Diabetes Control Plan
- The Problem
- Goals & Objectives
Vermont Plan for Diabetes Control
Recognizing that diabetes has become a common, life-threatening, and costly disease, the Vermont Department of Health began a diabetes control program in October 1996, with funding from the Centers for Disease Control & Prevention.
The goals of the diabetes control program are:
- to reduce the number of people with medical complications resulting from diabetes;
- to assist people with diabetes in successfully managing the disease; and
- to promote appropriate, high quality care by health care providers and insurers.
In September 1997, the Health Department called together about 70 health care professionals, advocates, health officials and people with diabetes to form the first statewide coalition on diabetes (now called the Diabetes Awareness Wellness Network, or DAWN), and to begin work on a diabetes control plan for the state.
To that end, three new working groups—Access to Services, Public Awareness & Education, and Patient Self-Care Management—joined two already established working groups—Clinical Practice & Professional Education and Surveillance, Research & Statistics—in developing the goals and objectives outlined in the following pages.
This is Vermont’s first Diabetes Control Plan. Most of the goals and objectives are designed specifically to reduce the burden of diabetes for the estimated 18,500 Vermonters who are already diagnosed. For the other 9,500 Vermonters who have diabetes and do not yet know it, the plan includes recommendations for informing the public and health care providers about risk factors and screening.
Diabetes is a disease that contributes significantly to death and disability among Vermonters. The national Healthy People Year 2000 objective is to reduce diabetes-related deaths to no more than 34 per 100,000 people. In Vermont, the rate for 1992-1996 was far worse, at 44.0.
Diabetes is common
An estimated 28,000 Vermonters suffer from diabetes, about one-third of whom have not yet been diagnosed. Diabetes is a statewide public health problem; in nearly every county, the diabetes-related death rate is worse than the Year 2000 goal.
Diabetes is serious
Diabetes is the 7th leading cause of death in Vermont. It is the major cause of lower limb amputations, blindness, and kidney disease. It is also a major contributor to high blood pressure, heart disease, stroke and infection.
Diabetes is costly
Diabetes results in about $37 million in hospital charges per year in Vermont. In 1992, Vermont spent an estimated $223 million on direct and indirect costs related to diabetes, according to estimates by the Centers for Disease Control and Prevention.
What is Diabetes?
Diabetes mellitus is a group of diseases characterized by high levels of blood glucose ("sugar") resulting from defects in insulin secretion, insulin action or both. Insulin is a hormone that regulates carbohydrate metabolism by controlling blood glucose levels. There are four types of diabetes:
Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 may account for 5 to 10 percent of all diagnosed cases of diabetes. Autoimmune, genetic and environmental factors appear to be involved in the development of this type of diabetes.
Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 may account for about 90 to 95 percent of all diagnosed cases of diabetes.
Risk factors for Type 2 diabetes include older age (40+), obesity, family history of diabetes, prior history of gestational diabetes (diabetes during pregnancy), impaired glucose tolerance, physical inactivity and race/ethnicity—people with African, Hispanic/Latino or American Indian ancestry are at particularly high risk for Type 2 diabetes, as are some Asian and Pacific Islander populations.
Gestational diabetes develops in 2 to 5 percent of all pregnancies, but disappears when the pregnancy is over. Gestational diabetes occurs more frequently in women from high risk racial and ethnic groups and those with a family history of diabetes. Obesity is also associated with higher risk of this type of diabetes. Women who have had gestational diabetes are at risk for later developing Type 2 diabetes. In some studies, nearly 40 percent of women with a history of gestational diabetes developed diabetes later.
Other specific types of diabetes result from specific genetic syndromes, surgery, medications, malnutrition, infections and other illnesses. Such types of diabetes may account for 1 to 2 percent of all diagnosed cases of diabetes.
Complications of Diabetes
- Heart Disease
- Adults with diabetes have heart disease death rates about two to four times as high as those of adults without diabetes. This is the leading cause of diabetes-related deaths.
- The risk of stroke is two to four times higher in people with diabetes.
- High Blood Pressure
- An estimated 60 to 65 percent of people with diabetes have high blood pressure.
- Kidney Disease
- Diabetes is the leading cause of end-stage kidney disease, accounting for about 40 percent of new cases.
- Nervous System Disease
- About 60 to 70 percent of people with diabetes have mild to severe forms of nervous system damage. This often includes impaired sensation of pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome and other nerve problems. Severe forms of diabetic nerve disease are a major contributing cause of lower extremity amputations.
- More than half of lower limb amputations occur among people with diabetes.
- Diabetes is the leading cause of new cases of blindness in adults 20 to 74 years old.
- Dental Disease
- Periodontal disease (a type of gum disease that can lead to tooth loss) occurs with greater frequency and severity among people with diabetes. Periodontal disease has been reported to occur among 30 percent of people aged 19 years or older with Type 1 diabetes.
- Complications of Pregnancy
- Between 3 to 5 percent of pregnancies among women with diabetes result in death of the newborn. This is two to three times the rate for women who do not have diabetes.
- Other Complications
- People with diabetes are more susceptible to other illnesses, particularly infections. For example, they are more likely to die of pneumonia or influenza than people who do not have diabetes.
Diabetes is Controllable
Much of the health and economic burden of diabetes-related complications can be averted through known prevention and treatment measures. A major goal of diabetes treatment is to keep blood glucose near normal levels at all times.
Training the person with diabetes in self-care management is integral to the treatment of diabetes. Although some risk factors for diabetes cannot be modified (such as genetic factors, age, race, ethnicity, or family history of diabetes), there are other risk factors that individuals can modify (such as obesity or physical activity).
Treatment of Type 1 requires a strict regimen that typically includes diet control, exercise, home blood glucose testing several times a day, and multiple daily insulin injections.
Treatment of Type 2 diabetes typically includes diet control, exercise, home blood glucose testing, and in some cases, oral medication and/or insulin. Approximately 40 percent of people with Type 2 diabetes require insulin injections.
Goals & Objectives
Public Awareness & Education
A national survey shows that only 8 percent of Americans consider diabetes a serious disease. Not only is diabetes serious, it is becoming even more prevalent as the population ages and at-risk minority populations increase. The national trend toward obesity and decreasing physical activity is also likely to increase prevalence.
Raise public awareness about the risk factors for diabetes and the need for regular preventive health care visits (including screening when appropriate).
- Objective: Promote workplace and community informational/educational initiatives.
- Objective: Establish site-appropriate guidelines for screening and diagnosis.
Raise public awareness about the complications of diabetes and the role that a healthy lifestyle, screening and diagnosis, education, treatment and support services play in controlling the disease.
- Objective: Create public education campaign(s) targeted toward various populations.
- Objective: Hold public events that raise awareness about diabetes.
Raise public awareness about the importance and availability of support systems (e.g. support groups, exercise sites, self-management training, etc.) associated with improved outcomes for people with diabetes.
- Objective: Develop a "model" structure for support groups, including a checklist of needed informational materials, supplies, etc.
- Objective:Increase the availability and the number of resources and activities for people with diabetes, their families and other interested parties.
Ensure that families, friends and community members have the information they need to support and assist people with diabetes in achieving their self-care management goals.
- Objective: Gather and assess current information, materials and resources that are available.
- Objective: Analyze and identify gaps in resources and materials.
- Objective: Develop and disseminate culturally appropriate information geared specifically for Type 1 and Type 2 diabetes for use in various settings (e.g. schools, nursing homes, meal sites, etc.).
Ensure full implementation of the Americans with Disabilities Act and other such legislation or policy in Vermont which affects people with diabetes in various settings (school, employment, health care, etc.).
- Objective: Promote a better understanding of the various laws and policies and how they relate to people with diabetes.
Access to Services
Recent state legislation (8 VSA §4089c) improved health insurance coverage for equipment, supplies, outpatient education and self-management training. Still, many Vermonters report that they do not have adequate access to services for a variety of reasons: gaps in insurance coverage, lack of health professionals specially trained in diabetes control, services not available locally, cultural, linguistic or literacy barriers, etc.
Ensure that all Vermonters with diabetes have access to quality services, equipment and supplies.
- Objective: Assess the local/regional availability of services, equipment and supplies.
- Objective: Publish and distribute a resource directory, which includes resources appropriate for diverse cultures and languages.
Provide training and technical assistance for health care professionals to ensure that appropriate care is available to all Vermonters with diabetes.
- Objective: Identify current training programs that are available to health care professionals, including physicians, nurses, diabetes educators, dietitians, pharmacists, optometrists, podiatrists, etc.
- Objective: Identify and assess barriers to training.
- Objective: Develop innovative, alternative methods of providing training to a wider range of health professionals.
Ensure that the needs of high risk or special populations are met.
- Objective: Identify high risk or special populations (examples: minorities, school children, seniors, home-bound persons, those with gestational diabetes), analyze the particular needs of these groups, and develop appropriate interventions.
Consider the development of policies that maximize access to comprehensive services, equipment and supplies.
- Objective: Establish a policy group (including representation from minority and special populations) to examine existing policies or practices and identify barriers to access.
- Objective: Develop initiatives to improve access to services.
Patient Self-Care Management
Patient education can translate to improved self-care management skills (self-monitoring of blood glucose, diet control, etc.) and a reduction in the occurrence and progression of diabetic complications. Yet many people with diabetes either do not know about self-care measures or don’t practice them.
Enhance the availability of standardized and current patient information, materials and programs.
- Objective: Identify the special patient education needs of people with Type1 and Type 2 diabetes.
- Objective: Develop and distribute culturally appropriate information and strategies to meet the identified needs.
Develop and enhance support systems for those affected by diabetes.
- Objective: Identify and assess existing support groups throughout the state and develop recommendations for patient self-care management.
- Objective: Develop appropriate strategies that encourage newly diagnosed patients to participate in basic education classes, workshops and/or individual sponsorships.
- Objective: Develop a Vermont diabetes web site and encourage and support the development of information resource centers at medical facilities and local Health Department offices.
Clinical Practice & Professional Education
Comprehensive preventive practices &endash; including diagnostic screening and clinical care to reduce the complications of diabetes &endash; should be a part of routine health care for all persons with diabetes.
Standardize the examination/treatment protocol for office visits throughout the state.
- Objective: Develop uniform medical practice and screening guidelines for diabetes.
- Objective: Provide training and services to support use of these guidelines.
- Objective: Monitor and assess provider acceptance and adherence to practice and screening guidelines.
- Objective: Refine methods and types of clinical interventions to promote patient compliance with their treatment plan.
Surveillance, Research & Statistics
Reliable data on prevalence, morbidity and mortality, health behaviors and preventive practices, etc. related to diabetes are essential for assessing the impact of diabetes on the health of Vermonters, and determining health policies and practices.
Compile and issue periodic reports concerning diabetes that can be used for program planning, monitoring and evaluation.
- Objective: Define the prevalence of diabetes, diabetes-related complications and health care utilization in Vermont.
- Objective: Define the prevalence of diabetes self-care management behaviors, and behavioral risk factors associated with the development and the progression of complications and disabilities.
- Objective: Define the levels of health care provider adherence to recommended diabetes practice guidelines.
- Behavioral Risk Surveillance System, 1990-1997. Vermont Department of Health.
- The Burden of Diabetes in Vermont, Centers for Disease Control & Prevention, 1997.
- Clinician’s Handbook of Preventive Services: Put Prevention into Practice. U.S. Department of Health and Human Services, Public Health Service, Office of Disease Prevention and Health Promotion, 1994.
- Diabetes in America, 2nd edition. National Institutes of Health-National Institute of Diabetes and Digestive and Kidney Diseases, NIH Publication No. 95-1468, 1995.
- Healthy People 2000: National Health Promotion and Disease Prevention Objectives. U.S. Department of Health and Human Services, Public Health Service, 1990.
- Vermont Vital Statistics System, 1980-1996. Vermont Department of Health.
Funding for this project was provided by a grant from the Centers for Disease Control & Prevention.
(Grant #U32/CCU 113560)
This plan is also available in large type and other accessible formats. Call 802-863-7606 for more information.