STRATEGIES FORPREVENTION AND CONTROL OFDIABETES. Marti Macchi, MEd, MPH Senior Consultant National Association of Chronic Disease Directors

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1 STRATEGIES FORPREVENTION AND CONTROL OFDIABETES Marti Macchi, MEd, MPH Senior Consultant National Association of Chronic Disease Directors

2 National Association of Chronic Disease Directors National public health association Provides a national forum for chronic disease prevention and control efforts Founded in 1988 Headquartered in Atlanta, GA 11 professional staff 25 national content experts 1,500 members

3 Mission Statement The National Association of Chronic Disease Directors provides statebased leadership and expertise for chronic disease prevention and control at the state and national level. and US

4 Integrative Values Collaborative Partnerships Member Driven Crosses ALL programs, projects, and strategies

5 Today s Presentation The Diabetes Problem National Diabetes Program Framework State Diabetes Systems (DPCPs) Diabetes Policy Implications and Opportunities Call to Action and Next Steps to address the Diabetes Problem

6 Diabetes: Recognizing the Problem

7 Diabetes in the United States Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

8 Number and Percentage of U.S. Population with Diagnosed Diabetes, CDC s Division of Diabetes Translation. National Diabetes Surveillance System available at

9 Cost of Diabetes $174 billion: Total costs of diagnosed diabetes in the United States in 2007 $116 billion for direct medical costs $58 billion for indirect costs(disability, work loss, premature mortality) After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes

10 Estimated lifetime risk of developing diabetes for individuals born in the United States in Total Non-Hispanic Black Non-Hispanic White Hispanic Percent Men Women Narayan et al, JAMA, 2003

11 Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI 30 kg/m 2 ) No Data <14.0% % % % >26.0% Diabetes No Data <4.5% % % % >9.0% CDC s Division of Diabetes Translation. National Diabetes Surveillance System available at

12 At Risk and Pre-Diabetes Obesity Pre-diabetes About 35% of adults Generally, less than 10% are aware

13 26 million with Diabetes 79 million with Prediabetes

14 Management and Complications Management Dilated Eye Exam Foot Exam Immunizations Influenza Pneumococcal Hepatitis B Self-glucose monitoring Complications Blindness Amputations End Stage Renal Disease Cardiovascular Disease

15 We re only touching the surface! People with diabetes complications People with diagnosed diabetes People with undiagnosed diabetes People with Prediabetes People at risk for diabetes

16 National Diabetes Program Framework Prevent Diabetes Prevent the complications, disabilities and burden associated with diabetes Eliminate diabetes-related health disparities Maximize organizational capacity to achieve the National Diabetes Program goals

17 State Diabetes Prevention and Control Programs (DPCP) Policy and Environmental Change Three Intervention Areas Creating supportive community environments to help people take responsibility for their health Health Systems Change Improving use and delivery of quality clinical preventive services to promote health and improve disease detection and management Community and Clinical Linkages Building a stronger connection between clinical and community settings; implementing community programs like the National Diabetes Prevention Program to improve quality of life and reduce health care costs Improve A1C, Blood Pressure, Cholesterol and Smoking (ABCS)

18 Identifying Solutions

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20 Diabetes Stocks and Flow Map

21 Strategy #1: Improve quality of clinical care for people with and at risk for diabetes to improve control of ABCS Policy-related Strategies: Support implementation of policies within health care organizations that contribute to and help sustain quality care improvements for people with diabetes/pre-diabetes. Support implementation or maintenance of evidence-based reimbursement strategies and policies (e.g., reduced patient insurance copayments; public insurance reimbursement of medications and testing supplies; physician reimbursement incentives and performance-based payment; value-based insurance designs; assistance for un- or underinsured patients with diabetes.) Clinical/Health Systems-related Strategies: Promote the adoption of models to improve delivery and quality of care in clinical settings (e.g., Patient Centered Medical Home, Planned Care Model). Communication/Media-related Strategies: Support health communication efforts that reinforce the interventions listed above to improve quality of clinical care for people with and at risk for diabetes.

22 Strategy #2: Increase access to sustainable selfmanagement education and support services for people with diabetes to improve control of ABCS Policy-related Strategies: Support implementation of policies that promote financial sustainability/reimbursement for DSME/CDSM programs. Support implementation of policies that promote financial sustainability/reimbursement for CHWs involved in providing selfmanagement education and support services for people with diabetes. Clinical/Health Systems-related Strategies: Expand the role of allied health professionals (e.g., pharmacists, nurses, community health workers [CHWs]) in providing diabetes selfmanagement education (e.g., Asheville Model). Communication/Media-related Strategies: Support health communication efforts that reinforce the interventions listed above to increase access to sustainable self-management education and support services for people with diabetes.

23 Strategy #2 (cont.): Increase access to sustainable self-management education and support services for people with diabetes to improve control of ABCS Community-related Strategies: Expand reach/spread of diabetes self-management education (DSME) and chronic disease self-management support (CDSM) programs in community settings to reach vulnerable populations with greatest diabetes burden/risk. Support implementation of policies/environmental supports within worksites that contribute to improved control of A1C, blood pressure, and cholesterol, and promote tobacco cessation among people with diabetes. Increase access to tobacco cessation services for people with diabetes who smoke (e.g., quitlines, etc.).

24 Strategy #3: Increase access to sustainable, evidence-based lifestyle interventions to prevent/delay onset of type 2 diabetes among people at high risk Community-related Strategies: Increase access/availability and use of the 16-session core and 6- session post-core lifestyle program as an intervention targeting populations with multiple diabetes risk factors including but not limited to women with previously diagnosed gestational diabetes. Facilitate access to safe, attractive, and affordable places for people with prediabetes or multiple diabetes risk factors to engage in physical activity, including but not limited to promotion of workplace policies and programs that increase physical activity. Policy-related Strategies: Partner with employers and health plans to offer the 16 session core and 6 session post-core lifestyle program as a covered benefit to prevent or delay onset of diabetes.

25 Strategy #3 (cont.): Increase access to sustainable, evidence-based lifestyle interventions to prevent/delay onset of type 2 diabetes among people at high risk Clinical/Health Systems-related Strategies: Implement systems to increase provider referrals of people with prediabetes or multiple diabetes risk factors to sites providing the 16 session core and 6 session post-core lifestyle intervention program.

26 NACDD Support to State Programs 3 Full Time Consultants Link to the states Technical assistance and support Policy State Technical Assistance Team (PSTAT) Policy training to address emerging policy issues Diabetes Policy Workshops Integrated educational forum focused on the foundational knowledge of policy change to Goal is to enhance state-based programming and regional collaboration among state Diabetes Prevention and Control Programs and their partners. Diabetes Council Influencing decisions Making Connections Building Capacity

27 QUESTIONS?

28 For Additional Information 2872 Woodcock Blvd. Suite 220 Atlanta, Georgia (770)