofits, state and local health departments, government organizations, tribal communities, corporate organizations, faith-based organizations, pharmacies, and more. In the decade since that first training, DTTAC has played a pivotal role in the development and scaling of the National DPP.

“The authorization by Congress in 2010 to establish the National Diabetes Prevention Program in the US was nothing short of a watershed moment for scaling prevention efforts in public health,” says Blais, executive director of Emory Centers for Public Health Training and Technical Assistance. “Public and private partnerships joined forces to build a nationwide delivery system for the lifestyle change program through organizations nationwide and to sustain that system through public/private payer coverage. The Medicare DPP is an outgrowth of this collective action. Emory Centers is proud to have provided thought leadership and community-informed services to support the scaling, adaptation, and evolution of the National DPP in real-world practice. Our DTTAC Master Trainer SelectTM program, DTTAC Spanish Lifestyle Coach Training and materials, DTTAC Advanced Learning, and our virtual delivery models and online learning communities are evidence of our innovation in response to that evolution.”

Ongoing skill development and adaptability of the public health workforce are essential for program sustainability. With the creation of the DTTAC Master Trainer SelectTM program in 2014, large organizations and networks have DTTAC train their own in-house lifestyle coaches for a more sustainable and cost-effective program, while receiving ongoing quality control and technical assistance from DTTAC. In partnership with CDC and the National Association of Chronic Disease Directors, DTTAC has developed a State Quality Specialist program for state departments of health across the nation. Its goal is to strengthen the capacity of frontline public health professionals to approach partnerships with community organizations that support the National DPP.

DTTAC has continued to innovate and expand its training approaches to serve diverse audiences, including Spanish-speaking coaches, rural communities, and tribal groups. Over the past 2 years, DTTAC has reached over 600 trainees with a four-part webinar series on health equity, providing education and applied learning on equitable National DPP delivery. Being at the forefront of virtual delivery of training and technical assistance has also allowed DTTAC to further its reach in rural communities and to effectively respond to barriers related to the COVID-19 pandemic, guiding CDC and community delivery organizations on how to adapt and sustain their National DPP programs.

“As the world of diabetes and diabetes prevention research continues to advance and evolve, so does the [National DPP] program,” says Arlene Becker, a registered dietitian, and DTTAC national master trainer since 2011. “I appreciate DTTAC staying up to date on all aspects affecting the risk for developing type 2 diabetes. Making the information culturally relevant, meaningful, interesting, and appealing for different types of learners is invaluable. The program keeps getting better as we continue to reach out into communities with this important message of prevention.”

DTTAC at Emory University

The pace of National DPP advancement has provided DTTAC with the opportunity to partner with Emory’s Georgia Center for Diabetes Translation Research (GCDTR) in an implementation science research project with Mary Beth Weber, PhD, MPH, and Olivia Manders, of the Hubert Department of Global Health, and Lillian Madrigal, PhD candidate in behavioral, social, and health education sciences to investigate the characteristics of lifestyle coaches, master trainers, and organizations that influence quality training delivery and participant outcomes. Funded by the CDC, the findings from this mixed-methods research will allow DTTAC to develop enhanced training and technical assistance services that improve community prevention practices and save lives.

“The importance of diabetes prevention to America’s health has never been more clear for two inter-related reasons,” says Mohammed K. Ali, MD, MSc, MBA, associate professor of global health and epidemiology at Rollins and associate director of GCDTR. “First, we are at a critical juncture where diabetes and its impacts on the health and economies of families, communities, employers, and insurers have reached dire proportions. And second, with nearly 90 million Americans at risk of developing diabetes, the odds are high that these trends will continue. This is why the work that DTTAC has done in the past decade is so critical to the next decade of scaling these efforts severalfold to meet the needs of the country and improving the metabolic health of America.”

Since 2019, DTTAC has partnered with Healthy Emory, a program for Emory employee health and wellness, to implement the National DPP as a wellness benefit to all eligible Emory employees. Learn more about the National DPP delivered for Emory University and Emory Healthcare employees at risk for type 2 diabetes, and find out how you might participate as a Lifestyle Coach for Emory’s diabetes prevention program.