Question: How can we prevent pre-diabetes, reverse pre-diabetes, stop progression of pre-diabetes and optimize self-care of diabetes at population-based levels? Answer: Develop scalable peer coaching programs that motivate healthy habits Imagine • Health care systems delivering “Train the trainers” programs for developing peer health coach (PHC) trainers • Trainers setting up PHC programs in health care organizations and community organizations • PHC programs, for patients and led by patients, that motivate healthy habits and self-care of diabetes • Patients with diabetes (PwD) actively engaged with their health care teams Overcome the Limitations of Evidence-based Guidelines The evidence is in. Our disease care systems are failing to reduce our rates of obesity, sedentary lifestyles, unhealthy diets, pre-diabetes and diabetes. Furthermore, our evidence-based guidelines work only for the “average person”, but not what works, in particular, for the individual. These guidelines only raise the organizational floor of performance. To break through the ceiling, we need peer health coaching programs to move beyond the time constraints of “1-to-1” clinical encounters. This convenient, accessible and inexpensive innovation combines self-reflective learning exercises with peer coaching methods. Such collaborative learning goes well beyond the short-term duration of randomized controlled trials. To overcome the limitations of scientific evidence and surface change, PwD can become the researchers of their behavior change by developing their own personal evidence about deep change. Overcome the Scalability Challenge PHC programs uses complexity concepts to cultivate self-organizing processes that synergize “n-to-n” peer inter-connectivity with meaningful inter-active learning. This “N to the power N” synergy unleashes mass collaborative learning to overcome the limitations of “1-to-1” clinical encounters and “1-to-n” population health approaches. Such collaboration, along with the digital learning and m-health revolutions, will align and galvanize top-down professional movements with bottom-up social movements. Such mass movements are essential for reducing the rates of obesity, sedentary lifestyles, unhealthy diets, pre-diabetes and diabetes. Implement PHC Programs Dr. Botelho, Professor of Family Medicine, has had a lifelong interest in motivating health behavior change. His background is in developing faculty development and innovative learning programs. His forthcoming book, Health Buddy Coaching: Discover Your Path to Healthy Habits outlines a dynamic self-discovery learning process about behavior change. A lack of knowledge and skills is not the major barrier to change. Most PwD know what to do and how to do it. More often than not, PwD resist and/or lack the motivation to change.

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