The Need for Diabetes Education in the U.S.

Veronica Culpepper, RN,MSM,CDEVALLEY HEALTHCARE SYSTEM

Columbus, Georgia

Objectives

The participants will be able to:• Name the four types of diabetes.• Cite the expected increase in diabetes in 2050.• Name four severe complications of

uncontrolled diabetes.• Cite how activity plays a role treating

diabetes.

Objectives continued…

• Name the seven self-care behaviors taught by diabetes educators.

• State the percentage of people with diabetes that get effective diabetes education.

• List two ways to increase the efforts of the diabetes educators to meet the needs of the increasing population with diabetes.

Types of Diabetes

• Pre diabetes• Type 1 diabetes• Type 2 diabetes• Gestational diabetes

Pre diabetes

• People with pre diabetes have a blood glucose levels higher than normal but not high enough to be classified as diabetes.

Type 1 Diabetes

• The pancreas stops producing insulin. Insulin is a hormone that regulates blood glucose. There is no known way to prevent type 1 diabetes. Type 1 diabetes usually occurs in children and young adults.

Type 2 Diabetes

• Type 2 diabetes is often called adult onset diabetes. It is associated with older age, obesity, family history of diabetes, history of gestational diabetes and race/ethnicity.

Gestational Diabetes

• Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy. Most often in American Indians, African Americans, Hispanic/Latino Americans and Asians. 35 to 60% of these women will develop diabetes in the next 10 to 20 years.

Prevalence of Diabetes in the U.S.

According to the Center for Disease Control and Prevention

• 25.8 million people (8.3% of the population) have diabetes--18.8 million people are diagnosed--7.0 million are yet undiagnosed

• 79 million Americans aged 20 years or older are estimated to have pre diabetes.

• The proportion of people with diabetes increases as people age.

• Diabetes is a concern for both men and women.--13.0 million or 11.8 % of all men 20 years or older have diabetes.--12.6 million or 10% of all men 20 years or older have diabetes.

• 1 out 0f 10 people in the U.S. have diabetes.• In 2050 1 out of 3 adults will have diabetes

including both diagnosed and undiagnosed.• Diabetes affects some racial/ethnic groups

more than others.--Non-Hispanic whites: 15.7 million, or 10.2% 20 years or older have diabetes--Non-Hispanic blacks: 4.9 million or 18.7% 20 years or older have diabetes

Complications of Uncontrolled or Unmanaged Diabetes

• Diabetes is the 7th leading cause of death in the U.S.

• Poorly controlled diabetes is the leading cause of adult blindness, end-stage renal disease and non-traumatic lower-limb amputations.

• Diabetes also doubles the risk of stroke and heart disease.

• People with diabetes are also at increased risk for neurological symptoms, cardio-vascular disease and other complications.

Estimated Diabetes Costs in the United States

• Total (direct and indirect

• Direct medical costs

• Indirect costs

$174 billion

$116 billionMedical expenses for people

with diabetes are 2.3 times higher than people without diabetes

$58 billion (disability, work loss, premature mortality)

Treatment of Diabetes

• Medications: both pills and injections.--People with Type 1 diabetes must have insulin to survive. --People with Type 2 diabetes may take no medication or pills along or pills or insulin.

Treatment of Diabetes cont.

• Meal plan--Meal plan is important for all people with diabetes.--Many people with type 2 diabetes can control blood sugar by following a health meal plan and exercise plan.

Treatment of Diabetes cont.

• Activity--Increase in activity is a must for losing weight and maintaining weight control --Decreases blood sugars--Decreases blood pressure and cholesterol

Role of Diabetes Educators Teaching Self Management Education

• Who are Diabetes Educators--Nurses, dieticians, pharmacist, physical therapist, who teach clients and their families how to manage their diabetes.--There are 15,000 certified diabetes educators.--There are 15,000 diabetes educators in practice who have not completed requirements for the CDE credentials.

• Diabetes education also known as diabetes self management education (DSME/T).

• DSME/T teaches life style intervention.

• Diabetes education focuses on the ADDE7⁽™⁾ Self-Care Behaviors that are essential for improved health status and greater quality of life.– Healthy Eating– Being Active– Monitoring– Taking Medication– Problem Solving– Healthy Coping– Reducing Risk

Proportion of people with diabetes who receive diabetes education

• Estimates vary from 1% to 50%.• According to the 2007 Roper Study, out of

16,660,000 diagnosed diabetes patients in the U.S., 4,249,00 had seen a diabetes educator in the past 12 months.

• AADE analyses of Centers for Medicare and Medicaid services reimbursement for diabetes education (DSMT) found about 1% of Medicare clients received education in 2004 and 2005.

Diabetes Education is an Effective Intervention

• A study show lifestyle intervention to lose weight and increase physical activity reduced the development of Type 2 diabetes by 58% during a 3 year period.

• Data shows that diabetes education saves money and decrease health care utilization.

• Hospital admissions was down 34% in patients who had at least one educational visit.

Diabetes Education is an Effective Intervention cont.

• Cost savings when A₁C decreases is associated with significant health care savings.

• Reduction of severe complications of uncontrolled diabetes.

The Problem with Diabetes Education (DSME/T)

• The problem with DSME/T is how many clients diabetes educators see? 30,000 educators versus 26 million Americans– Diabetes educators can effectively reach more

people by expanding their education team to include community health workers and medical assistants.

– Utilizing Telehealth

• Telehealth improves diabetes self management in an underserved community.

• Findings of comprehensive pilots done in several areas in rural South Carolina– Improved A₁C– LDL Cholesterol reduced in 12 months– High participant retention-6 and 12 month 90.9,

82.4% respectively– Medicare and many private insurers will pay for

DSME/T via Telehealth. Medicare restriction is the recipient, must be in a rural or an underserved area.

My experiences with DSME/T with GaTelehealth