Diabetes has touched nearly all of our lives. Perhaps diabetes has hit much closer to home with a relative, prevention and control of diabetes in Kansas. …

Kansas Diabetes Plan
Published July 2008

Kathleen Sebelius, Governor Roderick L Bremby, Secretary Kansas Department of Health and Environment Richard Morrissey, Interim Director Kansas Department of Health and Environment Division of Health

2008-2013

This publication was supported by Cooperative Agreement Number U32/ CCU022718-05 from the Centers for Disease Control and Prevention Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention

Letters
July 2008

Dear Fellow Kansans, Diabetes has touched nearly all of our lives You may have a neighbor, friend, or co-worker who has struggled with this devastating disease Perhaps diabetes has hit much closer to home with a relative, spouse or child affected by diabetes You yourself may be living with diabetes Diabetes is one of the leading causes of death and disability in Kansas and continues to increase at an alarming rate The increase in diabetes has paralleled the increase of the number of adult Kansans who are overweight or obese These parallel trends reflect a strong correlation between being overweight or obese and the
development of diabetes These alarming results have not been limited to adults Type 2 diabetes, which prior to 1980 was usually seen in adults, is becoming increasingly common in children and adolescents According to the Centers for Disease Control and Prevention, if current trends in obesity and type 2 diabetes continue, children born in the year 2000 will face a 1 in 3 chance of developing diabetes at some time in their life In Latino children, the risk is predicted to be even higher 1 in 2 The good news is that our understanding of diabetes and how to prevent and treat it is constantly improving We now know what actions can be taken to delay and even prevent the onset of diabetes and minimize its damaging health effects Adopting a healthy lifestyle, choosing healthier eating habits and increasing physical activity can reduce you and your childrens chances of developing diabetes By working together, we can decrease the burden of diabetes in our state I encourage all Kansans to take an active role in implementing the Kansas Diabetes Plan Please join us in spreading the message that diabetes prevention and control is a priority in Kansas Sincerely yours, Kathleen Sebelius Governor
of the State of Kansas

Letters
July 2008

The Kansas Diabetes Plan outlines a comprehensive approach for reducing the burden of diabetes in our great state It reflects the commitment and dedication of diabetes leaders representing over 40 organizations, programs and associations who came together to develop effective strategies for the prevention and control of diabetes in Kansas The Kansas diabetes community has a rich, innovative history of working together to improve diabetes care across the state In 2004, the Kansas Diabetes Prevention and Control Program DPCP convened the Kansas Diabetes Advisory Council KDAC and other key partners from around the state to conduct the first comprehensive performance assessment of the Kansas Diabetes Public Health System KDPHS The KDPHS is comprised of multiple public, private, and voluntary organizations that operate statewide to provide support for diabetes prevention and control Representatives from organizations that make up the System were invited to review and assess the performance of the KDPHS The tool for conducting this assessment was based on the Essential Public Health Services EPHS, which were developed in 1994 by national
health policy leaders and adapted by the Kansas Diabetes Advisory Council KDAC The assessment identified gaps in the KDPHS and the results served to guide statewide improvement efforts that are embedded in the Kansas Diabetes Plan The Plan is intended to provide guidance for collaborative statewide efforts to reduce the burden of diabetes and improve the health of Kansans over the next five years The Plan is organized by four priority areas and outlines five goals to address those areas The priority areas include: PrimaryPrevention QualityofCare PatientSelf-Management PolicyandAdvocacy The five goals addressed in the plan include: Increaseawarenessofpreventionandcontrolofdiabetes Improvecapacitytoaddressthepreventionandcontrolofdiabetes IncreaseKansashealthcareworkforcecompetencyindiabetesstandardsofcare Improveawarenessofandaccesstodiabetesself-managementinformation,programsandservices Influencepublicpolicytosupportimprovingdiabetesprevention,detectionandcarethroughoutKansas This plan is a call to action, urging individuals, communities and organizations to take an active role in implementing the Kansas Diabetes Plan to improve quality and years of life for Kansans living with
diabetes, reduce the complications of diabetes, reduce health disparities among Kansans living with diabetes and prevent new cases of diabetes Together we can make a difference in the lives of people at risk for, or living with, diabetes

Be Well, Roderick L Bremby Secretary

Forward
July 2008

Diabetes is one of the most common, complex and costly chronic health conditions in Kansas as well as the United States In Kansas, 71 of adults more than 150,000 have been diagnosed with diabetes and nearly 65,000 more have diabetes but are undiagnosed People with diabetes are at increased risk of numerous serious and potentially deadly complications Themostlife-threateningcomplicationiscardiovascular disease People with diabetes are at 3 to 5 times greater risk of developing cardiovascular disease than those without diabetes The risk of stroke forpeoplewithdiabetesis2to4timeshigherMorethan65ofdeathsinpeoplewithdiabetesare attributedtocardiovasculardiseaseMoreover,peoplewithdiabeteswhosmokeare3timesmore likely to die from heart disease than people with diabetes who dont smoke and have an increased risk for premature development of multiple complications of diabetes, including kidney
disease and nerve damage Diabeticretinopathycauses12,000to24,000newcasesofblindness each year making diabetes the leading cause of new cases of blindness in adults 20-74 years of age Diabetesistheleadingcauseofkidney failure in the United States About 10 to 40 of people with type 2 diabetes eventually will suffer from kidney failure In 2002, almost 154,000 persons with endstage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant About60to70ofpeoplewithdiabeteshavemildtosevereformsofnervous system damage, including impaired sensation to pain in the feet or hands, slowed digestion of food and carpal tunnel syndrome Morethan60ofnon-traumaticlower-limb amputations occur in people with diabetes In 2002, about 82,000 nontraumatic lower-limb amputations were performed in people with diabetes The rate of amputation for people with diabetes is 10 times higher than for people without diabetes Obesity is one of the major risk factors for diabetes If current trends in obesity and diabetes continue, children born in the United States in the year 2000 will face a 1 in 3 chance of developing diabetes at some point in their lives Diabetes research indicates
that through reasonable lifestyle modification of physical activity and diet, this devastating disease can be prevented Despite this promising research, however, diabetes prevalence rates continue to grow at epidemic proportions Therefore, it is essential to address the full continuum of care of diabetes, progressing from primary prevention of the disease, to secondary and tertiary management interventions Primary prevention interventions seek to delay or halt the development of diabetes through early detection of risk factors; secondary and tertiary prevention interventions focus on people with diabetes and seek to prevent secondary or control tertiary the devastating complications of this disease Strong collaborative partnerships offer great promise for successfully changing the course of diabetes in our state Kansas is well positioned to prevent new cases of diabetes and improve the lives of Kansans living with and at risk for diabetes

RichardMorrissey,InterimDirector Division of Health Kansas Department of Health and Environment

Acknowledgements
July 2008

The Kansas Diabetes Plan was made possible through the time, energy, expertise and dedication of individuals over the
course of three years We would especially like to thank those who devoted time to the Kansas Diabetes Advisory Council for developing the goals and strategies of the Plan, as well as those who participated in the assessment meetings around the state Without their passion and dedication for Kansans affected by diabetes, this Plan would not exist Kansas Diabetes Advisory Council Members: Ann Gustafson, Pharm D AnneKimmel,MS,RD,BC-ADM,RN,CDE AsadEhtisham,MD,MBBS,FAHA Beverly White Bill Dyar CarolynBland,PA DavidRobbins,MD DebbieHinnen,ARNP,BC-ADM,CDE,FAAN DebbieJohnson DeniceCurtis,DDS,MPH DianaGuthrie,PhD,ARNP,BC-ADM,CDE,FAAN DonnaGarwood,RN,BSN,CPHQ DorenFredrickson,MD,PhD EdwardEllerbeck,MD FranciscaDevora,RN GeorgeAnnEaks,ARNP,CDE,BC-ADM JenniferBrull,MD JillLee,RN,MHS,CNOR JillSumfest,MD,MS,FACS JoanBooker,ARNP,CNS/CFNP,CDE Joan Hardy Joshanna Stone, JD JuliaFrancisco,MPH KathyFriesen LindaChansler,RN,CDE BelindaPChilds,ARNP,MN,CDE,BC-ADM LisaStehno-Bittel,PhD,PT LynnFisher,MD MaryMeckHiggins,PhD,RD,LD,CDE MaryVirden,MSE,RN MelindaKrautman,MS,RN MiriamIbrahim,BS,OT,MPH MonaBroomfield,RN,BSN NancyCopelandLee,RN OlindaHarbaugh,RD,LD,MPH,CDE PattyLarraga,RN,BSN RebeccaBaca,RN,BSN
RichardGuthrie,MD,FAAP,FACECDE RichardPruiksma,MD SebeMasquat,RN ShirleyDinkel,PhD,ARNP,BC SteveCorbett,MA

GlaxoSmith Kline UnitedMethodistMexicanAmericanMinistries UniversityofKansasMedicalCenter CEO, Center for Health and Wellness American Diabetes Association GraceMedHealthClinic UniversityofKansasMedicalCenter Mid-AmericaDiabetesAssociates NationalKidneyFoundationofKS/WesternMO KansasAssocfortheMedicallyUnderserved Mid-AmericaDiabetesAssociates KansasFoundationforMedicalCare UniversityofKansasMedicalCenter UniversityofKansasMedicalCenter UnitedMethodistMexicanAmericanMinistries RiverviewHealthServices PrairieStarFamilyPractice PreferredHealthSystems PreferredHealthSystems StCatherineHospital Atwood Family Practice Kansas African American Affairs Commission JuliaFranciscoConsultingServices UniversityofKansasMedicalCenter PrairieStarHealthCenter Mid-AmericaDiabetesAssociates,PA UniversityofKansasMedicalCenter LifelineFamilyMedicine KansasStateUniversity KUHealthPartners,SilverCityHealthCenter KUHealthPartners,SilverCityHealthCenter RenoCountyHealthDept PrairieStarHealthCenter KansasFoundationforMedicalCare HunterHealthClinic InstituteforMinorityHealth/Education/Research
InstituteforMinorityHealth/Education/Research Mid-AmericaDiabetesAssociates,PA PrairieBandPotawatomiHealthCenter PrairieBandPotawatomiHealthCenter WashburnUniversity PrairieBandPotawatomiHealthCenter
5

Acknowledgements
July 2008

Kansas Diabetes Advisory Council Members Continued: StephanieCundith,MS,RD,LD MidwestDairyCouncil TamaraTiemann,MS,RD,LD KansasDepartmentonAging TravisHaas,MHSA KansasHealthPolicyAuthority TrudySims UniversityofKansasMedicalCenter, Office of Continuing Education Kansas Department of Health and Environment Program Staff: Chris Tilden, PhD Director, Office of Local and Rural Health Cyndi Treaster, LSCSW Kansas Department of Health and Environment FarooqGhouri,MD,MPH AdvancedEpidemiologist,BRFSSProgramManager GhazalaPerveen,MD,PhD,MPH DirectorofScienceandSurveillance/HealthOfficer GloriaVermie,RN,MPH Director,RuralHealth JoeKotsch,RN,BSN,MS MaternalandInfant/PerinatalServices KateWatson,MA,MPA ProgramManager,DiabetesPreventionandControl Program MartiMacchi,MEd Director,SpecialStudies MistyJimerson,MS ProgramManager,HeartDisease/StrokePrevention Program PaulaMarmet,MS,RD,LD Director,OfficeofHealthPromotion,KDHE Tara Schooler Health Educator, Diabetes
Prevention and Control Program TeriCaudle,RN ChronicCareSpecialist,DiabetesPrevention and Control Program

Table of Contents
July 2008

VISION:
Kansans living free of diabetes and its complications

MISSION:
To effectively improve the lives of Kansans living with and at risk for diabetes, and to prevent new cases of diabetes

Table of Contents
Introduction 8 NationalPublicHealthGoals 8 Kansas Public Health Goals 9 Prevention and Control of Diabetes 12 The Kansas Diabetes Plan15 Prevention 17 QualityofCare 19 PatientSelf-Management 23 Policy and Advocacy 27 How to Get Involved 30 Measuring Progress 33 Appendices 34

Introduction
July 2008

The Kansas Diabetes Plan is intended to be a blueprint to guide collaborative statewide efforts to reduce the burden of diabetes and improve the health of Kansans over the next five years This plan demonstrates a commitment to improving the Kansas diabetes public health system based on the national and state diabetes public health priorities

National Public Health Goals
Nationalpublichealthgoalsfordiabetesinclude1goalsoutlinedinHealthy People 2010 and 2 objectives developed by the Centers for Disease Control and Prevention 1 Healthy
People 2010 is a set of health objectives for the nation to achieve over the first decade of the new century It can be used by many different people, states, communities, professional organizations, and others to help them develop programs to improve health The Healthy People 2010 agenda focused on two primary goals: Increasequalityofyearsofhealthylife This goal is designed to help individuals of all ages increase life expectancy and improve their quality of life Eliminatehealthdisparities This goal is designed to eliminate health disparities among different segments of the population by specifically targeting the segments that need to improve the most Healthy People 2010 goals are supported by specific objectives in multiple health focus areas including diabetes In Kansas, considerable progress has been achieved toward the Healthy People 2010 objectives for preventive care measures for diabetes as shown in Figure 1
Figure 1
100 90 80 70 60 50 40 30 20 10 0

Achievement to Date of Healthy People 2010 Preventive Care Measures in Adult Kansans With Diabetes
90 76 60 60 39 27 90 75 57 91 76 65 65 55

Pneumo Vac 18-64 yrs

Pneumo Vac 65 yrs

Flu Vac 18-64 yrs

Flu Vac 65 yrs

Foot
Exams

Eye Exams

HbA1c Tests

Healthy People 2010 Goals

Kansans Achievement to Date of Healthy People 2010 Goals

Age-adjusted to 2000 US Standard Population Source: 2006 Kansas Behavioral Risk Factor Surveillance System

See Appendix B for Kansas performance on all Healthy People 2010 Objectives for diabetes

2 The Centers for Disease Control and Prevention CDC, Division of Diabetes Translation has determined the national objectives for diabetes as follows: Increasethepercentageofpeoplewithdiabeteswhoreceive: o Recommended A1c tests o Recommended annual flu vaccination o Recommended pneumonia vaccination o Recommended foot exams o Recommended dilated eye exams
8

Introduction
July 2008

Reducediabetesrelatedhealthdisparitiesinhigh-riskpopulations Establishprogramsforwellness,physicalactivity,weightandbloodpressurecontrol,andsmoking cessation for people with diabetes Establishmeasurementprocedurestotrackprogramsuccessinimprovingdiabetescare Note: The Kansas Diabetes Prevention and Control Program Appendix A tracks and reports progress to CDC on Kansas progress toward achieving the national objectives for diabetes

State Public Health Goals
State public health goals are outlined
in Healthy Kansans 2010 Healthy Kansans 2010 is the Kansas corollary to Healthy People 2010 Healthy Kansans 2010 focuses on how health care providers, organizations, communities, and the state can encourage and provide opportunities for improving health outcomes in Kansas Participants in planning Healthy Kansans 2010 identified three crosscutting issues that are common to multiple health focus areas, including diabetes, and will result in the improvement of multiple leading health indicators: 1 Reducing and eliminating health and disease disparities: Health disparities stem from many factors, includingrace/ethnicity,age,gender,geographyrural/urban,socialandeconomicstatus,anddisability status o Diabetes related health disparities for adults in high-risk populations continue to be a challenge in Kansas In 2006, the age-adjusted prevalence of diagnosed diabetes in adult African Americans was 129 as compared to 64 in adult whites Similarly, the age-adjusted prevalence of diagnosed diabetes in adult Hispanics was 107 as compared to 67 in adult non-Hispanics Figure 2
Figure 2 2006 Estimated Prevalence of Diabetes in Adults by Race and Ethnicity
15 10 5 0 64 13 11 67

Whites

African
Americans

Hispanics

NonHispanics

Race and Ethnicity Category
Source: 2005-2006 Kansas Behavioral Risk Factor Surveillance System Age-adjusted to 2000 US standard population

o Health disparities are seen in diabetes death rates as well The age-adjusted diabetes death rate, with diabetes mentioned as primary or underlying cause, was 237 per 100,000 persons The ageadjusted diabetes death rate was higher among males 259 per 100,000 persons as compared to females 221 per 100,000 persons Similarly, African Americans 622 per 100,000 persons had a higher age-adjusted diabetes death rate as compared to whites 217 per 100,000 persons A higher age-adjusted diabetes death rate was also seen in Hispanics 330 per 100,000 persons compared to non-Hispanics 227 per 100,000 persons Figure 3
9

Introduction
July 2008

The burden of diabetes, its cost in human suffering and health care costs, is on the rise The time to act is now Utilizing national and state public health goals will help address the burden of diabetes statewide It is imperative that all Kansans work together to reduce the prevalence and impact of this devastating disease the Kansas Diabetes Plan is our collaborative guide to
reach that goal Jennifer Brull, MD Prairie Star Family Practice Plainville, Kansas

Figure 3
07 06 05 04 03 02 01 0

Age-Adjusted Death Rate in Persons with Diabetes by Gender, Race and Ethnicity - Kansas 2005
622 330

Deaths per 100,000 persons

237

259

221

217

227

2 System interventions to address social determinants of health: Social determinants issues such as income, education, and social supports impact the health of Kansans o Low income and education levels are associated with a higher burden of diabetes About 147 of Kansans with an annual household income below 15,000 had diabetes compared to an estimated 53 of Kansans with an annual household income of 50,000 or above In 2006, the prevalence of diabetes among Kansans with less than a high school education was 105 compared to Kansans with a college degree at 57 3 Early disease prevention, risk identification, and intervention for women, children and adolescents: Preventing potential health problems at the earliest possible point in life is crucial to increasing the number and quality of years of healthy life for Kansans o Type 2 diabetes is becoming increasingly common in children and adolescents
In addition, there is an increasing number of people who are at risk for developing diabetes due to poor eating habits, being overweight or obese, and having sedentary lifestyles In 2006, nearly 50 of Kansas adults were at risk of developing diabetes due to these very factors
10

t To al De at h Ra

Age-adjusted to 2000 US standard population Diabetes deaths defined by ICD-10 codes E10-E14

M ale s te

hit

ric

m ale s

an Am er ica ns

Hi sp an ics

ics

Prevention and Control of Diabetes
Diabetes related complications are serious but it should also be noted that the risk of complications can be reduced The Diabetes Control and Complications Trial DCCT, a clinical study conducted from 1983 to 1993bytheNationalInstituteofDiabetesandDigestiveandKidneyDiseasesNIDDK,showedthatkeeping blood sugar levels as close to normal as possible slows the onset and progression of eye, kidney, and nerve diseases caused by diabetes In fact, it demonstrated that any sustained lowering of blood sugar helps, even if the person has a history of poor control The studys findings are shown in the table below: Complication Eye Disease Kidney Disease NerveDisease Potential Risk
Reduction 76 50 60

Manynewcasesofdiabetescanbepreventedthroughanintegratedefforttoincreasetherecommended level of physical activity, proper nutrition and a decrease in obesity There is a strong correlation between obesity and the onset of type 2 diabetes During the last ten years, an increase in number of people with diagnosed diabetes has paralleled the increased number of people who are obese Figure 4

Prevention and Control of Diabetes
July 2008

Figure 4

Age Adjusted Prevalence of Diabetes, Overweight or Obese BMI25kg/m2 and Obesity BMI30kg/m2
Diabetes 70 60 50 40 30
488 472 466 505 483 564 544 551

Overweight or Obese

Obese

623 589 572 606 607 609 608

162 20 137 136 149 123 124 10 45 44 41 48 35 29 40 52 0

229 230 233 239 180 191 209 218 57 56 63 59 64 67

259 71

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Source: 1992-2006 Behavioral Risk Factor Surveillance System Age Adjusted to 2000 US Standard Population

There is good news The Diabetes Prevention Program DPP was a major clinical trial, or research study, aimedatdiscoveringwhethereitherdietandexerciseortheoraldiabetesdrugMetforminGlucophage could prevent or delay the onset of
type 2 diabetes in people with impaired glucose tolerance IGT The answer is yes In fact, the DPP found that over the 3 years of the study, diet and exercise sharply reducedthechancesthatapersonwithIGTwoulddevelopdiabetesby58Metforminalsoreduced risk, although less dramatically by 31 Figure 5 The DPP resolved these questions so quickly that, on the advice of an external monitoring board, the program was halted a year early The researchers published their findings in the February 7, 2002, issue of the New England Journal of Medicine

Figure 5

Summary Findings of the Diabetes Prevention Program
100

Reduction of Risk

80 60 40 20 0 31 58

Metformin

Lifestyle

Relative to Control Group standard intervention Risk Reduction

Kansas is taking the lead in fighting the pandemic of diabetes through innovation, partnerships, technology, communication and education David C Robbins, MD, Professor of Medicine, Section of Endocrinology, Kansas University

Diabetes State Plan
July 2008

Diabetes State Plan 2008-2013
Prevention Quality of Care Patient Self-Management Policy and Advocacy

ThepurposeofthePlanistoimprovethequalityandyearsoflifeforKansanslivingwith diabetes, reduce the
complications of diabetes, reduce health disparities among Kansans living with diabetes, and prevent new cases of diabetes
15

Prevention

Prevention
July 2008

Primary prevention interventions seek to delay or halt the development of diabetes Secondary and tertiary prevention interventions focus on people with diabetes and seek to prevent secondary or control tertiary the devastating complications of this disease

Goal Increase awareness of prevention and control of diabetes
Strategy 1: Develop and disseminate a comprehensive report on the burden of diabetes and its risk factors targeted to the general public Action Steps: PrepareaKansasDiabetesBurdenReport DevelopacollaborativeplanwithpartnerstodisseminatetheKansasDiabetesBurdenReportto communities across the State AssurethattheKansasDiabetesBurdenReportisupdatedinatimelymanner Strategy 2: Educate community members about the risk factors for diabetes Action Steps: Developuser-friendlyincludingbraille,largeprint,audioandculturallyappropriatepublicawareness materials Collaboratewithlocalpartnerstodevelopandimplementacommunicationplantoeducate community members about the risk factors for diabetes
Developaneducationprogramtargetingpeoplewithpre-diabetesandundiagnoseddiabetes

Goal Improve capacity to address the prevention and control of diabetes
Strategy 1: Develop the capacity to identify, and implement interventions for, Kansans at risk for diabetes Action Steps: ReviewtheresultsoftheKansasDiabetesPrimaryPreventionPilotStudythatidentifiedtheinfrastructure needed to address primary prevention of diabetes Appendix E UtilizetheresultsoftheKansasDiabetesPrimaryPreventionPilotStudytodevelopcapacitybuilding initiatives in collaboration with local partners TargetthefollowingsettingstoidentifyKansansatriskfordiabetes: o Schools o Worksites o Health care systems oFaith-based/communityorganizations Utilizeexistingpre-diabetesassessmenttools Facilitateplanning,implementationandevaluationofnutrition,physicalactivity,tobaccopreventionand obesity prevention programs using evidence-based strategies Strategy 2: Assure the availability of regular, ongoing professional education opportunities that include prevention strategies for health care professionals who provide diabetes care Action Steps: Developanddisseminateculturallyappropriateeducationmaterialstohealthcareproviders
Assessandenhanceexistingculturalcompetencytrainingcourses Promotetheutilizationofevidence-basedchronicdiseasepreventionandmanagementstrategiesby primary care providers Promotenationalguidelinesforpreventionofdiabetesandtreatmentofriskfactorsfordiabetes Promoteandenhancecomponentsformanagingpre-diabetesinprofessionaleducationprograms
17

Quality of Care

Quality of Care
July 2008

Diabetes is recognized as one particular chronic disease for which quality improvement efforts can make great strides Diabetes has widely respected national guidelines for what constitutes quality care and well-developed national measures of quality Despite this fact, the gap between evidencebased treatment and actual practice and outcomes continues to be wide There continues to be a large number of complications from diabetes that research demonstrates could have been prevented with high quality care States can play a key role in fostering diabetes quality improvement

Goal Increase Kansas health care workforce competencies in diabetes standards of care

Strategy 1: Assure that physicians, physician assistants, advanced registered nurse practitioners and nurses achieve competency in diabetes care
Action Steps: Coordinatetrainingandcertificationopportunitieswithprofessionalorganizationsandlicensingbodies Identifyandutilizeexistingdiabetesqualityofcaretrainingsthatincludeculturallyappropriatecontent Developandutilizenewtrainingsasneeded Ensurethecurriculumformedical,nursingandphysicianassistantstudentsiscurrentandincludes information on working with people with disabilities Increasecompetencyofhealthcareprofessionalsindiabetesqualityofcarebyutilizingthemostrecent, vigorous scientific research currently being translated into practice

Ive had Type 2 diabetes for about 15 years Im only in my 40s and Ive had both of my feet amputated due to complications of diabetes and Im now on dialysis due to kidney failure For years, I had the same doctor who told me that a blood sugar of 200 was just fine I know now that a consistent blood sugar of 200 is what created these horrible complications I now have a good doctor who has helped me get my blood sugar under control but the damage is done — Wyandotte County Resident
19

Quality of Care
July 2008

Strategy 2: Assure that nutritionists, pharmacists, diabetes educators and exercise physiologists achieve competency in diabetes care
Action Steps: Coordinatetrainingandcertificationopportunitieswithprofessionalorganizationsandlicensingbodies Identifyandutilizeexistingdiabetesqualityofcaretrainingsthatincludeculturallyappropriatecontent and information on how to work with people with disabilities Developandutilizenewtrainingsasneeded Ensurethatthecurriculumfornutritionists,pharmacists,diabeteseducatorsandexercisephysiology students is current Increasecompetencyofhealthcareprofessionalsindiabetesqualityofcarebyutilizingthemostrecent, vigorous scientific research currently being translated into practice Note: Training components for diabetes care will differ between the health care professionals described in Strategy 1 and Strategy 2 Strategy 3: Increase utilization of electronic health records EHR to improve diabetes management Action Steps: IdentifyanddisseminateinformationonexistingEHRresources EnsureEHRdevelopmenteffortsarecoordinatedthroughoutthestate WorkwithpublicandprivatepayerstodevelopincentivesforimplementationofEHRsystems CoordinateeffortswiththeGovernorsCommissionforHealthInformationExchange/HealthInformation Technologyandotherrelevanttaskforces/workgroups
Strategy4:Developastatewidediabetesregistrytobeusedasasurveillancesystemtotrackquality of care improvement statewide Action Steps: Formasub-committeeoftheKansasDiabetesTaskForcetooverseedevelopmentandimplementation of the registry o Review a sample of established registry systems to model from o Determine the components of the registry o Identify data that is currently collected o Determine data that needs to be collected o Collaborate with key partners to design the registry o Build the infrastructure for data collection The Kansas Diabetes Task Force is described in the Policy and Advocacy Section on page 27 Strategy5:Increasenetworkingopportunitiesforhealthcareproviderstosharequalityofcarebest practices at the state and local level Action Steps: Createandmaintainregionaldirectoriesofdiabeteshealthcareprovidersandorganizations Developandimplementacommunication/disseminationplanforraisingawarenessaboutdiabetes quality of care issues and best practices o Post best practices on the Kansas Diabetes Prevention and Control Program website Developaplanforsustainingpartnerengagement

Strategy 6: Expand the number of health care professionals in rural areas Action Steps:
Identifychallenges/barrierstorecruitingandretaininghealthcareprovidersinruralareas UtilizetheHealthProfessionalShortageAreaHPSAdesignatedlocationsinKansas,createdbythe Office of Local and Rural Health, to determine the areas of greatest need Developaplanforenhancingruralhealthcaresystemstoassisthealthcareprovidersintheprovisionof diabetes quality of care in rural areas Increasehealthcareproviderawarenessofincentiveprogramstorecruitandretainhealthcare providers in rural areas

Quality of Care

Patient Self-Management

Patient Self-Management
July 2008

Self-management activities are undertaken by an individual to control and monitor their diabetes outside the clinical setting More than 90 percent of diabetes care is self-care Self-care can include monitoring blood glucose levels, following a treatment plan, eating healthy, exercising, losing weight, checking for foot ulcers, attending classes and support groups, and scheduling regular clinical examinations and testing

Goal Improve awareness of and access to diabetes self-management information, programs and services
Strategy 1: Identify diabetes self-management programs and services Action Steps:
Conductstatewideandregionalassessmentsofdiabetesrelatedprogramsandservicestoidentify areas of excellence as well as areas in need of improvement The assessment should include: o Populations with little or no access to diabetes self-management programs and services o Cost effective programs and services o Service delivery system effectiveness o Populations with mobility limitations Analyzetheresultsoftheassessmenttoidentifygapsindiabetesself-managementprogramsand services Utilizetheresultsoftheassessmenttocreateandmaintainregionaldirectoriesofdiabetesselfmanagement programs and services Combinethedirectorieswiththeregionaldirectoriesofdiabeteshealthcareprovidersand organizationsdescribedintheQualityofCaresectiononpage20 PostdirectoriesontheKansasDiabetesPreventionandControlProgramwebsite Strategy 2: Improve public access to diabetes self-management information Action Steps: Identifyresourcesthatprovideinformationtopatientswithdiabetesabout: o The role of weight management and physical activity in self-management of diabetes o Signs and symptoms of diabetes o Blood sugar control, lipid control and blood pressure control o Definitions of normal ranges for blood sugar, HbA1c, lipid
profile, and blood pressure o Explanation of complications of diabetes and strategies for slowing the progression of complications IdentifyADArecognizededucationprogramsandproviders CombinetheinformationcollectedinthetwobulletsaboveandpostontheKansasDiabetesPrevention

Can you tell me where I can go for diabetes education? My doctor just diagnosed me with Type 2 diabetes and wouldnt take time to tell me about how to take care of this at home He said I should go to a diabetes self-management class to get that information The place he referred to costs 500 for the 5-day class and my insurance wont cover it The doctor said I need to check my blood sugar regularly but Im not sure how to do even that Geary County Resident

Patient Self-Management
July 2008

and Control Programs website Ensureinformationpostedonthewebsiteis: o Accessible to the visually impaired o Available in a variety of languages EnsurethattheKansasDiabetesPreventionandControlProgramswebsitelinkstootherappropriate resources including the American Diabetes Association website Strategy 3: Provide evidence-based practice guidelines and information about diabetes patient selfmanagement to health care professionals
Action Steps: Determinetheresourcesneededmostbyhealthcareprofessionals: o Conduct surveys, focus groups, and literature search o Identify and review national resources DevelopapagededicatedtohealthcareprofessionalsontheKansasDiabetesPreventionandControl Programs website to house diabetes self-management information that includes: o Interactive web education programs oVideos o Links and downloadable information Establishasystemforupdatinginformationandsubmittingnewinformation Developandimplementacommunicationplantoinformhealthcareprofessionalsabouttheavailability of information on the Kansas Diabetes Prevention and Control Program website Strategy 4: Enhance diabetes patient self-management training opportunities for health care professionals Action Steps: DeveloptrainingprogramsforhealthcareprofessionalstoimplementContinuousQualityImprovement processes for diabetes patient self-management Raiseawarenessaboutexistingtrainingopportunities Reviewmodelprogramsthathavesuccessfullytranslatedresearchtopractice Developanimplementationplanbasedonthereviewofmodelprograms Developtrainingprogramsforhealthcareprofessionalsaboutthepsychosocialconsequencesof diabetes Strategy 5: Develop
relationships with organizations that provide care and/or resources for diabetes patient self-management in low-income and racial/ethnic groups Action Steps: Partnerwithorganizationsthatworkwithlow-incomeandracial/ethnicpopulationgroupstodevelop culturally appropriate strategies for long-term monitoring and follow-up Provideculturalcompetencytrainingtoprovidersregardinglow-incomeandracial/ethnicpopulations Identifycorporationsthatwouldbewillingtosponsoraninitiativetargetedtowardimprovingdiabetes servicestolow-income,underservedandracial/ethnicpopulations Strategy 6: Develop behavior modification interventions to motivate and educate patients to improve diabetes management and ensure that health care providers are partners in that process

Patient Self-Management
July 2008

Action Steps: Developstrategiestomotivatepatientsby: o Conducting focus groups with providers and patients o Conducting key informant interviews o Conducting a literature review Developapatientempowermentprogramthatfocusesonincreasingskillstomoreeffectively communicate with providers Reviewstudiesthatexaminethepsychologicalattitudesandneedsofpeoplewithdiabetesandshare results with health care providers
Developamediacampaigntargetedtopeoplewithdiabetestoraiseawarenessaboutselfmanagement issues Establishadiabeteshotlinetargetedtopeoplewithdiabetes Investigatealternatewaysforpatientself-managementeducationincluding: o Pod casts o Internet-based interactive classes o Cell phone messaging o Website patient education programs Strategy 7: Initiate a collaborative effort to bring together the various diabetes entities people and programs to improve the effectiveness of diabetes self-management programs and services Action Steps: Developaresourcelistwithcontactinformationthatincludesadescriptionofallprofessionaldiabetes efforts around diabetes self-management, care and prevention activities Updateanddistributetheresourcelisteitherquarterlyorbiannuallytotargetedaudience Developacomprehensivesystemforlinkingpatientswithdiabetesandthoseathighriskfordiabetesto providers Strengthencoalition-buildingactivitiesamongpartnersatstateandlocallevelstofocusonpatientselfmanagement issues ModifyCDCsDiabetesatWorkmodelandpilottesttheworksiteprogramacrossthestate Identifydiabetesself-managementeffortsinschoolsandexpandonthoseefforts
Identifyregionalresourceslocalexpertsforhealthcareprofessionalstoincreasereferralopportunities for diabetes self-management services Recognizeandpromotediabetesnetworksthatcurrentlyexist

An older Hispanic couple in their 70s, both of whom have diabetes and other medical problems, came in for assistance to our program They were not able to apply for any kind of medical assistance programs, Medicare, or Social Security to help pay for medications The clinic has been able to provide some assistance with medications, but there are some services they needed that could not be covered by the clinic They are unable to work and currently live with a son because their trailer home burned down We had them visit with the dietitian to learn how to better control their diabetes by educating them about nutrition However, it was extremely difficult to implement a meal plan because they could barely understand what was being taught Complicating the matter is that they depend on food they receive from the food pantry and dont have much family support We try the best we can to help teach them how to manage their diabetes, but with so many obstacles it continues to be a struggle Garden City
Community Health Clinic
25

Policy and Advocacy

Policy and Advocacy
July 2008

There are many people with diabetes who are uninsured or underinsured and cannot access the supplies, medications, and education necessary to successfully manage the disease and prevent diabetes-related complications such as heart disease, stroke, kidney failure, blindness, and lowerlimb amputation Advocacy efforts are critical for influencing public policy to assure that people with diabetes have the necessary tools for effectively managing their disease

Goal Influence public policy to support improving diabetes prevention, detection and care throughout Kansas
Strategy 1: Form a Diabetes Task Force to review and recommend strategies to address emerging diabetes issues Action Steps: DeterminetheprocessforformingaDiabetesTaskForcewiththeGovernorsendorsement Draftadocument/letteroutliningtheneedforataskforcefortheGovernorsconsideration PreparealistofpotentialmembersfortheGovernorsconsideration DevelopalistofemergingdiabetesissuesfortheTaskForcetoreview oThelistshouldincludeidentificationoffundingsourcestosupportPrimaryPrevention,QualityofCare andPatientSelf-Managementstrategiesandactionsteps
DevelopadraftactionplanbyTaskForcemembersforaddressingemergingdiabetesissues o Include draft legislation for State sanctioned Diabetes Recognized Centers to offset the stringent requirements of the American Diabetes Association recognition program

Please help me I have had Type 1 diabetes since I was 12 years old and I am now in my 40s Im unable to work due to complications of diabetes I have lost one lower leg and I am having problems in my other leg I dont have health care insurance Im almost out of insulin and I dont have enough money to buy any The community health clinic said I couldnt access their low cost services because my Social Security income is too high to be eligible I will be out of insulin in a few days and I dont want to end up in the emergency room with ketoacidosis like Ive done in the past Topeka Resident

Strategy 2: Develop and implement a plan to organize diabetes advocates Action Steps: Recruitdiabetesadvocatesfromthefollowing: oAmericanDiabetesAssociation,KansasMedicalSociety,KansasAcademyofFamilyPhysicians, KansasFoundationforMedicalCare,KansasAssociationfortheMedicallyUnderserved,Kansas
NursesAssociation,Diabetessupportgroups,AssociationofDiabetesEducatorsinKansas,League ofKansasMunicipalities,KansasAssociationofCounties,diabetesclinics,healthplanrepresentatives, and other interested organizations and citizens Identifyadiabetesadvocatechampionwhohasknowledgeaboutthelegislativeprocess DevelopandimplementaplantoeducatediabetesadvocatesontheKansaslegislativeprocess Developanactionplanfordiabetesadvocates
27

Policy and Advocacy
July 2008

Strategy 3: Develop and implement a plan to raise awareness and secure support from the Kansas Legislature for education and health care service initiatives that benefit underserved Kansans at risk for or affected by diabetes Action Steps: Developamediaplantoraiseawarenessoflegislatorsandthegeneralpublicaboutdiabeteshealth care service initiatives CollectanddisseminatedataandinformationregardingthestatusofdiabetesinKansas Reviewexistinglawsandregulationsrelatedtodiabetescare,preventionanddetection Developaplanforaddressingthegapsbetweenexistinglawsandregulationsandidentifiedpolicy goals Identifykeydiabetesissuesforlegislatorstoaddressincludinglegislationtoprovidereimbursementfor diabetes screening and preventative services Strategy
4: Develop a plan to raise awareness among city and county officials about emerging diabetes issues Action Steps: Providecityandcountyofficialswithgeneraldiabetesdataandinformationtoincreaseknowledge and understanding of diabetes care Createanddisseminateaone-pagehandoutwithtalkingpointshighlightingwhydiabetesissues need to be addressed Partnerwithlocalcoalitionstoeducatelocalofficialsaboutemergingdiabetesissues

My doctor had me on a medication that was really helping to get my diabetes under control But the cost of the medication was so high that I could not continue using it I have to take medications for hypertension, high cholesterol and arthritis and I cant afford all of them because the co-pay is so high, so I have to choose which medicines I can take and which ones I have to cut out Some months its a matter of either taking my medicine or paying the rent I work three jobs and I still cant afford the medication and working that much has compromisedmyhealthevenmoreConsequentlymyA1cthispastyearaveragesaround 87 Im starting to have problems with my eyes and feet but I just dont know where to turn for help Wichita Resident

Policy and Advocacy

How to Get Involved

The
Kansas Diabetes Plan is a call to action for Kansans to work collaboratively on reducing the growing burden of diabetes in Kansas This is a Plan for the entire State of Kansas In order to achieve the Plan goals, many partners will need to work together to explore creative solutions for implementing change to systems, communities, and individual behaviors Diabetes has become a problem of epidemic proportion that cannot be solved by a single organization, group, or individual By public and private partners working together, we can implement the Plans goals that may prevent or delay the onset of diabetes in Kansans and improve care for those already living with diabetes What You Can Do 1 Review the Plans goals, strategies and action steps Identify activities that your organization is working on or would like to address 2 Become an active partner with the Kansas Diabetes Prevention and Control Program and others in implementing the Plan 3 Register your support for the Plan Registration is open to anyone involved in current diabetes prevention and control activities or anyone with new ideas or an interest in being involved 4
artnerwithotherPlanregistrantsorsomeone/organizationthatsharesyourgoalstomaximizeyour P impact on reducing the burden of diabetes How to Register Your Support You can register your support for the Kansas Diabetes Plan: PrintoutandcompletetheformonthefollowingpageFaxtheformtotheOfficeofHealthPromotion at 785 296-8059, or Viewthefollowingwebsitehttp://wwwkdheksgov/diabetes/indexhtm Click on the Kansas Diabetes Plan Registration Form, fill out the form, save the form to a hard drive, and then send the saved form to ohp@ kdhestateksus
30

How to Get Involved
July 2008

KANSAS DIABETES PLAN REGISTRATION FORM
Instructions: Fill out the form Save the form to your hard drive Email the saved form to ohp@kdhestateksu s or print a copy and fax to the Kansas Diabetes Prevention and Control Program at 785 296-8059 Important Note: Your support for this Plan may be publicly acknowledged on the Kansas Diabetes Prevention and Control Program website and in Plan related materials 1 I am supporting the Kansas Diabetes Plan as an: Individual Organization

2 Provide your name and name of the organization/group you represent

3 Indicate what type of organization you represent You may check more than one
Coalition Communication/Media Community Group Faith Community Group Food Service/Restaurant Government Agency Health Care Delivery Health Plan/Insurer Non-Profit Agency Professional Association Public Health Department Recreational/Sports Research Institution Retail/Business/ School/College/University Worksite/Employer Other

4 Indicate whether or not you will provide a link from your organizations website to the Kansas Diabetes Plan located at http://wwwkdheksgov/diabetes/indexhtm Yes Website link 5 Please list the activities that you and/or your organization can work on to help accomplish the Plan goals No

Contact Name Organization If Applicable Position/Title Mailing Address Telephone No Email Fax No

Credentials

Measuring Progress

Measuring Progress
July 2008

What is evaluation? Evaluation is the process of analyzing programs and interventions in the context within which they occur to determine if changes need to be made in implementation The evaluation process used in Kansas will attempt to determine as systematically and objectively as possible the relevance, effectiveness, and impact of the program and interventions Evaluation findings will help determine
adjustments that need to be made at any given point during the implementation process Why is evaluation important? Evaluation is a tool that can both measure and contribute to the success of a program or intervention in a number of ways that include: Formingthebasisformakingchoicesabouttheuseoflimitedresources Providinginformationtoimproveprogrameffectiveness Ensuringfundingandsustainability Providingasourceofinformationformakingmidcoursecorrections Providingthebasisfordecidingthedirectionforfutureprogramsandinterventions How will the evaluation be conducted? The Kansas Diabetes Prevention and Control Program DPCP will coordinate the evaluation efforts and track successes, challenges and lessons learned as partners work to implement interventions To that end, the DPCP will develop a tracking tool that will systematically gauge progress throughout the implementation of the Plan Information gathered utilizing the tracking system will support the ongoing assessment of the progress AssessmentProcessTheDPCPwillconvenepartnersfromaroundthestatetoconducta comprehensive performance assessment of the Plan goals, strategies and action steps The purpose of the assessment will be to identify
the progress that has been made and what still needs to be accomplished AssessmentMethodologyTheDPCPwillfacilitateathree-tieredcumulativeapproachtothe assessment Chronic disease prevention and control staff within the state health department will comprisethefirst-tierassessmentgroupandstakeholdersfromacrossthestatewillcomprisethe second-andthird-tierassessmentgroupsProgressonthePlansgoals,strategiesandactionsteps willbeidentifiedbythefirst-tiergroupandthenwillbereviewedandaddedtobythesecond-tier participantsThesameprocesswillberepeatedforthethird-tierparticipants Ongoing performance assessment of the progress will be used to guide future directions in Kansas for diabetes prevention and control initiatives

Appendices
July 2008

Appendices
Appendix A Kansas Diabetes Advisory Council, Kansas Diabetes Prevention and Control Program, Kansas Diabetes Public Health System Appendix B Healthy People 2010 Preventive Care Practice Chart Appendix C Types of Diabetes, Diabetes Signs, Symptoms and Complications Appendix D The Impact of Diabetes in Kansas Appendix E Diabetes Primary Prevention Action Plan Appendix F Definition of Terms Appendix G Resources

Appendices
July
2008

Appendix A
Kansas Diabetes Advisory Council
The Kansas Diabetes Advisory Council KDAC is comprised of people with an interest or expertise in diabetes prevention and control who represent health care delivery systems, professional and voluntary organizations, academic institutions, faith-based organizations, and people with diabetes Formed in 1989, the KDACs purpose is to: GuidethedevelopmentandoverseetheimplementationoftheKansasDiabetesPlan ProvideguidanceandexpertisetotheKansasDiabetesPreventionandControlProgramsactivities Fostercommunication,increaseandsustainpartnershipsandenhancecapacitybuildingwithinthe Kansas Diabetes Public Health System
Kansas Diabetes Public Health System

Communities Voluntary Organizations Health Care Delivery Systems

Diabetes Self-Management

Diabetes Public Health System Assuring conditions for diabetes control

Employers Businesses

Kansas Diabetes Prevention Control Program Academia

The Media

Increasepublicandproviderawarenessofdiabetes Advocateforlegislation,policiesandprogramstoimproveaccesstocareandtoimprovethe treatment and outcomes for Kansans with diabetes
RepresentpublicandprivatepartnerstocoordinateactivitiesthatpromotequalityofcareforKansans with diabetes Developstatecapacityforeffectivelyaddressingtheprimarypreventionofdiabetes Fosterinteragencycollaborationandnetworkingforidentification,utilization,andexpansionof resources for diabetes control services The KDAC has four workgroups that are organized around the priority areas identified through a strategic planning process The workgroups include: Primary Prevention: This workgroup addresses issues around pre-diabetes, overweight and obesity, nutrition and physical activity, and other relevant issues

Appendices
July 2008

Quality of Care: This workgroup focuses on standards of care, access to services, and other relevant issues Patient Self-Management: This workgroup focuses on barriers to patient self-management including culture, language, and cost issues Policy/Advocacy: This workgroup focuses on assessing current policy issues including reimbursement barriers and advocacy strategies for securing additional funding

Kansas Diabetes Prevention and Control Program
The Kansas Department of Health and Environments Diabetes Prevention and Control Program DPCP was established in
1987 through funding from the federal Centers for Disease Control and Prevention CDC The DPCP is devoted to improving the health of Kansans at risk for or with diabetes by: Facilitatingstatewidepartnershipswithhealthcaresystems,communitiesandotherstakeholders Coordinatingstatewideeffortstoimprovediabetesqualityofcare Collectinganddisseminatingdiabetessurveillanceandevaluationdataforprogramdevelopmentand policy guidance Facilitatingoutreacheffortstoaddresshealthdisparitiesinhigh-riskpopulations Developingandpromotingpopulation-basedcommunityinterventions Developingandpromotingculturallyappropriatehealthcommunications Program Highlights Kansas Diabetes Advisory Council Purpose: To improve the states strategic direction and the state diabetes health systems infrastructure Description: The Council is composed of 50 participating members representing organizations in government, health care systems, academia, insurance and others The Council structure includes the general membership, steering committee and workgroups KDAC is the lead organization for developing thestrategicdirectionforaddressingdiabetesissues/gapsinKansas Statewide Diabetes Quality of Care Project Purpose: To improve
the quality of care for diabetes patients Description:TheDiabetesQualityofCareProjectisinitsfourthyearandisbeingimplementedinforty-four healthcare organizations around the state The participants of this project implement the Chronic Care ModelandutilizetheChronicDiseaseElectronicManagementtotrackstandardsofcareinpatientswith diabetes The projected patient registry across all sites is about 14,000 Kansans with diagnosed diabetes School Personnel Training Program for Managing Students with Diabetes Purpose: To educate school personnel about diabetes and to share a set of practices that enable schools to ensure a safe learning environment for students with diabetes Description: The DPCP facilitates a train-the-trainer program to train school nurses and other school personnel in basic diabetes care in order to help students with diabetes succeed in an academic environment Lay Health Worker Program Purpose: To increase access to and awareness of diabetes self-management education and skills to minority, low income and underserved populations Description: The DPCP works with healthcare organizations in Wichita and Garden City to implement the Lay Health Worker Program in the Hispanic and
African American populations within these communities Diabetes education has long been held as a cornerstone for effective diabetes care and this program will improve access to culturally appropriate diabetes self-management education
36

Appendices
July 2008

Diabetes Quality of Care Conference Purpose: To provide access to the most current information related to diabetes clinical improvements, diabetes self-management strategies, standards of diabetes care, and diabetes primary prevention strategies Description:TheDiabetesQualityofCareConferenceattractsspeakersfromaroundNorthAmerica and Canada to provide continuing education appropriate for physicians, physicians assistants, nurse practitioners, nurses, dietitians and others who are involved either directly or indirectly in providing care to people with diabetes Chronic Disease Self-Management Program Kansans Optimizing Health Program Purpose: To provide self-management education to people who are living with chronic disease, including people with diabetes Description: The Kansas Optimizing Health Program KOHP was developed utilizing Stanford Universitys
ChronicDiseaseSelf-ManagementProgramCDSMPcurriculumTheprogramconsistsofasixweek workshop designed to help people who live with chronic disease learn skills that can assist them with the dailymanagementofsymptomsassociatedwithchronicdiseaseandtomaintainand/orincreaselifes activities Kansas Diabetes Plan Purpose: To improve the lives of Kansans living with and at risk for diabetes and to prevent new cases of diabetes Description: The Kansas Diabetes Plan serves as a blueprint for the development of a comprehensive and balanced system for linking diabetes resources Representatives from communities, healthcare delivery systems, businesses, media, academia, DPCP, diabetes self-management services and voluntary organizations are represented on the Kansas Diabetes Advisory Council KDAC which was the lead organization in the development of the Plan Kansas Diabetes Burden Report Purpose: To provide data for stakeholders to support decisions regarding diabetes activities Description:TheKansasDiabetesBurdenReportisnecessarytoobtainpopulation-basedinformation/data for planning, implementing and evaluating efforts to reduce the burden of diabetes in Kansas The Burden Report will be published in
Summer 2008 and updated as necessary

Appendices
July 2008

Appendix B
Kansas Performance on Healthy People 2010 Objectives for Diabetes
HP 2010 Objective Increase proportion of persons with diabetes who receive formal diabetes education Prevent diabetes Reduce overall rate of diabetes that is clinically diagnosed Increase proportion of adults with diabetes whose condition has been diagnosed Reduce the diabetes death rate Reduce diabetes-related deaths among persons with diabetes Reduce deaths from cardiovascular disease in persons with diabetes Reduce the rate of lower extremity amputations in persons with diabetes Increase proportion of adults with diabetes who obtain an annual urinary microalbumin measurement Increase proportion of adults with diabetes who have a glycosylated hemoglobin measurement at least once a year Increase proportion of adults with diabetes who have an annual dilated eye exam Increase proportion of adults with diabetes who have at least an annual foot exam Increase proportion of persons with diabetes who have at least an annual dental exam Increase proportion of adults 40 years and older with diabetes who take aspirin at least 15 times per month
Increase proportion of adults who perform self-blood-glucose monitoring at least once daily

Current Kansas Status 551 12 new cases per 1,000 population peryear 71casesper1,000population 70 708deaths/100,000population 54 deaths per 1,000 persons with diabetes 1714 deaths per 100,000 persons withdiabetes 241 lower extremity amputations per 10,000personswithdiabetes NoKansasdataavailablethatis directly comparable to HP2010 target 903 with at least one glycosylated hemoglobin measurement annually 55 with at least two glycosylated hemoglobinmeasurementsannually 655

HP 2010 Goal 60 38 news cases per 1,000 population per year 25 cases per 1,000 population 78 46deaths/100,000population 78 deaths per 1,000 persons with diabetes 299 deaths per 100,000 persons with diabetes 18 lower extremity amputations per 1,000 persons with diabetes per year 14

574

720

643 2005 KS BRFSS

620

2006KSBRFSSageadjustedtotheyear2000standardpopulation 2004-2005KSVitalStatisticsdata,ageadjustedtotheyear2000standardpopulation BasedonCDCestimateof70diagnosedcasesofdiabetes 2004-2005KSHospitalDischargeData,ageadjustedtotheyear2000standardpopulation
2004-2005KSBRFSS,ageadjustedtotheyear2000standardpopulation 2004KSBRFSS,ageadjustedtotheyear2000standardpopulation Statisticallysignificantat95confidenceintervalfrom2005prevalenceof77Continuousmonitoringandfollow-upneedstocontinue overtime to determine whether it is a real decline or just a one point in time decrease in the proportion of adults who had their Hemoglobin A1c measured at least twice annually

Appendices
July 2008

Appendix C
Types of Diabetes
Type 1 Diabetes Type 1 diabetes, previously called insulin dependent diabetes or juvenile onset diabetes, is an autoimmune disease that is usually diagnosed in children, teenagers and young adults In type 1 diabetes, the bodys mechanism to fight infection immune system attacks or destroys the insulin-producing beta cells in the pancreas A person who has type 1 diabetes must take insulin, either by injection or insulin pump, everyday to live Risk factors for type 1 diabetes include autoimmune, genetic and environmental factors Type 1 diabetes accounts for 5-10 of all diagnosed cases of diabetes Type 2 Diabetes Type 2 diabetes, previously called adult-onset diabetes is the most common form of diabetes in adults People with type 2
diabetes produce insulin, but either do not make enough insulin or their bodies do not use the insulin they make Treatment includes oral medications, often in combination with other types of therapy Risk factors for type 2 diabetes include: Familyhistoryinoneormorefirstdegreerelatives Forwomen,aprevioushistoryofgestationaldiabetesordeliveringababyweighingmorethan9 pounds Non-Caucasianrace/ethnicityHispanic/Latino,AfricanAmerican,AmericanIndian Pre-diabetes Hypertension Sedentarylifestyle OverweightBodyMassIndex[BMI]250kg/m2orobeseBMI300kg/m2 Of those Americans who are diagnosed with diabetes, 90-95 have type 2 diabetes Pre-Diabetes Pre-diabetes is a condition that occurs when a persons blood sugar levels are higher than normal but not highenoughforadiagnosisoftype2diabetesMostpeoplewithpre-diabeteseventuallydeveloptype 2 diabetes However, studies have shown that people with pre-diabetes can prevent or delay the onset of type 2 diabetes through modest weight loss, healthy diet and regular exercise The risk factors for prediabetes are the same as the risk factors for type 2 diabetes Gestational Diabetes Gestational diabetes develops in some women during pregnancy and usually
disappears when the pregnancy is over Obesity is associated with a higher risk of developing gestational diabetes Women who have gestational diabetes are more likely to develop type 2 diabetes later in life Healthy eating habits and physical activity can help lower blood sugar levels, however insulin may still be required

Signs and Symptoms
A person can have diabetes for years without experiencing any symptoms Some of the most common symptoms of diabetes include: Excessivethirst Extremehunger Frequenturination
39

Appendices
July 2008

Unusualweightloss Increasedfatigue Irritability Blurredvision Slowhealingcutsorsores

Complications
UncontrolleddiabetescanleadtoseriouscomplicationsandevendeathNationalfactsandfigures Center for Disease Control and Prevention Heart Disease and Stroke Heartdiseaseandstrokeaccountforabout65ofdeathsinpeoplewithdiabetes Adultswithdiabeteshaveheartdiseasedeathratesabout2to4timeshigherthanadultswithout diabetes Theriskofstrokeis2to4timeshigherforthosewithdiabetes High Blood Pressure About73ofadultswithdiabeteshavebloodpressure130/80oruseprescriptionmedicationsfor hypertension Eye Disease Diabetesistheleadingcauseofnewcasesofblindnessamongadults
Inpeoplewhohavediabetes,retinopathycauses12,000to24,000newcasesofblindnesseach year Kidney Disease DiabetesistheleadingcauseofkidneyfailureintheUnitedStates About10-40ofpeoplewithtype2diabeteseventuallywillsufferfromkidneyfailure Flu and Pneumonia Peoplewithdiabetesaremoresusceptibletomanyotherillnessesand,oncetheyacquirethese illnesses, often have worse prognoses For example, they are more likely to die with flu or pneumonia than people who do not have diabetes Nervous System Disease About 60-70 of people with diabetes have mild to severe forms of nervous system damage including: o Impaired sensation to pain in the feet or hands o Slowed digestion of food o Carpal tunnel syndrome Severeformsofdiabeticnervediseaseareamajorcontributingcauseoflower-extremityamputations Amputations MorethanhalfoflowerlimbamputationsintheUnitedStatesoccuramongpeoplewithdiabetes

Source: Centers for Disease Control and Prevention, Division of Diabetes Translation, National Diabetes Fact Sheet, 2005

Appendices
July 2008

Appendix D
National Public Health Goals
Diabetes is common, complex and costly Diabetes is a Common Problem In Kansas, it is estimated that nearly 216,000 adults have diabetes
151,000 Kansans with diabetes that have been diagnosed and 65,000 with diabetes who have not been diagnosed From 1992 to 2006, the prevalence increased by an alarming 58 Figure 1
Figure 1
Prevalence 10 8 6 4 2 0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 44 41 48 35 29 40 52 57 56 63 59 64 67 71

Age-Adjusted Prevalence of Diabetes in Adults, Kansas 1992-2006

Source 2006 Kansas BRFSS Age-adjusted to 2000 US standard population

Diabetes is a Complex Problem The risk factors associated with diabetes contribute to the complex nature of this disease Adult Kansans diagnosed with diabetes face complications that disproportionately affect them compared to adult Kansans who dont have diabetes Figure 2 Higher prevalence of certain risk factors among adults with diabetes increases the risk of complications Adult Kansans with diabetes have a higher prevalence of being overweight and obese, lacking physical activity, high blood pressure and high blood cholesterol Fortunately, there were fewer Kansans with diabetes who were current smokers compared to Kansans without diabetes
Figure 2 Prevalence of Adults With and Without Diabetes that Reported Being Overweight, No
Leisure Time Physical Activity, High Blood Pressure, High Blood Cholesterol and Smoking, Kansas 2006
1000 Overweight 900 830 800

Prevalence

700 600 500 400 300 200 100 00

607

No leisure time physical activity
365 215

High blood pressure
615

High blood cholesterol
563

312 214

Smoking
206 137

ith W

W ith

ith W

Source: 2005-2006 Kansas Behavioral Risk Factor Surveillance System Overweight is defined as BMI 25 kg/m2 Data for high blood pressure and high blood cholesterol are from 2005 Kansas BRFSS

ith W

e et iab tD ou es ith et ab Di

ith t ou

ith

e et iab tD ou es et

ab Di

et ab

Di e ab te s

et iab

e et s

Diabetes Status

Appendices
July 2008

Kansans in general are at risk for developing diabetes There is a strong correlation between obesity and the onset of type 2 diabetes During the last ten years, an increase in the number of Kansans with diagnosed diabeteshasparalleledtheincreaseinthenumberKansanswhoareoverweightand/orobeseFigure3
Figure 3 Age Adjusted Prevalence of Diabetes, Overweight or Obese BMI25kg/m2 and Obesity BMI30kg/m2
Diabetes 70 60 50 40 30
488
472 466 505 483 564 544 551

Overweight or Obese

Obese

623 589 572 606 607 609 608

162 20 137 136 149 123 124 10 45 44 41 48 35 29 40 52 0

229 230 233 239 180 191 209 218 57 56 63 59 64 67

259 71

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Source: 1992-2006 Behavioral Risk Factor Surveillance System Age Adjusted to 2000 US Standard Population

Diabetes is a Costly Problem In2004,thedirectandindirectcostofdiabeteswasestimatedatastaggering14billionFigure4Nearly half493ofthetotalcostofcarefordiabeteswaspaidbyMedicaid,Medicare214andotherpublic funds 176 Private insurance paid one-third 345 of the total expenses for diabetes care
Figure 4 Estimated Direct and Indirect Costs of Diabetes in Kansas

Indirect Cost 400 Million

Direct Cost 1 Billion

Source: 1992-2006 Kansas Behavioral Risk Factor Surveillance System Age-adjusted to 2000 US standard population

Appendices
July 2008

Appendix E
Primary Prevention of Diabetes in Kansas: ACTION PLAN BLUEPRINT

Monitor Health Status to Identify Health Problems and Goals
1 Prepare annual Kansas state surveillance report based on yearly BRFSS data related to diabetes disease burden and its risk factors
lack of physical activity, unhealthy dietary habits, obesity, and smoking Widespread communication of above mentioned report by developing user-friendly online system 2 Partner with related professional associations eg, KS Optometry, KS Podiatry, Kansas Association for the Medically Underserved KAMU to identify people at risk and associated health problems 3 Develop a Medical Advisory Board for Diabetes 4 Use mass media to create demand for self-assessment tool eg, Ask your doctor if youre at risk for diabetes 5 Develop the ability to monitor overweight in schools 6 Use databases of people screened through related associations eg, National Kidney Foundation 7 Promote statewide use of American Diabetes Association ADA self-assessment tool 8 Use Behavioral Risk Factor Surveillance Survey BRFSS, Youth Risk Behavior Survey YRBS, Youth Tobacco Survey YTS, existing Women, Infant, and Children WIC data, and pre-natal assessments from the Department of Social and Rehabilitation Services SRS to identify people at risk 9 Develop the ability to monitor pre-diabetes Impaired Glucose Tolerance for all Kansans 10DevelopaplanforanObesityRegistryeg,thosewhohaveachievedsignificantweightlossand have
maintained it to assist planning for obesity efforts 1 Enhance communication and consultation between state and local health departments to use diabetes surveillance reports to assess burden of disease and its risk factors at the local level eg, BRFSS, YRBS, YTS 2 Develop a mechanism to disseminate diabetes surveillance information from local health department level to local community organizations 3 Develop a mechanism to help local health departments and community organizations to understand the extent of diabetes related problems in their particular areas 4 Develop Diabetes Risk Registry 5 Foster student advocacy and support groups around diabetes risk factors 6 Promote assessments of local access to parks and walking trails 7 Investigate the problem at the local level with the help of special surveys over sampling in local places 8 Prepare maps of environmental hazards eg, vending machines in schools, walkability access related to risk factors

Essential Public Health Services

Recommendations Priorities

Recommendations

Diagnose and Investigate Health Problems and Health Hazards

Priorities

Appendices
July 2008

Inform, Educate, and Empower People about Health Issues
1
Disseminate diabetes risk information to policy makers 2 Health Education Plan Provide health education materials to communities 3 Create culturally appropriate education provided by credible sources eg, Promotoras 4 Promote existing guidelines for prevention and treatment of overweight and obesity eg, National Heart Lung Blood Institute, ADA 5 Identify dedicated health promotion state funding for diabetes and other chronic diseases 6 Develop media campaigns regarding diabetes, its risk factors, and primary prevention strategies 7 Establish an on-line information system related to diabetes and its risk factors, the extent and importance of the issues, strategies to deal with the issues, contact information of the resources and the community based programs available to help in dealing with diabetes and its risk factors at individual and community levels 8 Educate providers to encourage them to counsel patients to be active and eat healthy diets 9 Develop and maintain a service map identifying what services are available at the county level 10 Use mass media to create demand for self-assessment tools eg, Ask your doctor if youre at risk for diabetes 11 Utilize Quitline to support
smoking cessation 12 Provide communications that make the case for funding for health issues eg, health prevention versus funding for roads 13 Promote on-line access to diabetes related information at workplaces, businesses and schools 14 Support local speakers bureau related to risk for diabetes eg, model slide presentations with consistent messages 15 Provide model negotiation strategies and contracts with vendors to promote/provide healthy choices eg, soda machines, fast food restaurants 16 Collaborate with celebrities in promoting health activities

Essential Public Health Services

Recommendations
44

Mobilizing and Supporting Community Partnerships to Identify and Address Health Problems and Goals
1 Facilitate planning, implementation and evaluation of nutrition, physical activity, tobacco control and obesity control programs using evidence-based strategies by local health, community organizations, work places, and school administrations 2 Enhance physical environment to promote physical activity eg, hiking trails, parks, river access 3 Support local coalitions eg, develop set of tools such as tips, best and promising practices for local change efforts 4 Promote opportunities
for local communities for capacity building, leadership development and skills training for developing effective partnerships with various organizations 5 Expand regional outreach capacity to help local health and community organizations to identifyagenciesprovidingtechnicalandfinancialsupport,andtodeveloprelationshipswith those agencies 6 Develop a system to provide planning and implementing grants to local communities for primary prevention plans 7 Build ownership for this work among city/county level administrators eg, request to be on the city/county commissioners and administrative planning agendas 8 Link increase in state funding formula funds with health promotion and chronic disease risk activities in local communities

Recommendations

Priorities

Appendices
July 2008

Develop Policies and Plans that Support Individual and Community Health Efforts
1 Promote practice of evidence-based disease prevention and management strategies by health care providers 2 Promote clean indoor air policy development and system changes at work sites, schools and public places 3 Provide a reimbursement code for screening and other clinical preventive services for obesity 4 Create
opportunities to increase physical activity 5 Develop policies requiring physical education in the context of coordinated school health that meetsdefinedstandardsinallKansasschools 6 Develop policy to address the lack of availability of affordable fruits vegetables Work with juice/fruit
companies for subsidies to school athletic departments Subsidize fruit vegetable growers through farmers markets and roadside stands or grocery stores

Priorities

Essential Public Health Services

7 Develop strategies to provide incentives for employees to participate in physical activity, nutrition, weight reduction, and smoking cessation programs provided by employers 8 Promote provision of healthy eating choices at restaurants 9 Modify policies so that all who need important clinical preventive services get them 10 Develop policies and system changes regarding provision of safe public places for engaging community members in physical activities 11 Promote legislative action to increase Medicaid reimbursements eg, diagnosis for obesity, diabetes related services 12Supporttaxincentivesforbusinessesforemployeefitnessefforts 13 Identify and disseminate model ordinances eg, require developers to
include sidewalks in development, etc 14 Promote development of an appropriate reimbursement communication/consultation for preventive services by Medicaid and third party reimbursement systems 15 Develop policies to:
Remove physical activity barriers Support environmental change

Recommendations

16 Capitalize efforts on land use efforts to promote physical activity eg, hiking trails, river access 17 Provide tax credits for school districts that restrict access to unhealthy dietary choices eg, soda and ala carte vending machines and promote healthy alternatives eg, fruits, vegetables 18 Promote business policies that relate to point of purchase to promote healthy choices eg, checkout stand options 19 Promote provision of tax credits or insurance breaks for those enrolled in organizational weight lossmanagementeg,fitnessclubmemberships,WeightWatchers 20 Promote tax credits for those assuring access to health foods eg, food pantries

Appendices
July 2008

Enforce Laws and Regulations that Protect Health and Ensure Safety
1 Enforce laws and regulations against selling tobacco products to children and adolescents 2 Review existing laws and regulations related to prevention of
diabetes 3 Developaplanforaddressingthegapsbetweenexistinglawsandregulationsandidentified policy goals 4 Compareexistinglawsandregulationstopolicygoalsidentifiedinessentialservice5 5 Assess compliance with school policies that protect and promote health eg, physical activity 6 Collect sales tax on unhealthy products eg, soft drinks, super-sized high-fat meals and redistribute for prevention efforts in health opportunity zones eg, areas where there are high levels of diabetes Recommendations Priorities

Assuring Access and Linking People to Needed Services
1 Arrange food distribution programs eg, WIC, homeless food programs that are healthy and culturally appropriate 2 Partner with existing associations/organizations eg, National Kidney Foundation, Parish Nursestopromptfollow-upforthoseidentifiedtobeatriskfordiabetesthroughscreening activities 3 Promote development of parks, walking trails, bike trails, and other safe places assuring access for physical activity programs eg, after school programs, Parks and Recreation, YMCA, YWCA 4 Engage corporate sponsors in providing free materials promoting health habits 5 Maintain and enhance neighborhood schools as a resource for healthy
habits eg, playgrounds, afterschool activities, parental participation 6 Assure access to services for all through expanded health insurance coverage eg, nutrition and physical activity coverage, obesity coverage, screening service coverage 7 Prepare asset maps of providers who will assure/provide prevention services 8 Enhance cultural and linguistic competence eg, training courses, workshops and language access eg, interpreters 9 Promote local review of public transportation and enhance collaboration of access to health services 10 Link diverse groups of people to available supports for a healthier diet and appropriate physical activity eg, farmers markets 1 Provide ongoing training to staff members of participating partner agencies/organizations involved in providing diabetes prevention services eg, health service providers who provide clinical preventive screening, school health educators 2 Enhanceculturalcompetencethroughtrainingandcertificationprogramseg,workshops, courses 3 Enhance core competencies in bringing about community system changes through training and certificationprograms 4 Providecertificationandadvancementopportunitiesforthosedemonstratingenhancedcore
competencies eg, medical licensing exams 5 Enhance outreach capacity for mobilizing local support for diabetes surveillance 6 Assure adequate local and regional staff to ensure provision of needed services eg, public health nurses, Kansas State Department of Education, Kansas Department on Aging, school nurses 7 Develop communication /consultation to document competencies

Essential Public Health Services
46

Recommendations Priorities

Assure a Competent Public and Personal Health Care Workforce

Appendices
July 2008

Evaluate, Accessibility, and Quality of Personal and PopulationBased Health Services
1 Monitor and promote quality clinical preventive services related to diabetes eg, assessment of clinical services provided by physicians that meet current guidelines 2 Establish communication/consultations/technical support for health and community organizations for measuring progress and outcomes of the programs, as well as, interpretation and reporting of the process and outcome measures 3 Develop Diabetes Risk Registry to identify target population 4 Assure comparable measures across cities/counties 5 Evaluation based on community involvement Assure
capacity to evaluate outcomes of community-based interventions

Essential Public Health Services

Recommendations Priorities Recommendations Priorities

Research for New Insights and Innovative Solutions for Health Problems and Goals
1 Usedataontheoutcomesof theprimarypreventionprogramobtainedbyscientifically designed evaluation strategies for developing and investigating various research questions 2 Convene an annual conference for the purpose of educating the diabetes health community about primary prevention of diabetes 3 Conduct focus groups to determine what infrastructure is needed in the community to address primary prevention of diabetes 4 Convene work groups to develop interventions that will incorporate lessons learned from community focus groups

Appendices
July 2008

Appendix F
Definition of Terms A1c hemoglobin A1c or HbA1c A clinical test used to gauge the level of blood glucose control It provides an average of the blood glucose levels for the past 120 days A1c levels can range from about 6 normal to as high as 25 uncontrolled glucose levels Regular A1c testing is essential for monitoring the effectiveness of diabetes treatment plans Behavioral Risk Factor
Survey BRFSS The largest continuously conducted telephone survey in the world The Centers for Disease Control and Prevention coordinates and provides funding for the BRFSS Survey It is conducted annually in all 50 states, the District of Columbia and several territories The survey includes questions about disease prevalence, risk factors, lifestyle and health behaviors In Kansas, the survey has been conducted by the Kansas Department of Health and Environment since 1992 Behaviors An individuals lifestyle choices such as good nutrition, regular physical activity, and actions to control blood glucose, blood lipid and blood pressure levels that decrease the risk of diabetes or its complications Blood Glucose The main sugar that the body makes from food we eat Glucose is carried through the bloodstream to provide energy to all of the bodys living cells The cells cannot use glucose without the help of insulin Centers for Disease Control and Prevention 2003 Take Charge of Your Diabetes, 3rd edition Blood Pressure The force of the blood against artery walls Blood pressure is expressed as a ratio example:120/80,readas120over80Thefirstnumberisthesystolicsis-TAH-likpressure,orthepressure
when the heart pushes blood out into the arteries The second number is the diastolic DY-uh-STAH-lik pressure, or the pressure when the heart rests Body Mass Index BMI A formula that assesses both height and weight in order to classify overweight andobesityandtoestimatetherelativeriskofdiseaseBMIstatusincludes185underweight,185-299 kg/m2normal,250-299kg/m2overweight,and300kg/m2obese Chronic Disease An illness that is present over a long period of time Diabetes is a progressive chronic disease that requires ongoing treatment and monitoring, as yet there is no cure Cultural Competency culturally competent organizations design and implement services that are tailored or matched to the unique needs of individuals, children, families, organizations and communities served NationalCenterforCulturalCompetence Diabetes Educator A health care professional who teaches people with diabetes how to manage their disease some diabetes educators are certified diabetes educators: professionals with expertise in diabetes education who have passed a certification exam Diabetes educators work in hospitals, physician offices, managed care organizations, home health care services and other settings
Diabetes mellitus A condition characterized by hyperglycemia resulting from the bodys inability to use blood glucose for energy In type 1 diabetes, the pancreas no longer makes insulin and therefore blood glucose cannot enter the cells to be used for energy In type 2 diabetes, either the pancreas does not make enough insulin or the body is unable to use insulin correctly
48

Appendices
July 2008

Diabetic Ketoacidosis A life threatening condition in persons with type 1 diabetes that requires immediate treatment It is characterized by extremely high blood glucose levels with the presence of ketones in the urine and bloodstream Left untreated, diabetic ketoacidosis can lead to coma and death Symptoms include: nausea and vomiting, stomach pain, fruity breath odor and rapid breathing Dilated eye exam A specific eye exam that includes dilating the pupil of the eye so that the retina the back of the eye can be carefully examined This type of exam is crucial for people with diabetes Dialysis An artificial process for cleansing wastes from the blood a job normally performed by the kidneys However, in persons with kidney failure, this job must be accomplished through special equipment
instead Disparate populations A term used in the public health arena to describe populations receiving unequal treatment based on differences such as gender, race, ethnicity, income, disability, education, geographic location or sexual orientation Gestational diabetes mellitus GDM A type of diabetes mellitus that develops only during pregnancy and usually disappears upon delivery, but increases the risk that the mother will develop diabeteslaterGDMismanagedwithmealplanning,activityand,insomecases,insulin Healthy Kansans 2010 The Kansas state health plan, vision, mission, goals, objectives, and priorities for the public health system partnership Healthy People 2010 The prevention agenda for the nation It is a statement of the national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats Hemoglobin A1C A test that summarizes how much blood glucose has been sticking to the red blood cells during the past three to four months Since red blood cells regenerate every four months, doctors can get a good idea about how glucose has affected the life of the cells during that time period
Hyperglycemia Also called high blood glucose A condition in people with diabetes where blood glucose levels are too high Symptoms include frequent urination, unusual thirst and weight loss Hypoglycemia Also called low blood glucose Is a condition that results when blood glucose levels are too low Symptoms include feeling nervous or anxious, feeling numb in the arms and hands, and shakiness or dizziness Impaired fasting glucose IFG A condition in which a blood glucose test, taken after an 8- to 12-hour fast, shows a level of glucose higher than normal but not high enough for a diagnosis of diabetes IFG, also calledpre-diabetes,isalevelof110mg/dLto125mg/dLMostpeoplewithpre-diabetesareatincreased risk for developing type 2 diabetes Impaired glucose tolerance IGT A condition in which blood glucose levels are higher than normal but arenothighenoughforadiagnosisofdiabetesIGT,alsocalledprediabetes,isalevelof140mg/dLto 199mg/dL2hoursafterthestartofanoralglucosetolerancetestMostpeoplewithpre-diabetesareat increased risk for developing type 2 diabetes Other names for IGT that are no longer used are borderline, sub-clinical, chemical or latent diabetes

Appendices
July 2008

Incidence
How often a disease occurs; the number of new cases of a disease among a certain group of people over a specific period of time Insulin A hormone that helps the body use blood glucose for energy The beta cells of the pancreas make insulin Insulin resistance A condition that occurs when the body cannot use the insulin it makes effectively and as a result, glucose levels rise Ketones Chemical substances the body produces when it does not have enough insulin in the blood If ketones build up in the body, serious illness or a coma can result Pancreas An organ that makes insulin and enzymes for digestion The pancreas is located behind the lower part of the stomach and is about the size of a hand Prevalence The number of people in a given group or population who are reported to have a specific disease at any one point in time Pre-diabetes A condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke Other names for prediabetes are impaired glucose tolerance and impaired fasting glucose Risk Factors Characteristics of
individuals that increase the probability that they will experience disease or death compared to the rest of the population Risk factors for developing diabetes include genetics, environmental exposures, and socio-cultural living conditions Risk factors for complications of diabetes include the same factors as above and more importantly, uncontrolled blood sugar, blood lipid or blood pressure levels Self-management Education Instruction about nutrition, exercise, medications, blood sugar monitoring, and emotional adjustment to help people control their diabetes and make healthy lifestyle choices Type 1 Diabetes A condition characterized by high blood glucose levels caused by a total lack of insulin Occurs when the bodys immune system attacks the insulin-producing beta cells in the pancreas and destroys them The pancreas then produces little or no insulin Type 1 diabetes develops most often in young people but can appear in adults Type 2 Diabetes A condition characterized by high blood glucose levels caused by either a lack of insulin or the bodys inability to use insulin efficiently Type 2 diabetes develops most often in middle-aged and older adults but can appear in young
people Definitions adapted and/or excerpted from: 1 Centers for Disease Control and Prevention 2002 Take Charge of Your Diabetes 3rd edition Atlanta: US Department of Health and Human Services 2 NationalInstituteofDiabetesandDigestiveandKidneyDiseasesDiabetesDictionary http://wwwniddknihgov/health/diabetes/pubs/dmdict/dmdicthtm

Appendices
July 2008

Appendix G
Resources
American Diabetes Association, http://wwwdiabetesorg American Association of Diabetes Educators, http://wwwaadenetorg American Dietetic Association http://wwweatrightorg American Heart Association http://wwwamericanheartorg Centers for Disease Control and Prevention, http://wwwcdcgov Diabetes at Work, http://wwwdiabetesatworkorg Healthy Kansans 2010, http://wwwhealthykansansorg Healthy People 2010, http://wwwhealthypeoplegov NationalDiabetesEducationProgram,http://wwwndepnihgov NationalDiabetesInformationClearinghousehttp://diabetesniddknihgov NationalInstituteofDiabetesandDigestiveandKidneyDisease,http://wwwniddkgov NationalHeartLungandBloodInstitutehttp://wwwnhlbinihgov/indexhtm NationalKidneyFoundationhttp://wwwkidneyorg Kansas Department of Health and Environment,
http://wwwkdheksgov

Source:bcs.uni.edu

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