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Collaborating to combat diabetes

More than half of the adults in Monterey County have prediabetes or diabetes, a figure so alarming that a unique coalition, Monterey-Salinas Healthcare Collaborative’s Diabetes Initiative, was formed to attack the problem from a united front.


  • Community Hospital of the Monterey Peninsula and its nonprofit parent, Montage Health
  • Salinas Valley Memorial Healthcare System (SVMHS)
  • Community Health Innovations, a sister company to Community Hospital that is partly owned by SVMHS
  • Monterey Bay Independent Physician Association, a group of more than 525 local doctors

“Leaders of these organizations came together and said ‘We’re going to move the dial on the impact of diabetes, one of the biggest health issues we have’”
Dr. Anthony Chavis, chief medical officer of Montage Health.

Monterey County’s public health director has described diabetes as a local epidemic: 13 percent of the county’s adult population, 28,000 people, has diabetes; and 45 percent, 105,000 people, has prediabetes, often a precursor to the disease. Both figures are above national averages.

“The good news is that, in many cases, diabetes can be prevented; and a primary goal of the collaborative is to connect at-risk people with programs that have been proven to do just that,” says Terril Lowe, RN, chief nursing officer of Montage Health. “The partners have been meeting for more than a year, reviewing what programs and services were already available, looking at what is working elsewhere, and figuring out the best approach here and devoting resources to it.”


  • Recruiting three endocrinologists, doctors who specialize in diabetes, to address a local shortage (two, Dr. Leonard Sanders and Dr. Resmi Premji, are at Montage Medical Group’s office in Marina)
  • Recruiting and reassigning nurse practitioners, registered nurses, and registered dietitiansto work specifically on diabetes
  • Hiring a Diabetes Initiative coordinator, Jordan Johnson, a registered dietitian and certified diabetes educator, to help direct and implement the growing efforts
  • Hiring a pediatric wellness coach, Taylor Gann, to work with children and their families to establish good nutrition and exercise habits early
  • Partnering with others in the community, including the Central Coast YMCA, which offers a nationally successful program to address prediabetes
  • Launching a new Community Hospital class, Diabetes Self-Management Therapy, to help people learn to manage the disease and prevent complications

Community Hospital is tackling diabetes inside the hospital and out. The hospital has advanced certification in inpatient diabetes care from the Joint Commission, and its outpatient diabetes program is recognized by the American Diabetes Association for quality self-management education and support. For the community, that means Community Hospital is focused on reducing new cases of diabetes and helping those who already have the disease manage it successfully.

The risks of not managing the disease can be dire. People with diabetes have much higher risks than the general population of other diseases and complications:

  • 1.7 times higher death rates from cardiovascular disease
  • 1.8 times higher rates of heart attacks
  • 1.5 times higher rates of stroke
  • 33 percent have eye disease, with increased risk of blindness
  • Greater risk of kidney failure
  • Greater risk of leg amputations due to poor circulation

The most effective ways of reducing the risks of diabetes are basic and well-known: a healthy diet, exercise, a healthy weight, no smoking, and moderate alcohol consumption. But for many people, that’s easier said than done, says Chavis.

“It’s not really about us knowing what to do,” says Chavis. “Sometimes it’s just very difficult to carry out — for a lot of reasons, including social, environmental, and economic challenges, or simply thinking we are too busy.”

Ways to reduce risks of diabetes

But even small steps can make a difference. Studies have shown that people at risk for developing diabetes can delay or even prevent it with modest weight loss through diet and exercise. The National Diabetes Prevention Program, which the YMCA offers at many locations, including Monterey and Salinas, found that people who made certain lifestyle changes cut their risk of developing type 2 diabetes, the most common in adults, by 58 percent. People over 60 cut it even more — by 71 percent. Participants lost 5–7 percent of their weight through healthier eating and spent about 150 minutes, less than three hours a week, on physical activity.

Because of the Diabetes Prevention Program’s effectiveness, the Diabetes Initiative is working to make it available to as many people as possible, either in person or online. A growing number of insurance companies pay for the cost of the program, including Aspire Health Plan, Anthem Blue Cross, and Central California Alliance for Health. Together, they insure about 60 percent of Monterey County residents.

Next steps for the Diabetes Initiative include continued development of local hospital programs, closer work with doctors to encourage referrals to the diabetes prevention programs, increased community education, creation and support of prenatal education resources, and partnerships with schools and daycare providers.

“Our goal is to reach everyone who can benefit, with a range of programs and services,” Lowe says, “so that people can find an approach that works for them, at a time and in a place that works for them.”
Terril Lowe, RN, chief nursing officer of Montage Health


Type 1 diabetes
Your body does not make insulin, which takes the sugar (glucose) from the foods you eat and turns it into energy for your body.

Type 2 diabetes
Your body does not make or use insulin well. You may need to take pills or insulin to help control your diabetes. Type 2 is the most common type of diabetes.

Your blood sugar level is higher than normal but not yet high enough to be type 2 diabetes. Without lifestyle changes, people with prediabetes are very likely to progress to type 2 diabetes.

Gestational diabetes
Some women get this kind of diabetes when they are pregnant. Most of the time, it goes away after the baby is born. Even if it goes away, these women and their children have a greater chance of getting diabetes later in life.



Diabetes Self-Management Therapy
This 10-hour class series teaches individuals and families day-to-day skills needed to live a healthy life with diabetes. We will help you understand the type of diabetes you have, the role of blood glucose monitoring in managing your diabetes, meal planning, nutrition for a healthy heart, and the benefits and side effects of your medications. You will also get tips for stress management and problem-solving.

Diabetes and Nutrition Therapy program:

  • Individual appointments
  • Diabetes and pregnancy: information about gestational diabetes
  • Insulin pump training
  • Continuous glucose monitoring
  • Weigh of Life: Diabetes prevention practices are part of this 12-week class aimed at changing behaviors to achieve permanent weight loss
  • Topics in Diabetes: A free monthly discussion on the latest about diabetes, led by experts including endocrinologists, podiatrists, and nutritionists
  • Diabetes Support Groups: Learn from others in these free monthly sessions in Monterey and Seaside

Find information at

Online risk assessment
Take our free online assessment at By answering some questions, we can help determine whether you are at high, medium, or low risk for diabetes and direct you to resources that can help.

(sister company of Community Hospital)

Dr. Resmi Premji
Dr. Leonard Sanders

2930 2nd Avenue, Suite 200, Marina, CA 93933
(831) 582-2100 |

A list of resources throughout Monterey County can be found on the web site of Community Hospital’s sister company, Community Health Innovations, at

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