A Template for Better Health: Diabetes Prevention Toolkit

A Template for Better Health Diabetes prevention program toolkit designed to make Extension health education more effective

By Vanessa da Silva (with Rose Hayden-Smith & Heather Martin)


A Template for Better Health: Diabetes prevention program toolkit designed to make Extension health education more effective

Copyright © Extension Foundation Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). Published by Extension Foundation.

ISBN: 978-1-955687-18-8

Publish Date: 08/23/2022

Citations for this publication may be made using the following:

Da Silva, V. Kansas City: Extension Foundation (2022). A Template for Better Health: Diabetes Prevention Program Toolkit Designed To Make Extension Health Education More Effective (1 st ed). ISBN: 978-1-955687- 18-8

Producer: Ashley S. Griffin

Peer Review Coordinator: Rose Hayden-Smith

Technical Implementers and Co-writers: Rose Hayden-Smith, Heather Martin

Production: Rose Hayden-Smith

Welcome to A Template for Better Health: Diabetes prevention program toolkit designed to make Extension health education more effective , a resource created for the Cooperative Extension Service and published by the Extension Foundation. We welcome feedback and suggested resources for this publication, which could be included in any subsequent versions. This work is supported by New Technologies for Agriculture Extension grant no. 2020-41595-30123 from the USDA National Institute of Food and Agriculture. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the U.S. Department of Agriculture.

For more information please contact:

Extension Foundation c/o Bryan Cave LLP One Kansas City Place

1200 Main Street, Suite 3800 Kansas City, MO 64105-2122 https://extension.org/



Vanessa da Silva, PhD, RD

Soghra Jarvandi, MD, MPH, PhD

Extension Specialist University of Arizona

Associate Professor, Health Specialist University of Tennessee

Jennifer Brown, MS

Zena Edwards, MS, RDN

Extension Associate Professor Food Safety & Nutrition Washington State University Clark County

Nutrition Extension Specialist North Carolina State University

Carlin Rafie, PhD, RDN

Alison Berg, PhD, RDN, LD

Associate Professor and Extension Nutrition and Health Specialist University of Georgia

Assistant Professor and Extension Nutrition and Health Specialist University of Vermont


One in 10 people in the United States lives with diabetes, the seventh leading cause of premature death in the country. And it’s estimated that nearly 100 million American adults have prediabetes — t hat’s nearly one in three people. Addressing this public health crisis is the driving force behind an online toolkit developed by a team of Extension professionals across the country, led by an Extension Specialist at the University of Arizona. Their goal is to help Extension professionals everywhere launch a Centers for Disease Control and Prevention (CDC)-recognized Diabetes Prevention Program (DPP) easily and quickly.


“A Growing Health Problem”

Ten years ago, the CDC launched the National DPP, designed to be delivered by health providers and educators, to try to address this growing health problem. Research has proven that the National DPP can be highly effective, but the program has yet to reach many of the people who need it most, many of them in rural and medically disadvantaged communities. As a key provider of health education, especially in underserved areas, Cooperative Extension is in a prime position to bring this lifestyle change program to those at highest risk for this chronic disease, including those already diagnosed with prediabetes (higher than normal blood sugar), which increases the risk of type 2 diabetes, heart attack, and stroke. Although prediabetes can be detected through simple screening, it’s often undiagnosed and roughly 8 out of 10 people with prediabetes don’t know they have it. But because of the CDC’s implementation requirements for the DPP and the program’s complexity, many Extension professionals may feel like they don’t have the time or resources to implement it. This toolkit is designed to make it easier for Extension professionals to provide the DPP in their communities. The idea for this toolkit was born in 2017, when Extension professionals from several southern states came together to apply for CDC funding to support an effort to scale up the DPP throughout Extension, across the “diabetes belt . ” The funding was not awarded, but the group remained intact and grew to include Extension peers from across the country. The group members agreed that they had had a toolkit like this, it would have saved them a lot of time, so the DPP toolkit team began pooling its lessons learned, tips, sample budgets, recruitment materials, etc. These resources became the basis of a website, which has recently been revamped.

The DPP toolkit now includes these resources:

program startup checklists

webinars to help state Extension services promote diabetes prevention classes and retain participants surveys to measure the effectiveness of classes

guidelines for delivering the program remotely

a discussion board for connecting with other DPP leaders


Future versions may offer the following:

case studies about success in implementing best practices a roadmap for fast- tracking DPP implementation

implementation manuals

templates/steps for reporting outcomes to the CDC newsletter/text templates for communicating with DPP participants guidance for getting Medicare reimbursement a bilingual version of the toolkit

(See “Tools in the Toolkit” for the resources the website now includes.)

The DPP toolkit team’s work has been influenced by Cooperative Extension’s National Framework for Health and Wellness, published in 2014, and the National Framework for Health Equity and Well-Being, published in 2022, which is organized around the themes of health equity, social determinants of health, and working


through coalitions to increase community health assets. This framework provides an important rationale for the team’s work and inspires the team to think about what it does in bigger and broader ways.

Planned Outcomes

Reducing the incidence of type 2 diabetes is the primary purpose of this program. The DPP toolkit developers hope to see an increased number of Extension professionals getting the funding to deliver a DPP and being fully recognized by the CDC for their diabetes prevention work. The DPP toolkit team also hopes to see an increased number of Extension teams applying to be Medicare suppliers for the DPP, which is uncharted territory for

The DPP toolkit team also hopes to see an increased number of Extension teams applying to be Medicare suppliers for the DPP.

Extension that offers tremendous cost-recovery potential. The developers and the national Extension DPP coalition to which they belong also are working to aggregate their data and show collective impact across Extension. Qualitative data will be important, too, because diabetes prevention work is human work. If the toolkit team can gather video stories, testimonials, and case studies from participants and educators, it can put human faces on the program, sharing testimonials with potential program participants, with Extension educators, directors, and administrations, and with legislators and other stakeholders. This kind of input could go a long way toward demonstrating the impact of this work.

The Future of the DPP

There may be opportunities for Extension to scale the DPP by identifying and tapping into partnerships and funding models it doesn’t traditionally access. Establishing a national collaboration with the CDC could accelerate the opportunity to scale in a sustainable way. Partnering with state health departments is another model a few states have used successfully.

One strategy worth exploring is for Extension programs to become Medicare DPP providers to receive insurance reimbursement for programmatic work. This is a novel approach and would be a large undertaking. Another would be to have a single state complete the process and model it for others. Yet another approach might be to collaborate with the CDC in other ways. A model for this may exist in the Extension Collaborative on Immunization Teaching and Engagement (EXCITE) program. Created in response to the COVID-19 pandemic, the program represents a partnership between the Extension Foundation and the Extension Committee on Organization and Policy, through an interagency agreement with the USDA National Institute of Food and Agriculture and the CDC. The EXCITE program is open to all land grant universities and addresses some of the critical challenges in diabetes prevention work: health literacy, health disparity, and access to healthy lifestyle education.


Digital hubs and toolkits have become increasingly popular, effective conduits for valuable, researched-based content that can make a measurable difference for Extension’s target audi ences. The DPP toolkit is still a work in progress, and the team looks forward to getting peer feedback that will help enhance and expand this important resource.


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