# Presentation: 512720

## Steps to A Healthier U.S.Putting Prevention First: Programs in Public HealthDiabetes Prevention and Control

- David P. Hoffman, M.Ed.
- New York State Department of Health
- April 15, 2003

## Diabetes Facts and Figures

- In the U.S. today....
- 17 million people have diabetes (~6.2% of the population)
- Of them, 5.9 million have diabetes and don’t know it
- Among U.S. adults 40-74 years of age....
- 16 million have impaired glucose tolerance*
- 10 million have impaired fasting glucose*
- 	***pre-diabetes conditions**

## Populations at Risk

**Compared to non-Hispanic whites**
- Non-Hispanic blacks are 2x more likely to have diabetes...
- Hispanic/Latino American are 1.9x more likely to have diabetes...
- American Indians and Alaska Natives are 2.6x more likely to have diabetes...
- Asian Americans, Native Hawaiians, Pacific Islanders are at increased risk...limited data

## Deaths Due to Diabetes

- The risk for death among people with diabetes is about 2x that of people without diabetes
- Diabetes is the 6th leading cause of death (underlying cause) listed on death certificates – BUT...we know it is underreported as complications are often the direct cause of death

## Today	

- 2714 people will learn they have diabetes
- 105 people with diabetes will be diagnosed with blindness
- 192 people with diabetes will have a lower extremity amputation to save their lives

## Complications of Diabetes

- Heart disease-leading cause of diabetes related deaths
- Stroke- 2-4x higher among pwd
- High blood pressure
- Blindness-leading cause in adults 20-74

- Kidney Disease-leading cause of ESRD
- Nervous system disease- 60-70% of pwd
- Amputations- 60% of nontraumatic lower limb
- Complications of pregnancy

## Economic Impact

- Annual cost of diabetes in medical expenditures and lost productivity rose from $98 billion in 1997 to $132 billion in 2002*
- $13,243 spent/year on people with diabetes compared to $2,560 for people who don’t have diabetes*
- * **Diabetes Care, March 2003**

## Preventing Complications- Saves Lives & Dollars and Makes Sense 

- For every 1% reduction in A1C, the risk of developing microvascular diabetic complications (eye, kidney, nerve) is reduced by _**40%**_
- Blood pressure control can reduce CVD by 33%-50% and can reduce microvascular disease (eye, kidney, nerve) by ~33%

## Preventing Complications- Saves Lives & Dollars and Makes Sense 

- Improved control of cholesterol and lipids can reduce cardiovascular complications by 20%-50%
- Comprehensive foot care programs can reduce amputation rates by 45%-85%
- Detection and early treatment of diabetes related kidney disease can reduce the development of kidney failure by 30%-70%

## Diabetes is Preventable

- Research in the U.S. and abroad have found that lifestyle changes can prevent or delay the onset of type 2 diabetes among high-risk adults (DPP and Finnish Diabetes Study)
- Lifestyle interventions included diet and moderate physical activity
- For both sexes, all ages and ethnic groups, the development of diabetes was reduced by 40%-60%

## Public Health Approach-New York State Diabetes Prevention and Control Program (DPCP)  External Partners

- CDC – National Center for Chronic Disease Prevention and Health Promotion – DDT
- Diabetes Centers of Excellence (3)
- Community Coalitions for Diabetes Prevention (13 regional)
- Governor’s Initiative Projects for Children with Diabetes (4)
- Health Disparities Diabetes Collaboratives (10 FQHCs)
- Westchester Diabetes Coalition (NYHPA/ADA)

## Public Health Approach - New York State Diabetes Prevention and Control Program (DPCP)  Internal Partners

- Office of Medicaid Management (DUR Diabetes – ACE inhibitor use, IPRO chart review project, provider updates)
- Office of Managed Care (diabetes care satisfaction survey, HEDIS/QARR measures)
- AIDS Institute (Expanded Syringe Access Demonstration Project)

## Centers of Excellence

- University or consortium-based programs that engage in diabetes-related research, provider education and state-of-the-art care for people with diabetes

## Centers of Excellence

- Charged with improving access of special and at-risk populations to comprehensive diabetes care
- Develop and test tools and interventions for health care providers and patients - share results through publications and annual teaching days

## Community Coalitions

- Address national objectives for diabetes prevention and control (recommended eye and foot exams, A1C tests, flu and pneumococcal immunizations, reduce health disparities, smoking cessation, weight management, blood pressure control, etc.)
- Many diverse community partners

## Interventions/Initiatives

- Provider and professional education
- Tool kit development and distribution
- Nutrition and physical activity programs/research
- Community education

- Publication/teaching tool development
- Chart tool development
- Supermarket Project
- Support groups
- Outreach to special populations

## Governor’s Initiative Projects

- Partnerships between school systems and local diabetes centers, JDRF, ADA, AADE, etc.
- Ensure that children with diabetes are able to fully participate in all facets of scholastic experience.
- Educate school personnel: nurses, teachers, coaches, administrators, Board Members, food service employees, bus drivers, etc.

## Diabetes Collaboratives

- Interagency, public-private partnership between HRSA’s Bureau of Primary Health Care, CDC-DDT, DPCPs, and the Institute for Health Care Improvement.
- Use proven quality improvement and diabetes care practices to improve the health care and health status of people with diabetes who use community health centers for care.
- State programs (DPCPs) provide technical assistance

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## Contributions of  NYS DPCP

- Reduced incidence of End Stage Renal Disease (from 3.7 per 1,000 people with diabetes in 1993 to 3.2 per 1,000 people with diabetes in 1999) – a 6 year decline of 13.5%
- Estimated national related health care costs among people with diabetes are $6.6 billion/yr., but could be reduced to 5.7 billion by 2008 if the NY experience were extrapolated nationally

## Contributions of  NYS DPCP

- Reduced hospitalization rates (from 598 per 1,000 people with diabetes in 1993 to 420.5 per 1,000 people with diabetes in 1999) – a 6 year decline of 29.8%
- Estimated national cost of diabetes related hospitalizations in the US is $4.6 billion/yr., but could be reduced to $3.3 billion by 2008 if the NY experience were extrapolated nationally

## Contributions of  NYS DPCP

- Reduced rate of Lower Extremity Amputations (from 9.8 per 1,000 people with diabetes in 1993 to 6.3 per 1,000 people with diabetes in 1999) – a 6 year decline of 35.7%
- Estimated national cost of diabetes related LEAs in the US is $4.1 billion/year, which could be reduced to $3.3 billion by 2008 if the NY experience were extrapolated nationally

## Contributions of  NYS DPCP

- Increased flu immunization rates (from 53.4% in 1993 to 59.8% in 1999)
- According to the CDC, flu and pneumococcal infections cause an estimated 10,000 to 30,000 deaths among people with diabetes every year nationally

## Challenges and Opportunities

- Twin epidemics of diabetes and obesity – national attention and new resources
- Diverse/aging population – culturally sensitive educational materials/tools
- Categorically funded programs with similar goals and objectives – collaboration
- Diabetes Prevention findings – next steps
- Daunting statistics – single largest prevention investment in history –Steps to a Healthier US