MOKA launches Diabetes Prevention program

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Keli’s health journey serves as inspiration 

When Keli started on her health journey to reverse prediabetes, she weighed over 200 pounds, felt fatigued when she walked and often felt hungry even after meals. She showed signs of prediabetes for years, confirmed by A1c levels, and had complex health issues along with challenges interacting with others.

Thanks to regular exercise and dietary changes, Keli’s blood sugar is within the high normal range. She has lost over 40 pounds since December 2019, buying into a healthier lifestyle and maintaining it. She’s also made great strides to build relationships with staff members and her housemates.

Keli’s health transformation has been so impressive it’s made the Belmont Woods team responsible for motivating her a little envious – and also proud.

“Seeing someone lose 43 pounds and you’re gaining 2 to 5, you start to think ‘I need someone to follow me to do these things,’” says Home Supervisor Everlyne Biboko. “Other than weight, relationship wise she has a roommate. Nobody ever thought she would share a room with someone.”

Keli is a shining example of the benefits of early intervention and prevention of diabetes. Improving health care outcomes of individuals in MOKA’s residential homes has been a priority for a few years, says DeeAnn Hands, MOKA’s Clinical Care Coordinator, noting that individuals with an intellectual or developmental disability (IDD) diagnosis are underserved by medical professionals due to their complex health care needs.

MOKA wanted to target diabetes prevention because of the number of individuals at risk, along with the health care costs and employee time associated with diabetes management. With the backing of a two-year, $40,000 grant from The Wege Foundation, MOKA employees had the time and resources to develop a formal program for residential homes in four counties.

“We already had some of the material we wanted to act on, but we didn’t necessarily have the resources,” DeeAnn says. “We also had great support from the residential support staff who themselves were learning more about diabetes and seeing some of the risk factors and really advocating for individuals that they support in the group home to receive some equity in treatment and care.”

Prior to the grant, MOKA administered a survey to individuals or their guardians or support staff members in residential homes to get an idea of who either had Type 2 diabetes or was at risk of developing it. The survey, which follows CDC guidelines, is now part of the admissions process and looks at lifestyle factors, medical diagnoses, genetic risk factors, weight, blood pressure, and the use of psychiatric medications, which can increase the risk for developing Type 2 diabetes.

The second component of the program focuses on educating residential support staff about diabetes risk factors, getting them to implement and encourage lifestyle changes around diet and exercise, and speaking up to health care providers about health concerns. MOKA is implementing the training and interventions home by home, with about a third of the 32 residential programs participating so far.

“We’ve not reached all of the homes, but we will over time,” DeeAnn says. “We do not have a single home that doesn’t either have somebody with Type 2 diabetes or at risk for Type 2 diabetes.”

Residential support staff members provide 24-7 care, often taking individuals to doctors’ appointments and planning meals and activities. They also have an advocacy role when health issues aren’t being addressed.

“It isn’t that diabetes is more prevalent; it’s really that it’s undertreated in folks who have that (IDD) diagnosis,” DeeAnn says. “We identify a lot of people who have those symptoms of diabetes Type 2, and we have to get into fairly lengthy conversations and activities to even get lab work drawn to get that identified or diagnosed because without a diagnosis treatment isn’t going to occur.”

Everlyne identified three residents she was concerned about and reached out to DeeAnn to prioritize her home and get interventions underway. As home supervisor, Everlyne worked hard to find a primary care physician to address Keli’s multiple health concerns.

Belmont Woods’ residential employees did their own research and education and started to implement interventions on their own. “I feel like, in a lot of ways, I was more supportive of their efforts than leading their efforts,” DeeAnn says. “I was really impressed with that team, and the whole team was on board with that.”

Besides Keli’s prediabetic state, she experienced tooth decay and other infections that required ongoing antibiotics. Her health continued to decline until the Belmont Woods’ team sought out a new doctor.

Keli’s new primary care physician took her diabetes risk factors seriously and also removed or changed medications that were unnecessary. Many psychiatric medications block the feeling of satiety, or fullness after a meal, which causes people to seek out food and overeat, DeeAnn says.

The Belmont Woods staff members changed the home’s menu, replacing carbohydrates with healthier fruits, vegetables, and protein. The dietary changes benefitted all the home’s residents, but Keli’s entire personality has changed.

“For her and the other individuals, once your weight goes down and you eat healthy, I think many things fall into place in life, just everything falls in its right place,” Everlyne says. “We work on exercise. We work on diet. We engage them and help them stay active to live their best life.”

The home’s employees talked Keli through the changes to her diet and engaged her when she was bored. They encouraged her on the treadmill, accompanied her on walks and hikes, and joined her in dance parties.

“Even when she’s struggling, those hard times when she has high anxiety, the staff has been resilient to give her a break or say ‘how about we do this,’” Everlyne says. “Once she does exercise, she is so friendly.”

Keli used to dislike exercise, but now she has a consistent workout routine and walks on the treadmill twice a day. Her goal weight is around 150, and she is well on her way to reaching it.

“She watches all the Disney movies while she is on the treadmill, so it’s kind of fun for her,” says Shameka Tims-Mosley, Residential Support Staff.

But if Keli doesn’t feel like it, they suggest she exercise after a nap or go for a walk or dance with her. She also likes riding the stationary bicycle at the YMCA.

“For me, I would go for a walk with her, or I would just dance with her,” says Amy Wheaton, Residential Support Staff. “If you dance with her, that builds that relationship with her.”

The Belmont Woods team rallied behind Keli with support and encouragement. The employees acted as cheerleaders, praising her for her weight loss and boosting her self-confidence. Keli also saw the benefits as she started walking for longer periods of time at a higher level.

“Her walk used to be very unsteady,” says Amy. “We used to go hiking and she just couldn’t do it because of the uneven ground; she couldn’t keep up with peers.”

“And now, she’s able to even jog for short periods of time,” notes Shameka.

The employees talk to Keli like they would each other and explain to her why they are recommending certain diet and lifestyle changes. She has seen the fruits of those changes in the form of new clothes and increased energy.

“When you explain to her what she’s going to miss out on or what she’s gaining, she appreciates that because it’s going to work to her benefit,” says Shadrack Owuor, Residential Support Staff.

Along with her health, her relational skills have come a long way. Keli now eats with other individuals, has a roommate, and wants to help employees around the home.

“Keli is also very affectionate,” Shameka says. “So, if she does not want to do something and bursts out crying, we rub her back or give her a hug or tell her we care about her and tell her we love her and give her that affection, and then she’s ready.”

Everlyne gives a lot of credit to the Belmont Woods’ employees for their consistency, resiliency, and empathy. They treat Keli like family and show her love and compassion.

Each employee has worked to build a relationship with Keli and shown flexibility in how they communicate and interact with her. It is the basis for Keli’s success.

“It’s more of a holistic approach to her health, to her life,” Everlyne says. “Part of her success story is the fact that you can reason with her and she can listen.”

Story by Marla Miller. Photo by Lara Parent.