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System Change for Health Integration in the Delivery of Diabetes Prevention

Creating an efficient and sustainable ecosystem to address prediabetes and prevent diabetes in Wisconsin

Full Project Name:System Change for Health Integration in the Delivery of Diabetes PreventionPrimary Community Organization:YMCA of Metropolitan MilwaukeePrimary Academic Partner:David Nelson, PhD, Family MedicineAward Amount:$199,539
Award Date
July2022
Project Duration:18 months

Project Description Narrative:


Research conducted by the National Institutes of Health has shown that programs like the YMCA's Diabetes Prevention Program (DPP) can reduce the risk for type-2 diabetes across a diverse group of high-risk adults, regardless of age, gender, and ethnic group.

The YMCA of Metropolitan Milwaukee has partnered with the Wisconsin Department of Health Services to develop a collaborative network to create a sustainable environment for diabetes prevention programming in Wisconsin. The YMCA and the Medical College of Wisconsin will establish a system that advances health equity by using social determinants of health screening for all enrollees in the DPP.

This framing will help the YMCA's partners, and the organization itself, better understand how to serve marginalized and historically underserved populations, particularly prioritizing the needs and priorities of Black, Indigenous, and People of Color communities in Wisconsin.

Community partners: Advocate Aurora Health, Laine Strategies, National Association of Chronic Disease Directors, Wisconsin Department of Health Services Division of Public Health, YMCA of Metropolitan Milwaukee, YMCA of Northern Rock County, YMCA of Racine, YMCA of Sheboygan County, YMCA of Superior Douglas, YMCA of Waukesha County

Project Updates:


  • Established an umbrella hub organization with three subsidiaries to serve as the core of the systems change for health integration
  • Received Medicare approval for the YMCA to become a Medicare Diabetes Prevention Program
  • Established robust networks of healthcare systems

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