STRATEGIES FOR PREVENTION AND

CONTROL OF DIABETES

Marti Macchi, MEd, MPH

Senior Consultant

National Association of Chronic Disease Directors

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

Mission Statement

The National Association of Chronic

Disease Directors provides state-

based leadership and expertise for

chronic disease prevention and

control at the state and national

level.

and US

Integrative Values

�Collaborative

�Partnerships

�Member Driven

Crosses ALL programs,

projects, and strategies

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

Diabetes: Recognizing the

Problem

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, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2009

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

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

Estimated lifetime risk of developing diabetes for

individuals born in the United States in 2000

0

10

20

30

40

50

60

Men Women

Perc

en

t

Total Non-Hispanic WhiteNon-Hispanic Black Hispanic

Narayan et al, JAMA, 2003

Age-adjusted Percentage of U.S. Adults Who Were Obese

or Who Had Diagnosed Diabetes

Obesity (BMI ≥30 kg/m2)

Diabetes

1994

1994

2000

2000

No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%

No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at

http://www.cdc.gov/diabetes/statistics

2009

2009

At Risk and Pre-Diabetes

• Obesity

• Pre-diabetes

– About 35% of adults

– Generally, less than 10% are aware

26 millionwith Diabetes

79 millionwith Prediabetes

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

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

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

State Diabetes Prevention and Control

Programs (DPCP)

Three Intervention Areas • Policy and Environmental Change

– 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)

Identifying Solutions

Diabetes Stocks and Flow Map

Strategy #1: Improve quality of clinical care for people

with and at risk for diabetes to improve control of

ABCSPolicy-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.

Strategy #2: Increase access to sustainable self-management 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 self-

management 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 self-

management 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.

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.).

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.

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 pre-

diabetes or multiple diabetes risk factors to sites providing the 16

session core and 6 session post-core lifestyle intervention program.

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

QUESTIONS?

For Additional Information

���� 2872 Woodcock Blvd. Suite 220 Atlanta, Georgia 30341

�(770) 458-7400

���� www.chronicdisease.org

���� mmacchi@chronicdisease.org