Diabetes and the Recovery Act

Diabetes affects nearly 26 million people in the United States, while another 79 million are estimated to be at increased risk for diabetes, according to the Centers for Disease Control and Prevention.

The U.S. Department of Health and Human Services (HHS) has provided more than $500 million under the Recovery Act for programs across the Department to increase research into the causes and treatments of diabetes, invest in health information technology that can lead to better and more efficient care, support prevention and wellness strategies, and increase access to health care.

Learn more about diabetes and see highlights* about the impact of HHS programs on this deadly disease:

National Institutes of Health (NIH) Diabetes Research

NIH awarded $274 million in Recovery Act funds for research to help scientists better understand and predict the progression of diabetes, as well as treat diabetes-associated conditions. NIH also awarded another $10.8 million in grants for diabetes-related comparative effectiveness research (CER). Some of the groundbreaking research includes:

• A study to identify genetic contributors to diabetes and cardiovascular risk factors in African Americans, who are at elevated risk for type 2 diabetes and heart disease. University of Virginia Charlottesville. Read more…
  
• An investigation into the effects of maternal diet during pregnancy on the later development of obesity, a major risk factor for type 2 diabetes in offspring.  Harvard Pilgrim Health Care Inc. Read more…
  
• Development of tools to image and measure the amount and activity of “brown fat,” which has been recently discovered in adults. Brown fat burns energy instead of storing it and may be a way to stimulate weight loss. Joslin Diabetes Center.  Read more…
  
• Studies of how diabetes alters blood flow in the brain and contributes to cognitive decline in the elderly, with the hope that they will help develop ways to prevent this diabetic complication.  Beth Israel Deaconess Medical Center. Read more…
  
• Research in mice to develop a vehicle to deliver a specific gene that may prevent type 1 diabetes.  North Dakota State University. Read more…
  
• Research into the viability and sustainability of an intervention to improve diet and exercise and decrease diabetes and heart disease risk in two urban American Indian populations. Cardiovascular disease is the leading cause of death in American Indian/Alaska Native populations and diabetes is the leading risk factor for the disease. University of Colorado Denver. Read more…

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Agency for Healthcare Research and Quality (AHRQ) Treatment Effectiveness Research

The Recovery Act provides $1.1 billion for research that compares the effectiveness of different medical treatments. The intent is to provide evidence-based information to inform health care decision-making by patients, clinicians, and the clinical and public health communities. AHRQ is spearheading the initiative, which includes NIH and the Office of the Secretary (OS). AHRQ is overseeing $11.2 million for diabetes-related comparative effectiveness research, of which $6.1 million is funded by the Office of the Secretary. The following are highlights of on-going diabetes-related CER. Search for research...

• A University of California, Los Angeles, project compares the effectiveness of two primary care redesign strategies increasingly used by community clinics and health centers to improve the quality of care for patients with diabetes and other chronic illnesses. Eighteen health centers serving 9,900 patients with diabetes across Santa Clara, Los Angeles, and San Diego counties in California will test one of the strategies in their primary care practice or serve as a control clinic.  Read more…
  
• The Kaiser Foundation Research Institute is comparing the effectiveness of diabetes prevention strategies in women with gestational diabetes. Type 2 diabetes develops within five years after delivery in 50 percent of women with gestational diabetes. The study will include 2,400 pregnant women at 44 medical centers of Kaiser Permanente Northern California. Read more…
  
• The Maine State Department of Health and Human Services is studying the impact of mental illness and substance abuse on diabetes intervention and outcomes. Read more…

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Centers for Disease Control and Prevention (CDC) Prevention Efforts

CDC provided nearly $229.7 million in Recovery Act funds for a major Prevention and Wellness program, Communities Putting Prevention to Work (CPPW), to help 25 communities develop evidence-based programs aimed at lack of physical activity and poor nutrition, two risk behaviors that lead to obesity, a major contributor to diabetes. About $75 million was also awarded to States for programs targeting obesity and tobacco use.

“Many of the environments in which we live promote physical inactivity and increased consumption of less healthy food. We need intensive and sustainable efforts that can reach large numbers of people in multiple settings – such as child care facilities, workplaces, schools, communities and health care facilities – to help people make healthier choices,” said Dr. William H. Dietz, director of the Division of Nutrition, Physical Activity and Obesity of CDC’s National Center for Chronic Disease Prevention and Health Promotion.

“The evidence-based changes being implemented in CPPW communities, states and territories are designed to make healthy choices available, affordable and easy, and will support Americans who want to make healthy lifestyle changes,” he said. Read more…

Some of the programs include:

• Jefferson County (Alabama) Department of Health.  Jefferson County passed the Smart Code zoning amendment to increase the number of walkable communities in the area. The county is also improving access to healthy food and beverage options in “food deserts” and establishing neighborhood walking groups in low-income communities. Read more…
  
• Public Health: Seattle and King County (Washington). The program supports development of healthy corner stores and increased access to safe and accessible places for activity in schools and parks. Read more about Seattle and King County programs…
  
• La Crosse County (Wisconsin). Twenty-one convenience stores have become members of Gunderson Lutheran Medical Center’s “500 Club,” promoting healthier food options. Read more…
  
  
• Pueblo of Jemez (New Mexico). The Pueblo promotes physical activities for adults and children and works with local growers to increase access to fresh fruits and vegetables.  Read more…
  
• Kauai (Hawaii). Kauai municipalities are promoting safe access for pedestrians, bicyclists and public transit users. Read more…

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Administration on Aging (AoA) Helps Seniors Manage Diabetes

Monitoring blood glucose level is an important step in a diabetic person’s management of his condition. Diabetes affects nearly 26 million people in the United States, while another 79 million are estimated to be at increased risk for diabetes.

Nearly 27 percent of Americans aged 65 and older have diabetes and almost half have prediabetes, according to the CDC. In collaboration with CDC’s CPPW program, AoA awarded $27 million in grants to States for Chronic Disease Self-Management Programs (CDSMP) and Diabetes Self-Management Programs (DSMP), which are designed to help older adults learn how to cope with chronic diseases, partly by increasing physical activity, improving nutrition and communicating more effectively with their health care providers.  Read more…

As of June 1, 2011, more than 36,200 people have participated in the CDSMP workshops for diabetes, arthritis and pain self-management. More than 3,700 seniors participated in more targeted six-week DSMP workshops.  Examples of some of the state programs include:

• Delaware has established programs for older adults at faith-based organizations, health care organizations, residential facilities, senior centers, and even prisons. Delaware is also working with a Medicaid managed care facility to target seniors who are at particularly high risk for complications. In addition, the State is training medical professionals and people with diabetes to lead self-management programs.
  
• New Jersey established a prison initiative, implementing DSMP workshops in all 13 state prisons; 18 such workshops were conducted from August 2010 to June 2011. The workshops are promoted by the prisons’ health care teams, and the doctors who see inmates with diabetes every three months encourage them to sign up for the workshops. A side benefit appears to be that the inmates now feel a sense of control over an aspect of their lives. There are currently waiting lists for the workshops.

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Health Information Technology (IT) and Diabetes Treatment

Health information technology (IT) makes it possible for health care providers to better manage patient care through secure use and sharing of health information with electronic health records (EHR). Tracking and coordinating a patient’s care is of particular importance to people with diabetes, who often need a variety of health care providers: They might see a primary care doctor for overall management of the disease, an ophthalmologist for eye care, and a podiatrist for necessary foot care. The Office of the National Coordinator for Health Information Technology (ONC) funds 17 Beacon Communities, pilot projects in which communities use health IT to improve care and reduce costs. Almost all are focused, at least in part, on using health IT to improve care for diabetic patients. The following are examples of Beacon Communities’ activities related to diabetes:

• Beacon Community of the Inland Northwest (Spokane WA). This Beacon, which represents rural and traditionally medically underserved populations, is expanding the Inland Northwest Health Services health information network that connects hospitals and health care facilities. The Beacon hopes that connecting more and a greater variety of clinicians with each other and with new disease management and electronic clinical decision support tools will help them better coordinate care and provide preventive health care services for their diabetic patients. Read more…
  
• Southeastern Michigan Beacon Community (Detroit MI.). This Beacon is particularly concerned about the prevalence and burden of diabetes among under-served populations. The Beacon is leveraging new and existing technologies to eliminate fragmentation of care by integrating health IT, onsite coaching and engagement of ethnic, community and faith-based organizations. This allows providers to reconcile patients’ medications to avoid duplication and ensure safety and to coordinate patient care after hospitalizations. Read more…
  
• Central Indiana Beacon Community (Indianapolis IN). The Indiana project, led by the Indiana Health Information Exchange, includes multiple chronic conditions but focuses particularly on diabetes. The exchange sends secure health information, such as lab results, medications and treatment histories, to doctors, hospitals and other care providers. In collaboration with private health insurers, the exchange has built a preventive health and chronic disease management program that provides timely data reports to providers to help them track patients and alert them when they are due for screenings and follow-up care. Read more…

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Community Health Centers and Diabetes

The Health Resources and Services Administration (HRSA) awarded $338 million in Recovery Act grants to help more than 1,100 Community Health Centers meet the increased demand for patient services during the economic downturn. Here’s how some centers indicated their stimulus dollars are helping diabetic patients:

• Carolina Health Centers Inc., Greenwood SC, hired a certified diabetes educator and developed a best practice certified diabetes education program. This new resource provides treatment plans education and support necessary to follow and implement healthy lifestyle changes. As of April 2011, the diabetes educator has served more than 700 patients and had more than 1,400 patient education encounters.
  
• Innis Community Health Center Inc., Innis LA, added a diabetes nurse educator, who works with the integrated team of primary care, dental and behavioral health providers to ensure improvement in the health of existing and new diabetic patients.
  
• Southbridge Medical Advisory Council Inc., Wilmington DE, hired a physician whose focus is to improve the management of patients with chronic disease, particularly diabetes and heart disease.
  
• Southeast Missouri Health Network Inc., New Madrid MO, was able to hire four new nurses and a new lab technician, allowing the center to educate the nearly 1,500 diabetic patients in its registry on the importance of medication and diet compliance, setting reasonable self-management goals and checking blood sugars.

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HRSA and Health Care Personnel

HRSA provided Recovery Act funds to the National Health Service Corps (NHSC) for loan repayment assistance to primary care health providers working in underserved communities across the country. While NHSC clinicians do not specialize, they may focus on a particular disease or condition due to the needs of the communities in which they serve and their own experience. Some, like Rita Meadows, a nurse practitioner who is a participant in the NHSC loan repayment program, have a special interest in treating and preventing diabetes.

Meadows arrived at her NHSC practice site in southern Delaware with a passion for diabetes management because her daughter is a type 1 diabetic. With support from her supervising physician, Meadows conducts group and individual weight management sessions for pre-diabetic and obese patients.  One of her many successes is a 9-year old girl who went from being obese, having high cholesterol levels, and being pre-diabetic in 2009, to being a very healthy 11-year-old today.

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