Geographic Access to Diabetes Prevention Programs in New York State

BACKGROUND:   New York State’s (NYS) Division of Chronic Disease Prevention has supported the delivery of the Diabetes Prevention Program (DPP) through community-based organizations across the state. The DPP is a 16-week lifestyle change program designed to prevent or delay type 2 diabetes in adults who are at high risk for the disease.  In 2009, 10 YMCA sites across the state were selected to deliver the program.  In subsequent years, additional community-based organizations developed capacity to deliver DPP. The goal of the New York State DPP is to establish partnerships that serve as a statewide delivery system offering effective, accessible and affordable diabetes prevention programs.

METHODS:   Geographic information systems (GIS) analysis was used to identify counties with high pre-diabetes risk factor composite scores based on county-level prevalence of obesity, physical inactivity, hypertension, and diagnosed diabetes. The score was calculated using data from the 2008-09 NYS expanded Behavioral Risk Factor Surveillance Survey (eBRFSS) and the 2009 NYC Community Health Survey. Spatial network analysis was used to calculate 30-minute drive-time buffers around existing DPP sites. Tract-level data from the 2010 Census was used to calculate the percent of the NYS population living within the buffers. Potential DPP sites were identified using 2011 data indicating the locations of Federally Qualified Health Centers, Independent Living Centers, and Area Agencies on Aging.

RESULTS:   In 2010, over 15.5 million New Yorkers, including 12 million adults over the age of 18, could drive or be driven to an existing DPP site within 30 minutes. Although approximately 80% of New York’s population resides within a 30-minute drive time to a DPP, the majority of the people living in 10 of the counties with the highest prediabetes risk factor score live at a distance beyond a 30-minute drive to an existing site.

CONCLUSIONS:   The expansion of DPP sites through additional community-based facilities would improve access to prevention programs in communities with high pre-diabetes risk factor profiles, and facilitate the improvement of community-clinical linkages across the state to sustain prevention efforts for type 2 diabetes. The NYS Department of Health has used information from GIS analysis to identify areas with limited access to DPPs, and encourages key partners to locate programs in community-based organizations serving those at-risk populations.