Diabetes Treatments

On behalf of the Department of Health and our partners in diabetes prevention and South Dakota with a blueprint for the control of diabetes and the health …

South Dakota Diabetes State Plan

2007-2009

OFFICE OF THE SECRETARY

600 East Capitol Avenue Pierre, South Dakota 57501-2536 605/773-3361 FAX: 605/773-5683 wwwstatesdus/doh

Dear South Dakotans: On behalf of the Department of Health and our partners in diabetes prevention and control, it is my pleasure to present to you South Dakotas first ever diabetes state plan Diabetes is a serious public health problem in our state More than 50,000 South Dakotans have been diagnosed with this chronic disease and another 25,000 have the disease but do not know it Unfortunately, both of these numbers are projected to continue increasing This plan provides South Dakota with a blueprint for the control of diabetes and the health complications associated with the disease It is a comprehensive strategy for reducing the impact of diabetes and for helping those with diabetes manage their disease The ultimate goal of this plan is to put in place a more effective system of early diagnosis, access to quality care, promotion of healthy lifestyles, and education and awareness so South Dakotans with diabetes can live longer, healthier lives It is our hope that the collaboration that created this plan
continues Working together, we can better manage the diabetes epidemic and improve the quality of life for the individuals and families affected by this disease Thank you to the committed partners who have helped to develop this plan and are working with us to create a healthier South Dakota To learn more about the state plan, contact the South Dakota Diabetes Prevention and Control Program at 605 773-3737 Sincerely,

Doneen B Hollingsworth Secretary of Health

South Dakota Diabetes State Plan 2

South Dakota Diabetes State Plan 2007-2009
Published February 2007

Doneen Hollingsworth, Secretary South Dakota Department of Health

For additional information or copies of this plan, contact: South Dakota Department of Health 615 East 4th Street Pierre, South Dakota 57501-1700 605-773-3737 http://diabetessdgov

This publication was supported by Cooperative Agreement U32/CCU822730 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

This document is in the public domain and may be downloaded, copied and/or reprinted The South
Dakota Diabetes Prevention Control Program and its partners appreciate citation and notification of use

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TABLE OF CONTENTS
Letter from Secretary of Health Doneen Hollingsworth2 Table of Contents4 Acknowledgements5 Executive Summary 9 What Is Diabetes? 11 Burden of Diabetes in South Dakota 13 Plan Process 17 Essential Public Health Services 1-Monitor heath status to identify and solve community health problems19 2-Diagnose and investigate health problems and health hazards in the community 21 3-Inform, educate, and empower people about health issues 22 4-Mobilize community partnerships to identify and solve health problems 23 5-Develop policies and plans that support individual and community health efforts 24 6-Enforce laws and regulations that protect health and ensure safety25 7-Link people to needed personal health services and assure the provision of health care when otherwise unavailable26 8-Assure a competent public and personal health care workforce 27 9-Evaluate effectiveness, accessibility, and quality of personal and population-based health services 28 10-Research for new insights and innovative solutions to health problems29 Appendices
Appendix A References 30 Appendix B Definition of Terms 31

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ACKNOWLEDGEMENTS
The South Dakota Diabetes State Plan 2007-2009 is the result of a statewide collaboration and was developed with contributions of time and talent from many individuals The following individuals and organizations served as members of the stakeholders group and were the primary contributors Karla Abbott Avera McKennan Health and Disease Management Sioux Falls Tracy Baum Flandreau Santee Sioux Clinic Flandreau Darlene Bergeleen Office of Community Health Services South Dakota Department of Health Wessington Springs Kristin Biskeborn State Nutritionist South Dakota Department of Health Chamberlain Anna Marie Bosma Aberdeen Area Indian Health Center Aberdeen Verna Bourassa South Dakota Foundation for Medical Care Sioux Falls Goldie Burnham South Dakota Foundation for Medical Care Sioux Falls Khin Chit Northern Plains Tribal Epidemiology Center Rapid City Susan Barnes Avera Sacred Heart Hospital Yankton Elizabeth Baure Veterans Administration Black Hills Health Care Ft Meade Colette Beshara Diabetes Prevention Control Program South Dakota Department of Health Pierre Kari
Blasius Ft Thompson Indian Health Center Ft Thompson Bob Bosse South Dakota Public Broadcasting Vermillion Dan Boyd South Dakota State Library Pierre Steve Case St Marys Healthcare Center Pierre Jacy Clarke Chronic Disease Epidemiologist South Dakota Department of Health Pierre

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Rebekah Cradduck South Dakota Association of Healthcare Organizations Sioux Falls Mary Haan Avera McKennan Hospital Sioux Falls Dawn Hahn South Dakota Foundation for Medical Care Sioux Falls Marlene Hearnen Avera St Lukes Hospital Aberdeen Barb Hemmelman South Dakota Department of Health Childrens Special Health Services Pierre Larry Iversen South Dakota Department of Social Services Office of Medical Services Pierre Rhonda Jensen Sioux Valley Hospital Sioux Falls Gilbert Johnson South Dakota Association of Healthcare Organizations Sioux Falls Donna Keeler South Dakota Urban Indian Health Pierre Heather Kruse South Dakota State University School of Pharmacy and Lewis Pharmacy Sioux Falls

Carol Dreke University of South Dakota School of Nursing Vermillion Arlette Hager Cheyenne River Sioux Tribe Eagle Butte Paula Hallberg Community Healthcare Association of the Dakotas
Sioux Falls Carole Ann Heart Aberdeen Area Tribal Chairmens Health Board Rapid City Erika Huber South Dakota School Nurses Association Huron Amy Iversen-Pollreisz South Dakota Department of Human Services Pierre Sue Johannsen Huron Clinic Huron Kendra Kattelmann Nutrition, Food Science, Hospitality Department South Dakota State University Brookings Lisa Kollis-Young, OD Optometrist Sioux Falls Christina Lammers, MD South Dakota State University School of Nursing Brookings

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Ellen Lee St Marys Healthcare Center Foundation Pierre David Lonbaken, DPM Podiatrist Pierre Matt McGarvey Wellmark Foundation Des Moines, IA Sherri Ann Moore Pine Ridge Indian Health Services Pine Ridge Jane Mort South Dakota State University School of Pharmacy Brookings Sandra Namken Hamlin County Extension Services Hayti Sarah Patrick Center for Rural Health Improvement Sioux Falls Colleen Permann PHS Indian Hospital Wagner Colleen Reinert Coordinated School Health Program South Dakota Department of Health Pierre Diane Rolof Rapid Endocrinology and Diabetes Center Rapid City Diane Schreur Union County Community Health Clinic Elk Point

Mary Lobb-Oyos Avera McKennan Hospital
Sioux Falls Melissa Magstad Bartron Clinic Watertown J Michael McMillin, MD Endocrinologist Sioux Falls Judy Morgan Communication Services for the Deaf Sioux Falls Kathi Mueller Office of Data, Statistics and Vital Records South Dakota Department of Health Pierre Margot Nelson Augustana College Department of Nursing Sioux Falls Sherry Peer Sioux Valley Hospital Sioux Falls Josie Peterson Office of Rural Health South Dakota Department of Health Pierre Christine Rinki Northern Plains Tribal Epidemiology Center Rapid City Steve Schroeder, MD South Dakota Foundation for Medical Care Sioux Falls Roger Shewmake University of South Dakota Center for Family Medicine Sioux Falls

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Ann Skogland Community Healthcare Association of the Dakotas Ft Pierre Mark Stubbs American Diabetes Association Omaha, NE Connie Tice Black Hills Diabetes Association Rapid City Gala Woitte Juvenile Diabetes Research Foundation Tea

Peggy Stoddard South Dakota Department of Health Office of Rural Health Pierre Lynn Thomas Sioux Valley Health Plan Sioux Falls Colleen Winter Office of Health Promotion South Dakota Department of Health Pierre Lynn Thomas Sioux Valley Health Plan
Sioux Falls

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EXECUTIVE SUMMARY
More than 50,000 South Dakotans have diabetes and projections show that number will continue to increase Diabetes can cause severe complications including heart disease and stroke, blindness, lower extremity amputations, kidney failure, dental disease, depression and increased susceptibility to infections There can be significant personal and social costs resulting from impaired health and quality of life for people affected by diabetes The disease also carries a significant economic cost of approximately 132 billion yearly for the nation The good news is that we currently have an understanding of diabetes and how to control it It is imperative for us to take advantage of that scientific understanding and work together to maximize human and economic resources to lessen the burden of diabetes The South Dakota Diabetes State Plan 2007-2009 was developed by the South Dakota Diabetes Strategic Planning Coalition, a large group of diverse partners - health care professionals, advocacy groups, government agencies, tribal health, persons with diabetes and concerned family members, quality improvement and wellness programs
and many others The plan covers a three-year time frame 2007 through 2009 and is organized around the 10 Essential Public Health Services These 10 services are considered the foundation for public health policies and practices and are applicable to all chronic disease conditions They include: 1 Monitor health status to identify and solve community health problems 2 Diagnose and investigate health problems and health hazards in the community 3 Inform, educate, and empower people about health issues 4 Mobilize community partnerships to identify and solve health problems 5 Develop policies and plans that support individual and community health efforts 6 Enforce laws and regulations that protect health and ensure safety 7 Link people to needed personal health services and assure the provision of health care when otherwise unavailable 8 Assure a competent public and personal health care workforce 9 Evaluate effectiveness, accessibility, and quality of personal and population-based health services 10 Research for new insights and innovative solutions to health problems
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CDCs national goals for diabetes and the Healthy People 2010 objectives are the
long-term benchmarks for this plan The intent is that the committed partners in this effort will lead the way to put these recommendations into action for the health of all South Dakotans This plan is a call to action, urging individuals, communities and organizations to get involved to achieve this vision The success of this plan depends upon all of us taking action

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WHAT IS DIABETES?
Diabetes is a disorder of metabolism the way our bodies use digested food for growth and energy Most of the food we eat is broken down into glucose, the form of sugar in the blood Glucose is the main source of fuel for the body After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy For glucose to get into cells, insulin must be present Insulin is a hormone produced by the pancreas, a large gland behind the stomach When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced Glucose builds up in the
blood, overflows into the urine, and passes out of the body in the urine Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose

Type 1 Diabetes
Type 1 diabetes is an autoimmune disease An autoimmune disease results when the bodys system for fighting infection the immune system turns against a part of the body In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas The pancreas then produces little or no insulin A person who has type 1 diabetes must take insulin daily to live At present, scientists do not know exactly what causes the bodys immune system to attack the beta cells, but they believe that genetic, autoimmune, and environmental factors are involved Type 1 diabetes accounts for 5 to 10 percent of diagnosed diabetes in the US It develops most often in children and young adults but can appear at any age Symptoms of type 1 diabetes usually develop over a short period of time, although beta cell destruction can begin years earlier Symptoms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue If not diagnosed and treated with
insulin, a person with type 1 diabetes can lapse into a lifethreatening diabetic coma, also known as diabetic ketoacidosis

Type 2 Diabetes
About 90 to 95 percent of people with diabetes have type 2 diabetes and about 80 percent of people with type 2 diabetes are overweight Type 2 diabetes is increasingly being diagnosed in children and adolescents However, national data on prevalence in youth is not available

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The symptoms of type 2 diabetes develop gradually Their onset is not as sudden as in type 1 diabetes Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores Some people have no symptoms Risk factors for type 2 diabetes include: Family history of diabetes Obesity Racial and/or ethnic heritage with African-Americans, Hispanic Americans, Native Americans, Asian Americans, and Pacific Islanders having a higher risk Age over 45 Previous impaired glucose tolerance pre-diabetes Hypertension equal to or greater than 140/90 mm Hg History of gestational diabetes mellitus or delivery of a baby weighing more than nine pounds Sedentary lifestyle When type 2
diabetes is diagnosed, the pancreas is usually producing enough insulin but the body cannot use it effectively This condition is called insulin resistance After several years, insulin production decreases The result is the same as for type 1 diabetes glucose builds up in the blood and the body cannot make efficient use of its main source of fuel

Pre-diabetes
A related condition, called pre-diabetes, occurs when a persons blood sugar level is higher than normal, but not high enough for a diagnosis of diabetes People with pre-diabetes have impaired fasting glucose fasting blood sugar level of 100 to 125 milligrams per deciliter mg/dl or impaired glucose intolerance blood sugar level of 140 to 199 mg/dl after a 2-hour glucose tolerance test Most people with pre-diabetes develop type 2 diabetes within 10 years

Gestational Diabetes
About 4 percent of pregnant women in the United States develop gestational diabetes during their pregnancy1 As with type 2 diabetes, gestational diabetes occurs more often in some ethnic groups and among women with a family history of diabetes Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin Women with gestational
diabetes may not experience any symptoms Although this form of diabetes usually disappears after the babys birth, women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years Maintaining a reasonable body weight and being physically active may help prevent its development Untreated or poorly controlled gestational diabetes can cause health problems for the infant Studies show babies born to mothers with gestational diabetes are at increased risk for development of type 2 diabetes

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BURDEN OF DIABETES IN SOUTH DAKOTA
State Demographics
South Dakota is one of the least densely populated states in the nation with 775,933 people living within its 75,885 square miles for an average population density of 99 people per square mile Nearly 60 percent of South Dakotas total population live in small, rural communities of 5,000 or fewer people, with communities of less than 500 people comprising a large portion of this population group The population of South Dakota is predominantly white with Native American being the largest minority, 880 percent and 84 percent respectively Adults age 65 and
older comprise 142 percent of the population which is higher than the national average of 124 percent2 The percent of South Dakotans living below 100 percent of the federal poverty level is 124 percent Four of the five counties in the United States with the lowest per capita income are on South Dakota Indian reservations2 Another factor to consider is transportation to access services For some, this means traveling great distances over 50 miles to see a primary care provider and even further to see a specialist Access to primary care physicians is limited in the state with over two-thirds of the state designated by the federal government as a Health Professional Shortage Area Access to comprehensive diabetes care teams is even more limited

Prevalence of Diabetes
Diabetes prevalence rates in the United States have increased dramatically since the mid1930s The 2005 Behavioral Risk Factor Surveillance System BRFSS reports that the prevalence of diagnosed diabetes in South Dakotans over the age of 18 was 64 percent 35,825 adults Figure 1 The prevalence of persons with diagnosed diabetes in South Dakota has doubled since 1998 Data from the South Dakota BRFSS indicate prevalence of
diagnosed diabetes generally increases as age increases3 In addition, national estimates indicate that about 30 percent of people with diabetes dont know they have it4 Using this estimate, another 15,350 South Dakotans are likely to have the disease According to a survey of South Dakota new mothers who gave birth between August 2004 and January 2005, 42 percent reported having diabetes before or during their pregnancy5

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The Centers for Disease Control and Prevention estimate that about one in every 400 to 600 children and adolescents aged 20 or younger has type 1 diabetes In 2005, the prevalence of type 1 and type 2 diabetes in South Dakotans 17 years and younger was 053 For the past few decades, the prevalence of overweight and obesity has steadily increased which puts South Dakotans at an increased risk for type 2 diabetes South Dakotas percentage of overweight and obese adults defined as a body mass index of 250 or above has increased from 530 percent in 1993 to 628 percent in 2005 In addition, 225 percent of adult South Dakotans reported no leisure time physical activity in 20053

Figure 1 Percent of Respondents Who Were Told They Have
Diabetes, 1988-2005
80 70 60 50 40 30 20 10 00 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 43 39 38 34 49 43 36 29 43 38 31 49 57 61 63 71 66 64

Source: Behavioral Risk Factor Surveillance System, South Dakota Department of Health, 1988-2005

Though still rare, type 2 diabetes is occurring more frequently in children and adolescents, particularly among Native Americans, African Americans, and Hispanic/Latinos Overweight is a risk factor for development of type 2 diabetes The 2004-2005 School Height and Weight Report for South Dakota students shows increasing rates of obesity in our children with 164 percent of K-12th grade students considered overweight and an additional 166 percent at risk for overweight6

Disparities
Racial and ethnic sub-populations in the United States suffer from diabetes at disproportionately higher rates than the majority population South Dakotas 2005 Behavioral Risk Factor Surveillance System data reflects this racial disparity The prevalence of diagnosed diabetes among Whites was 61 percent compared to Native Americans at 132 percent more than two times the prevalence among whites3

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State Plan 14

Risk Reduction
While there are no known modifiable risk factors that can lower a persons probability of developing type 1 diabetes, making lifestyle changes such as improved nutrition, weight control, and regular physical activity can reduce the risk of developing type 2 diabetes Recent clinical trials have established that intensive control of blood glucose levels greatly reduces complications for people with type 1 diabetes and type 2 diabetes In 2002, results from the Diabetes Prevention Program demonstrated that type 2 diabetes can be prevented or delayed by weight loss and increased physical activity for many people at risk for the disease

Preventive Health Practices
People who have diabetes suffer an increased risk of developing a number of disabling and lifethreatening complications including heart disease, stroke, kidney failure, blindness, neuropathy, and peripheral vascular disease However, much of this burden could be prevented with early detection, improved delivery of care, education on diabetes self-management and good self-care practices Studies in the United States and abroad have found that better blood sugar control reduces the risk for eye
disease, kidney disease, and nerve disease by 40 percent in people with type 1 or type 2 diabetes Blood pressure control reduces the risk for heart disease and stroke among people with diabetes by 33 percent-50 percent It also reduces the risk for eye, kidney, and nerve diseases by about 33 percent Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30 percent-70 percent Improved control of blood cholesterol levels can reduce cardiovascular complications by 20 percent-50 percent Detecting and treating diabetic eye disease with laser therapy can reduce the risk for loss of eyesight by about 50 percent-60 percent Comprehensive foot care programs can reduce amputation rates by 45 percent85 percent Figure 2 shows the level of self-care and medical care that persons with diabetes received in South Dakota
Figure 2 Preventive Health Practices of Adult South Dakotans with Diabetes, 2005 Taken course to manage diabetes 64 Check blood glucose 1 times per day 67 Doctor visit in past year 90 A1c check in past year 93 Foot exam in past year 71 Eye exam in past year 74 Influenza vaccination in past year 69 Pneumococcal
vaccination 55 Dentist visit in past year 41
Source: Behavioral Risk Factor Surveillance System, South Dakota Department of Health, 2005

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Persons with diabetes are at a greater risk of death due to influenza and pneumonia People with diabetes get periodontal disease more often than people who do not have the disease Gum infections can make it hard to control blood sugar, and once an infection starts, it can take longer to heal Tobacco use can exacerbate the vascular complication of diabetes While South Dakota adults with diabetes are less likely than those without diabetes to be current smokers 182 percent vs 205 percent, their incidence is still quite high3

Morbidity
People with diabetes can experience a number of complications which can be classified as either acute or long-term The acute complications of diabetes can occur at any time and can usually be corrected, while the long-term complications may take decades to develop and are often irreversible People with diabetes are much more likely to be hospitalized for the complications of diabetes than for diabetes itself

Mortality
Diabetes ranked as the eighth leading cause of death by
disease in South Dakota in 2005 South Dakota vital records data indicate that Native Americans were more likely to die from diabetes as the primary cause than whites in 2005 91 percent vs 29 percent8

Cost
The economic impact of diabetes is enormous Diabetes can lead to a variety of disabling and life-threatening complications, including heart disease, stroke, blindness, kidney failure, nerve damage, and lower extremity amputation All of these conditions contribute to diabetes staggering cost to the nation, which was estimated by the CDC to be nearly 132 billion in both direct and indirect costs Direct medical costs: 92 billion Indirect costs related to disability, work loss, premature death: 40 billion Average annual health care costs for a person with diabetes: 13,243 Average annual health care costs for a person without diabetes: 2,5607

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PLAN PROCESS
In 2004 the Diabetes Prevention and Control Program of the South Dakota Department of Health contracted with University Partners in Health Promotion at South Dakota State University to conduct an assessment and evaluation of provision of the 10 Essential Public Health Services related to diabetes
in the state The results of that evaluation were reviewed by the South Dakota Diabetes Advisory Council The evaluation determined the need to develop a South Dakota diabetes state plan and involve additional partners to impact diabetes prevention and control services in South Dakota The South Dakota Diabetes State Plan 2007-2009 was developed by the South Dakota Diabetes Strategic Planning Coalition The Coalition was a large group of diverse partners - health care professionals, advocacy groups, government agencies, tribal health, persons with diabetes and concerned family members, quality improvement and wellness programs and many others too numerous to detail The Coalition set as its mission to reduce the economic, social, physical, and psychological impact of diabetes in South Dakota by improving access to care and enhancing quality of services The Coalition functioned in four workgroups to develop action steps around the 10 Essential Public Health Services These ten services are considered the foundation for public health policies and practices and are applicable to all chronic disease conditions The 10 Essential Public Health Services are organized around the four parameters
of public health assessment, policy development, assurance, and systems management Prevention of diabetes is not addressed in this plan South Dakota has developed the South Dakota State Plan for Nutrition and Physical Activity To Prevent Obesity and Chronic Diseases 20069 , its first comprehensive plan to increase healthy eating and physical activity as ways to reduce overweight and obesity and their subsequent risk for chronic diseases such as diabetes, cardiovascular disease, and hypertension

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Outcome Objectives
In addition to the Essential Public Health Services, the objectives delineated in this plan are intended to improve the outcome objectives of the Diabetes Prevention and Control Program of the South Dakota Department of Health and other diabetes goals from Healthy People 2010 The following are the long-term benchmarks of the South Dakota Diabetes Prevention and Control Program: Increase the percent of adult South Dakotans with diabetes who have a dilated eye exam at least once in the previous year to 807 percent in 2009 Increase the percent of adult South Dakotans with diabetes who have had a foot exam performed by a health care
professional at least once in the previous year to 785 percent in 2009 Increase the percent of adult South Dakotans with diabetes who receive a yearly influenza vaccination to 734 percent in 2009 Increase the percent of adult South Dakotans with diabetes who have ever received a pneumonia vaccination to 490 percent in 2009 Increase the percent of adult South Dakotans with diabetes who have had at least 2 glycosylated hemoglobin measurements during the previous year to 820 percent in 2009 Expand linkages to promote wellness and physical activity for persons with diabetes in South Dakota by 30 percent by 2009 Identify and reduce health disparities for high risk populations with respect to diabetes control and prevention in South Dakota Next Steps This plan provides South Dakota with a blueprint for the control of diabetes and the health complications associated with the disease The Department of Healths Diabetes Prevention Control Program will focus its resources on the objectives that are in line with its priorities Partners who collaborated in the development of this plan will focus their resources on objectives related to their priorities Additional partners are welcome in the
implementation of the plan Evaluation efforts will be ongoing to determine the plans impact Data collected through a variety of methods will assist in evaluating impact The collaboration that created this plan nee ds to continue in order to meet the plans objectives Working together, the quality of life for individuals and families affected by diabetes will be improved and the burden that diabetes brings will be reduced

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Parameter of Public Health: ASSESSMENT Essential Service 1: Monitor Health Status to Identify Health Problems
Objectives: 11 By January 2008 and annually thereafter, prepare and disseminate an epidemiology report outlining trends of available indicators By October 2008, identify diabetes mortality and morbidity indicators for high risk groups in South Dakota By October 2008, identify additional data initiatives to address gaps and limitations in existing data sources used to describe diabetes mortality, morbidity, and complications for high risk groups in South Dakota By January 2009 and annually thereafter, conduct analyses using the identified data sources to identify disparities in diabetes mortality, morbidity, and
complications in the high-risk groups

Essential Service 1 includes:
Assessment of statewide diabetesrelated health status and its determinants, including the identification of health risks and the determination of diabetes health service needs Attention to the vital statistics and diabetes-related health status of specific groups that are at higher risk than the general population Identification of community assets and resources, which support the state diabetes health system in promoting health and improving quality of life Utilization of technology and other methods to interpret and communicate diabetes-related health information to diverse audiences in different sectors Collaboration in integrating and managing diabetes-related information systems

12

121

122

13

By March 2008, complete an assessment of clinics, hospitals, payers, research, and other facilities that have computerized diabetes information systems including what systems Patient Electronic Care System, Diabetes Care Management System, Electronic Medical or Health Record systems and others are being used By July 2008, complete an assessment of data available from information systems including what data is
currently collected, what data can be shared with and without expense and what data cannot be shared By October 2008, compile a list of all available data sources related to diabetes in South Dakota and share information with partners to avoid duplication of effort and assess progress in diabetes management and control

14

141

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15

By January 2009, identify additional data initiatives to address gaps and limitations in existing data sources used to describe diabetes mortality, morbidity, and complications in South Dakota

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Essential Service 2: Diagnose and Investigate Health Problems and Health Hazards in the Community
Objectives: 21 By October 2008, develop and promote needed resources for screening, case finding, referral and follow-up systems for facilities and organizations By October 2008, monitor data about access, availability and quality of diabetes health care to plan diabetes services for South Dakota populations
Essential Service 2 includes:
Epidemiologic investigation of disease patterns of diabetes and other related health and social conditions Opportunistic population-based screening, case
finding, investigation, and the scientific analysis of diabetesrelated health problems

22

23

By October 2009, expand the collection, quality, and scope of population-based surveillance data for adults, children, and disparately affected populations with, and at risk for, diabetes 24 By October 2009, analyze the age, type of diabetes and ethnicity data to determine what target audiences may not be aware of resources

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Parameter of Public Health: POLICY DEVELOPMENT Essential Service 3: Inform, Educate, and Empower People about Health Issues
Objectives: 31 By September 2007 and as needed thereafter, the South Dakota Diabetes Prevention and Control Program will add sections to its website to serve as a central point to promote available information and educational resources By October 2007 and yearly thereafter, determine target audiences for diabetesrelated health information campaigns By September 2007 and yearly thereafter, determine a schedule for diabetes-related health information campaigns and methods of delivery By September 2007, develop at least one diabetes-focused public service announcement By December 2007, develop and implement a
coordinated media plan using the public service announcement By October 2007 and yearly thereafter, increase the number of South Dakota Diabetes Information Link program recipients by 1,000 each year By October 2007, revise the South Dakota Diabetes Information Link program enrollment cards to distinguish enrollees by age, type of diabetes and ethnicity
Essential Service 3 includes:
Health information, health education, and health promotion activities designed to reduce health risk and promote better health Health communication plans and activities such as media advocacy and social marketing Accessible health information and educational resources Health education and promotion program partnerships with schools, faith communities, work sites, personal care providers, and others to implement and reinforce health promotion programs and messages

32

33

34

35

36

37

38

By October 2007, promote use of the professional and general public diabetesawareness displays to agencies conducting diabetes and pre-diabetes awareness programs By October 2008, develop South Dakota Diabetes Information Link program welcome packets focused towards 0-11 year olds and 12-17 year olds

39

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Essential Service 4: Mobilize Community Partnerships to Identify and Solve Health Problems
Objectives: 41 By October 2008, develop a partnership with health systems monitoring diabetes care to establish an annual reporting process By November 2008, convene two Partners Conferences to facilitate continued collaboration among partner organizations By October 2008, show a measurable increase in the number of collaborating partners and members involved in the plan implementation By October 2009, develop a partnership with South Dakota Public Broadcastings South Dakota Focus to dedicate an episode to diabetes topics each year
Essential Service 4 includes:
The organization and leadership to convene, facilitate, and collaborate with statewide partners including those not typically considered to be health-related to identify diabetes priorities and create effective solutions to solve state and local diabetes-related health problems The building of a statewide partnership to collaborate in the performance of public health functions and essential services in an effort to utilize the full range of available human and material resources to improve the states
diabetes health status Assistance to partners and communities to organize and undertake actions to improve the health of the states communities

42

43

44

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Essential Service 5: Develop Policies and Plans that Support Individual and Community Health Efforts
Objectives: 51 By October 2007 and annually thereafter, utilize available data sources to determine areas of need and initiatives that may be developed By March 2008 and annually thereafter, review and update the mission statement of the Diabetes Prevention Control Program By January 2009, develop a tool to determine diabetes costs along with anticipated impact of appropriate evidence-based interventions
Essential Service 5 includes:
Systematic health planning that relies on appropriate data, develops and tracks measurable health objectives, and establishes strategies and actions to guide community health improvement at the state and local levels The support of development of legislation, regulations, guidelines, and other policies to enable performance of the Essential Public Health Services, supporting individual, community, and state health efforts The promotion of democratic process of
dialogue and debate between groups affected by the proposed health plans and policies prior to adoption of such plans or policies

52

53

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Parameter of Public Health: ASSURANCE Essential Service 6: Enforce Laws and Regulations that Protect Health and Ensure Safety
Objectives: 61 By March 2007 and annually thereafter, monitor for legislation related to services for individuals with diabetes By July 2008, advocate for payment of diabetes self-management education provided by recognized Indian Health Service programs
Essential Service 6 includes:
The review, evaluation, and revision of laws and regulations designed to protect health and safety to assure that they reflect current scientific knowledge and best practices for achieving compliance Education of persons and entities obligated to obey or to enforce laws and regulations designed to protect health and safety in order to encourage compliance Enforcement activities in areas of public health concern, including, but not limited to the coverage of diabetes self-management education and supplies, access to care, school policy, workplace discrimination, birth and death certificate documentation,
and the protection of rights for Americans with disabilities

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Essential Service 7: Link People to Needed Personal Health Services and Assure the Provision of Health Care When Otherwise Unavailable
Objectives: 71 By October 2007, facilitate partnerships for the integration and sustainability of diabetes care in South Dakota By October 2007, identify barriers to diabetes care and develop strategies to eliminate or lessen these barriers By October 2008, develop and disseminate a tool for South Dakotans with diabetes to present at each health system they visit, profiling the education they have already received By October 2009, use evidence-based practice to support quality care to vulnerable groups
Essential Service 7 includes:
Assessment of access to and availability of quality diabetes-related health care services for the states population Assurances that access is available to a coordinated system of quality care which includes outreach services to link populations to preventative and curative care, health care delivery services, case management, enabling social and mental health services, culturally and linguistically appropriate services,
and health care quality review programs Partnership with public, private, and voluntary sectors to provide populations with a coordinated system of health care Development of a continuous improvement process to assure the equitable distribution of resources for those in greatest need

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Essential Service 8: Assure a Competent Public and Personal Health Care Workforce
Objectives: 81 By October 2007, post a diabetes continuing education program list on the South Dakota Department of Health web site By March 2008, identify existing diabetes curriculum for schools of medicine, nursing, pharmacy, and dietetics in South Dakota By July 2008, compare curriculum content to the American Diabetes Association Standards of Care and identify gaps By October 2008, develop curriculum guidelines specific to diabetes for health professional education programs in South Dakota By October 2007, develop a partnership with existing diabetes programs to mentor professionals pursuing diabetes certification
Essential Service 8 includes:
Education, training, development, and assessment of health professionals including partners, volunteers and other lay
community health workers to meet statewide needs for public and personal diabetes health services Efficient processes for credentialing technical and professional health personnel Adoption of continuous quality improvement and life-long learning programs Partnerships with professional workforce development programs to assure relevant learning experiences for all participants Continuing education in management, cultural competence, and leadership development programs

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821

822

83

84

By October 2007 and annually thereafter, provide an educational conference targeting healthcare professionals specifically nurses, dietitians, pharmacists, nurse practitioners, physician assistants and other health care professionals who provide education and treatment to those with diabetes 85 By October 2007, identify partnerships for continuing education related to diabetes

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Essential Service 9: Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services
Objectives: 91 By October 2007, assess the availability of specialty care for individuals with diabetes in South Dakota and identify geographically underserved areas
By October 2007, establish a mechanism for an annual status report of the South Dakota Diabetes State Plan and review by the South Dakota Diabetes Advisory Council By October 2007, develop a plan to enhance access to quality diabetes care and education throughout the state

Essential Service 9 includes:
Evaluation and critical review of health programs, based on analyses of health status and service utilization data, are conducted to determine program effectiveness and to provide information necessary for allocating resources and reshaping programs for improved efficiency, effectiveness, and quality Assessment of and quality improvement in the state diabetes health systems performance and capacity

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93

94

By July 2008, develop a mechanism for continuous review of access to quality diabetes care and education

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Parameter of Public Health: SYSTEMS MANAGEMENT Essential Service 10: Research for New Insights and Innovative Solutions to Health Problems
Objectives: 101 By October 2007, establish a central depository of information about diabetesrelated research being undertaken in South Dakota 102 By October 2007, maintain a list of collaborative
partnerships for diabetes research across the state, to include researchers, communities, organizations, and funding sources
Essential Service 10 includes:
A full continuum of research ranging from field-based efforts to foster improvements in public health practice to formal scientific research Linkage with research institutions and other institutions of higher learning Internal capacity to mount timely epidemiologic and economic analyses and conduct needed diabetes-related health services research

103 By October 2008, monitor research about diabetic care differences by race, ethnic group, gender, age, income, disability and payment source 104 By October 2009, encourage the development of South Dakota doctorate level programs that promote diabetes research

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APPENDIX A REFERENCES
1 American Diabetes Association Gestational Diabetes Retrieved January 2007 from http://wwwdiabetesorg/gestational-diabetesjsp 2 US Census Bureau, Census 2000 2000 South Dakota Retrieved January 2007 from http://quickfactscensusgov/qfd/states/46000html 3 South Dakota Department of Health Health Behaviors of South Dakotans 2005 4 Centers for Disease Control and
Prevention, November 16, 2005 National Diabetes Fact Sheet Retrieved September 2006 from http://wwwcdcgov/diabetes/pubs/estimates05htm 5 South Dakota Department of Health 2005 South Dakota Perinatal Risk Assessment Report 6 South Dakota Department of Health March 2006 School Height and Weight Report for South Dakota Students, 2004-2005 School Year 7 Centers for Disease Control and Prevention 2006 Diabetes: Disabling, Deadly, and on the Rise, 2006 Retrieved September 2006 from http://wwwcdcgov/nccdphp/publications/aag/ddthtm 8 South Dakota Department of Health November 2006 2005 South Dakota Vital Statistics Report: A State and County Comparison of Leading Health Indicators 9 South Dakota Department of Health January 2006 South Dakota State Plan for Nutrition and Physical Activity To Prevent Obesity and Other Chronic Diseases

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APPENDIX B 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 percent normal to as high as 25 percent uncontrolled glucose levels Regular A1c testing is
essential for monitoring the effectiveness of diabetes treatment plans At Risk of Overweight: In Body Mass Index measurements, at risk of overweight is defined as gender and age specific BMI at or above the 85th percentile and below the 95th percentile for children aged 2 to 20 years Behavioral Risk Factor Surveillance System BRFSS: BRFSS is a cross-sectional randomdigit dial telephone survey of non-institutionalized adults aged 18 and older This ongoing data collection effort examines the health behaviors of adults and provides national and state data on trends in diabetes and related topic areas More information is available online at http://wwwstatesdus/doh/Stats/ Benchmark: A point of reference or standard by which something can be measured, compared, or judged, as in benchmarks of performance 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 Blood Pressure: The force of the blood against the artery walls Two levels of blood pressure are measured: the highest, or systolic, occurs when the heart pumps blood into
the blood vessels, and the lowest, or diastolic occurs when the heart rests Body Mass Index BMI: BMI is a tool for measuring weight status in both youth and adults BMI is commonly the accepted index for the classification of overweight and obesity in adults and is recommended to identify children and adolescents who are underweight, overweight, or at risk of overweight when compared to the same age and gender BMI Formula: Weight in Pounds Height in inches x Height in inches x 703

Stated another way, BMI body weight in pounds divided by height in inches squared multiplied by 703 Centers for Disease Control and Prevention, Division of Diabetes Translation: The Division is part of the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services DHHS The

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mission of the Division of Diabetes Translation is to eliminate the preventable burden of diabetes through leadership, research, programs, and polices that translate science into practice Childhood Overweight: A description of children aged 2-20 years with a gender and age specific BMI value equal to or
greater than the 95th percentile Community: Defined in this document as a social unit usually encompassing a geographic area such a town, neighborhood or housing complex, shared characteristics such as ethnicity, age, gender, occupation, culture or history, or common interest such as an activity or health condition typically convened for the purpose of benefiting members while addressing a need or providing a service Complications: Conditions that can result from diabetes that is not controlled Complications can also be considered secondary health problems The most common are lower extremity amputations, kidney failure, blindness, premature death, stroke, heart disease, congenital malformations, perinatal death, and long- and short-term disability Diabetes: The short name for the disease called diabetes mellitus Diabetes results when the body cannot use blood glucose as energy because of having too little insulin or being unable to use insulin properly Diabetes Advisory Council: The advisory group for the South Dakota Diabetes Prevention and Control Program made up of health care providers, persons with diabetes, and others Dilated Eye Exam: An eye exam in which drops are put in
the eyes prior to the exam; the drops enlarge the pupils so that the doctor can clearly see the retina, or back of the eye Essential Public Health Services: A list of ten activities that identify and describe the core processes used in public health to promote health and prevent disease The framework was developed in 1994 All public health responsibilities whether conducted by the local public health agency or another organization within the community can be categorized into one of the services Health Care Provider: Physicians, physician assistants, nurse practitioners, certified diabetes educators, nurses, and other allied health professionals Health Care System: A system comprised of the organizations, institutions, and resources that are devoted to producing a health action, whether in personal health care or in public health services, whose primary purpose is to improve the health of the general population or a specified and recognized segment of the general population In South Dakota, the primary health care systems are Avera Health, Community Health Centers, Indian Health Service, Rapid City Regional, Sioux Valley Health System, and the Veterans Health Administration 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
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Impaired Fasting Glucose IFG: A condition in which the fasting blood sugar level is elevated 100 to 125 milligrams per deciliter or mg/dL but is not high enough to be classified as diabetes Impaired Glucose Tolerance IGT: A condition in which the blood sugar level is elevated 140 to 199 mg/dL after a 2-hour oral glucose tolerance test, but is not high enough to be classified as diabetes 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 eg, one year Mortality: Related to death Diabetes mortality is often referred to in describing the number of people that have died with diabetes as an immediate or contribution cause of their death Obesity: In Body Mass Index measurements, obesity is defined as a BMI equal to or greater than 300 in adults Overweight: In Body Mass Index measurements, overweight is defined as a BMI between 250 and 299
in adults For children 2-20 years, overweight is defined as BMI-for-age equal to or greater than the 95th percentile 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 Risk Factor: Characteristic 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 glucose, blood lipid or blood pressure levels Self-Management Education: Instruction about nutrition, exercise, medications, blood glucose monitoring, and emotional adjustment to help people control their diabetes and make healthy lifestyle choices South Dakota Diabetes Prevention and Control Program: A unit of the South Dakota Department of Health located under the Office of Health Promotion The program receives the majority of its funding from the CDC The program is dedicated to improving the health of people at risk for, or with, diabetes South Dakota
School Height and Weight Report: A summary of South Dakota student height and weight data collected by the South Dakota Department of Health in cooperation with the South Dakota Department of Education More information is available online at http://wwwstatesdus/doh/SchoolWeight/

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Notes
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Notes
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250 copies of this document were printed by the South Dakota Department of Health at a cost of 634 per copy

South Dakota Diabetes State Plan

Source:diabetesmiracle.org