(Note: This guest piece was written by Reita Jones, RN, KY Department of Public Health, Diabetes Prevention and Control)
According to the Centers for Disease Control and Prevention and the Kentucky Department for Public Heath, nearly 600,000 Kentucky adults are estimated to have diabetes. Of these, one in four don’t know they have it. Additionally, adults with diabetes are nearly twice as likely to die from heart disease and stroke. And for women with diabetes, the risks for cardiovascular disease are three to seven times greater compared with women who do not have diabetes. Thus, the 2019 theme for National Diabetes Month is “Take Diabetes to Heart”. This November and in the year ahead, you are encouraged to join organizations and communities across Kentucky to raise awareness about risk for this serious chronic health condition and the strong link between diabetes and risks for heart disease. You are also encouraged to share resources from links in this article and engage in discussion and action to make a difference in your client population and in the lives of people with diabetes.
Early Detection is Critical
First consider, could members of your family or client population be one of the four adults who have diabetes and don’t know it? Early detection and appropriate management are key in preventing or delaying devastating complications of poorly managed diabetes. How many times have you known of individuals seeking medical attention for a health problem that turns out to be a complication of diabetes and the diabetes had likely been present but undiagnosed for several years? Take steps now to engage and screen your client population at risk for diabetes or prediabetes, especially those who have not been seen for some time. See page 3, section 2 in the Standards of Medical Care in Diabetes – 2019, Abridged for Primary Care Providers for screening guidance. If you are not in a clinical setting, it is also a good choose to share the diabetes risk test with your network of influence, community and family.
Gaps in Diabetes Control and Cardiovascular Risk Reduction
Second, in bringing awareness around the strong link of diabetes and risk for heart disease, it is important to acknowledge that managing diabetes is much more than meeting blood glucose targets. Blood pressure and lipid management are equally important for reducing cardiovascular risks related to diabetes. However, despite many advances in therapies over the past 30 years, large gaps persist in cardiovascular risk reduction and heart disease management in people with diabetes. A January 2019 article with analysis of data in the U.S. Collaborative Diabetes Registry shows that only one in five individuals with diabetes meet appropriate targets for comprehensive cardiovascular risk factor control (ABCs – A1C, Blood pressure, LDL Cholesterol and non-Smoking status). Even fewer meet the recommendations for physical activity, healthy eating and body mass index.
Opportunity for Diabetes and Cardiovascular Improvement with DSMES
This low baseline, presents a tremendous opportunity for improvement in cardiovascular outcomes among individuals as well as populations of people with diabetes. Lifestyle management is a fundamental aspect of diabetes care and diabetes self-management education and support (DSMES) is the most comprehensive evidence-based intervention recommended in the latest American Diabetes Association standards of care for lifestyle management. It is an underutilized intervention which can be very effective in addressing the achievement gap for diabetes ABCs goals, especially considering that at least 90 percent of diabetes care is carried out by the person with diabetes or a family member.
DSMES services are an ongoing process to facilitate the knowledge, skill and ability necessary for optimal diabetes self-care. They include activities and tools that assist in implementing and sustaining the behaviors needed to manage diabetes. DSMES services incorporate the needs, goals and life experience of the person with diabetes and support informed and shared decision-making for active collaboration with healthcare teams to improve clinical outcomes over the course of a lifetime. DSMES services are provided by licensed/certified diabetes educators and are recommended at diagnosis, annually (based on assessment of education, nutrient and emotional needs), when new complicating factors arise and when transition in care occurs.
Studies have found that individuals who attend ongoing DSMES are more likely to use primary care and preventive services or follow-up on treatment recommendations. DSMES attendance is also associated with improved self-care behaviors; lowered A1C, blood pressure, and cholesterol levels; lower self-reported weight; healthy coping; improved medication adherence and quality of life; and reduced hospital admissions, readmissions and healthcare costs. It is also important to note that outcomes associated with DSMES services have been shown to be dose responsive in that more DSMES leads to better outcomes. It may also be helpful to look at the benefits rating for diabetes education with the parameters utilized to evaluate medications.
Despite the well documented benefits and reimbursement for the service, reports indicate that only 5-7% of individuals eligible for DSMES through Medicare or a private insurance plan actually receive it. In addition, licensed/certified diabetes educators, who deliver the services (within an organization or in the community), are seldom included on the multidisciplinary care team that plays a critical role in managing diabetes and all the relevant risk factors.
Everyone Can Play a Role to Increase DSMES Participation
During National Diabetes Month and in the year ahead “Take Diabetes to Heart” by taking steps to become familiar with the accredited and recognized DSMES programs in the Kentuckiana region and your community. The Kentucky Diabetes Resource Directory is an easily accessible source to search for programs by county and surrounding counties in the state. All public and private insurance plans in Kentucky cover the DSMES service although, provider referral, deductibles and copayments may apply. Access to diabetes education is less abundant, and in some cases non-existent, in rural areas of the Commonwealth. To address this gap, the Kentucky Department for Public Health’s accredited DSMES program (Healthy Living with Diabetes), services 58 counties across Kentucky through 16 local or district health departments.
And lastly, you are encouraged to take action on the steps below, as applicable, to promote DSMES access and participation in your network of influence. Health systems, employers, health plans, public health, academic organizations, consumer advocacy groups, local pharmacies, diabetes sales companies, communities and individuals can all play an important role to help drive improvement in diabetes ABCs and cardiovascular outcomes.