Diabetes Program Examples
These examples of state program strategies, collaborations, and methods have been collected from state diabetes programs across the country. These examples represent specific aspects of a single program and are not a description of the state program’s total effort. In each example, the type of strategy and contact information are provided.
National Diabetes Education Program
The National Diabetes Education Program is a federally sponsored initiative whose goal is to reduce the illness and deaths associated with diabetes and its complications. The program’s objectives are
- To increase awareness of the seriousness of diabetes and its risk factors and to increase awareness of strategies for preventing diabetes and its complications among groups at high risk.
- To improve understanding of diabetes and its control and promote better self-management behaviors among people with diabetes.
- To improve health care providers’ understanding of diabetes and its control and to promote an integrated approach to care.
- To promote health care policies that improve the quality of and access to diabetes care.
- To reduce health disparities among racial and ethnic populations disproportionately affected by diabetes.
The National Diabetes Education Program is jointly sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health and the Division of Diabetes Translation of the Centers for Disease Control and Prevention and supported by the participation of over 200 public and private partner organizations.
Type of Strategy: Health systems change/partnerships
Contact Information:
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Phone: 1-800-860-8747 or 301-654-3327
Fax: 301-907-8906
Email: ndic@info.niddk.nih.gov
Web site: www.ndep.nih.gov
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
4770 Buford Highway, NE, Mail Stop K-10
Atlanta, GA 30341-3717
Phone: 1-877-CDC-DIAB
Fax: 301-562-1050
Email: diabetes@cdc.gov
Web site: www.cdc.gov/diabetes
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Diabetes Today
Diabetes Today (DT) is a course that is offered around the country and in the Pacific Basin to train public health professionals and members of the community in approaches to mobilizing communities to address diabetes. Using community participation and leadership to identify and address community-level diabetes issues is a goal of this “train the trainer” course, which is offered in English, Spanish, and other languages. The DT course offers tools, processes, and methods for developing community-focused programs that are geographically appropriate and culturally relevant. Additionally, DT training promotes collaboration among community residents, health professionals, and health systems. As a result of DT training, participants from many communities whose residents are at high risk for diabetes have identified the need for more community support groups and diabetes education classes. In Laredo, Texas, for example, the Lado A Lado (Laredoans Against Diabetes and Overweight) community
program now offers support groups for adults with diabetes. Several counties in Virginia are working to establish diabetes education programs in accessible settings, such as local schools, hospitals, community health clinics, and churches. A DT program in Guadalupe, Arizona, trains lay health workers (“promotoras”) to conduct health promotion programs for people with diabetes and those at high risk of developing diabetes.
Type of Strategy: Community intervention
Contact Information:
Division of Diabetes Translation
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
4770 Buford Highway NE, Mail Stop K-10
Atlanta, GA 30341-3717
Phone: 770-488-5000
Fax: 770-488-5966
Web site: www.diabetestodayntc.org
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Project DIRECT
Project DIRECT is a comprehensive, community-based intervention carried out in a predominantly black and low-income community in North Carolina. This project began in 1992 with the formation of a partnership among local community stakeholders, who became key decision makers in all that followed. The project established a multilevel, community-based model that includes diabetes care (providing clinical services), outreach (improving community capacity to identify and treat patients with diabetes), and health promotion (reducing risk factors associated with diabetes through information sharing and environmental and policy changes). This project promotes the primary, secondary, and tertiary prevention of diabetes. Because Project DIRECT is a pioneer program of its type, its leaders now share the challenges they encountered and the lessons they learned with local, state, and national leaders interested in pursuing this community empower-ment approach to diabetes prevention and control elsewhere.22
Type of Strategy: Community intervention
Contact Information:
Diabetes Control Program Director
NC Department of Health and Human Services
Diabetes Prevention and Control Unit
1915 Mail Service Center
Raleigh, North Carolina 27699-1915
Phone: 919-715-3131
Fax: 919-733-0488
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New York Centers of Excellence
The New York Diabetes Program collaborates with 14 regional community coalitions and 3 university-based Centers of Excellence (State University of New York/Upstate Medical University in Syracuse, Mount Sinai Medical Center/East Harlem in New York City, and Columbia–Presbyterian Hospital/Naomi Berrie in New York City) to improve diabetes care. The Centers of Excellence work with peer-review organizations, health centers, hospitals, and community organizations to develop educational initiatives and promote collaboration among health care providers to improve diabetes services and access to care. The centers also develop methods to overcome socioeconomic, cultural, and language barriers to services. In 2 years, the community- and provider-focused interventions sponsored by the Centers of Excellence have reduced hospitalization rates by 35% and decreased lower-extremity amputation rates by 39%.
Type of Strategy: Health systems change/partnerships
Contact Information:
Diabetes Control Program Coordinator
Bureau of Chronic Disease Services
New York State Department of Health
Empire State Plaza Tower, Room 780
Albany, New York 12237-0678
Phone: 518-474-1222
Fax: 518-473-0642
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Improving Diabetes Care through Empowerment, Active Collaboration, and Leadership (Project IDEAL)
Project IDEAL is an initiative developed by the Minnesota Diabetes Control Program and Health Partners, a large managed care organization. IDEAL is a systematic, population-based intervention that facilitates diabetes care improvements by identifying the need for changes within primary care clinics and then making these changes happen. During the pilot stage of IDEAL, the frequency of eye exams, foot exams, and microalbumin testing increased substantially, and these results were replicated in the intervention phase. In 2 years, participants’ average A1C values decreased from 9.2% at baseline to 7.7%. Other effects of this intervention include a higher priority for diabetes in managed care and the application of the IDEAL methodology to address asthma, heart disease, hypertension, and other chronic conditions.
Type of Strategy: Health systems change/ partnerships
Contact Information:
Minnesota Diabetes Control Coordinator
Minnesota Department of Health
P.O. Box 64882
St. Paul, Minnesota 55164-0882
Phone: 651-281-9842
Fax: 651-215-8959
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The Diabetes Collaborative
The Diabetes Collaborative is an interagency, public-private partnership aimed at improving the quality of health care for secondary and tertiary diabetes prevention in federally funded community health centers. This partnership involves federal, state, and local entities. National partners include the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and the Institute for Health Care Improvement. State and local partners include community health centers and state diabetes programs. To date, 40 state programs are participating formally in the collaborative, along with approximately 300 community health centers. Improvement methods include applying the MacColl Institute for Healthcare Innovation’s Chronic Care Model23 and the Institute of Health Improvement’s Quality Improvement Model. 24 Common objectives include measuring patients’ A1C levels twice
per year, at least 90 days apart, and establishing patient self-management goals. Results of the collaborative’s efforts to date include a threefold increase (from 20% to 60%) in the percentage of patients who receive A1C testing
at the recommended interval.
Type of Strategy: Health systems change/partnerships
Contact Information:
Health Resources and Services Administration
Bureau of Primary Health Care
Health Disparities Collaborative
4350 East West Highway
Bethesda, MD 20814
Phone: 301-594-4292
Fax: 301-443-4983
Web site: bphc.hrsa.gov/programs/HDCProgramInfo.htm
Division of Diabetes Translation
National Center for Chronic Disease Prevention
and Health Promotion
Centers for Disease Control and Prevention
4770 Buford Highway NE MS K-10
Atlanta, GA 30341-3717
Phone: 770-488-5000
Fax: 770-488-5966
Email address: diabetes@cdc.gov
Web site: www.cdc.gov/diabetes
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Wisconsin Collaborative Diabetes Quality Improvement Project
The Wisconsin Diabetes Control Program developed
the Collaborative Diabetes Quality Improvement Project in partnership
with the University of Wisconsin Department of Preventive Medicine.
The objectives of this project are to facilitate standardized baseline
data collection and to identify and address gaps between current
practice and the Wisconsin Essential Care Guidelines. Twenty organizations
and 18 HMOs from across the state reported on six indicators of
diabetes care for approximately 25,000 people with diabetes in Wisconsin.
The indicators were the number of A1C tests performed, percentage
of people with poorly controlled A1C levels, number of lipid profile
tests performed, percentage of people with lipids controlled, number
of dilated eye exams performed, and number of people screened for
kidney disease. In 2000, all participating HMOs had improved in
the six selected indicators since 1999: the proportion of people
receiving lipid profiles increased by 10%, the proportion receiving
dilated eye exams increased by 8%, and the proportion receiving
one or more A1C tests increased by 2%. In addition, control of A1C
improved by 4%, control of lipid levels improved by 16%, and screening
for kidney disease increased 13%. Two factors critical to the success
of this project were that all of the participants, including participating
HMOs, were involved in developing the guidelines, and that information
was shared with all participants, many of whom were market competitors.
These factors facilitated better coordination of diabetes care,
which helped to improve the clinical indicators listed above.
Type of Strategy: Health systems change/partnerships
Contact Information:
Diabetes Control Program Coordinator
Wisconsin Department of Health
1 West Wilson Street
Room 218
Madison, Wisconsin 53701-2659
Phone: 608-261-6871
Fax: 608-266-8925
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The Michigan Diabetes Outreach Network (DON)
The Michigan DON consists of a series of regional networks designed to facilitate comprehensive diabetes assessment, education, referral, and follow-up care through innovative partnerships. Through the coordinated efforts of health departments, private home-care agencies, hospitals, clinics, physicians, and Native American health agencies, people who have diabetes are identified and provided individualized care. As a result of these efforts, most people enrolled in this system have been referred to and have seen all of the recommended health care providers. Furthermore, many of the participants have improved their self-care practices and are now able to self-manage their diabetes. The effectiveness of the DON model was established in 1991, when a published analysis showed that, in just 5 years, the DON serving the Upper Peninsula had reduced the diabetes-related death rate by 27%, the diabetes-related hospitalization rate by 45%, and the diabetes-related lower-extremity amputation rate by
31%. The DON model is the cornerstone of the Michigan Diabetes Control Program and an integral part of quality diabetes care efforts throughout the state.
Type of Strategy: Health systems change/partnerships
Contact Information:
Diabetes Control Program Coordinator
Diabetes, Dementia, Kidney Section
Michigan Department of Community Health
P.O. Box 30195
Lansing, Michigan 48909
Phone: 517-335-8445
Fax: 517-335-9461
MDON Web site: www.diabetes-midon.org
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Utah Statewide Communication Campaign
The goals of this campaign are to improve awareness of diabetes risk factors and screening methods, especially among groups at high risk, and to improve awareness of the most effective ways to control diabetes. The process for developing the campaign included the following:
- Updating the social marketing plan.
- Gathering and analyzing market research on media habits and appropriate messages for target population groups, including Hispanics, Polynesians, and seniors.
- Developing messages and choosing media channels and vehicles appropriate for the target population with diabetes. Decisions were based on market research and a review of materials previously developed by the Utah Diabetes Control Program (UDCP) and the National Diabetes Education Program (NDEP).
- Testing all messages and materials and distributing them.
- Airing NDEP/UDCP television and radio public service announcements, distributing news releases, and developing news stories.
- Developing other promotional items that list the UDCP Web page address and health resource line toll-free number and sending these materials to community partners to distribute to the public.
- Collaborating with local health departments
and other community partners to implement public awareness and education activities in their districts.
- Providing materials and training to help health resource line telephone operators respond proficiently to diabetes-related calls and make appropriate referrals.
- Updating and distributing the Diabetes Resource Manual
(for professionals) and the Diabetes Directory (for consumers).
- Maintaining the program’s Web page and adding frequently asked questions and questions for patients to ask their doctor.
Evaluation efforts to date have been limited to process evaluation. Utah will
conduct an overall diabetes awareness campaign evaluation as well
as the Utahns with Diabetes Follow-Up Survey. This communications
campaign is only one component of Utah’s Diabetes Control Program.
Together, the health communications, health systems, and community
interventions should help reduce the burden of diabetes in the state.
Type of Strategy: Health communications
Contact Information:
Diabetes Control Program Coordinator
Utah Department of Health
Chronic Disease Control
Division of Community and Family Health Services
288 North 1460 West
P.O. Box 142107
Salt Lake City, Utah 84114-2107
Phone: 801-538-6141
Fax: 801-538-9495
Web site: www.health.utah.gov/diabetes
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West Virginia Statewide Diabetes Media Campaign
The West Virginia Diabetes Program implemented
a media campaign from September 1999 through July 2002 to improve
the preventive health care practices of Medicare beneficiaries with
diabetes. The campaign featured rotating messages about A1C testing,
eye examinations, influenza immunizations, and other diabetes prevention
and diabetes care topics. Evaluation of this effort focused on determining
whether Medicare beneficiaries with diabetes saw or heard mass media
messages about diabetes and whether hearing messages was associated
with a self-reported response. The telephone survey was of a random
sample of 1,500 beneficiaries in the West Virginia Diabetes Database
from two groups of counties: those with high and those with low
exposure to the media campaign as determined from broadcast logs
and station coverage maps. The survey asked whether the beneficiary
had heard and responded to messages on specified topics.
Beneficiaries who had had high exposure to the messages were about 1.2 times more likely to recall hearing messages on A1C, foot examinations, and influenza immunizations than were beneficiaries with low exposure, and this difference was statistically significant (p<0.05). Furthermore, for all four message topics, having heard the messages was significantly associated with the likelihood of self-reported action (e.g., talking to a doctor about A1C testing).
Type of Strategy: Health communications
Contact Information:
Peggy Adams, RNC, MSN, CDE
Diabetes Control Program
Department of Health and Human Resources
350 Capitol St., Room 319
Charleston, West Virginia 25301
Phone: 304-558-0644
Fax: 304-558-1553
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