Diabetes Control Plan

Vermont Department of Health diabetes control plan

 

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:

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.

The Problem

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.

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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.

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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.
Stroke
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.
Amputations
More than half of lower limb amputations occur among people with diabetes.
Blindness
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.

Goal 1

Raise public awareness about the risk factors for diabetes and the need for regular preventive health care visits (including screening when appropriate).

Goal 2

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.

Goal 3

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.

Goal 4

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.

Goal 5

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.).

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.

Goal 1

Ensure that all Vermonters with diabetes have access to quality services, equipment and supplies.

Goal 2

Provide training and technical assistance for health care professionals to ensure that appropriate care is available to all Vermonters with diabetes.

Goal 3

Ensure that the needs of high risk or special populations are met.

Goal 4

Consider the development of policies that maximize access to comprehensive services, equipment and supplies.

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.

Goal 1

Enhance the availability of standardized and current patient information, materials and programs.

Goal 2

Develop and enhance support systems for those affected by diabetes.

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.

Goal 1

Standardize the examination/treatment protocol for office visits throughout the state.

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.

Goal 1

Compile and issue periodic reports concerning diabetes that can be used for program planning, monitoring and evaluation.

References

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.