Got Diabetes? There's a Plan for That

E-newsletter Issue #121 | August 29, 2013

Driving from New York to California is a long and tiring trip. Trying to make that drive without a map or GPS to guide you is infinitely harder.

The same can be said of states trying to reduce their rate of diabetes without a comprehensive plan. If you don’t have a clear idea of where you are or where you’re going, how do you know which path to take?

The Diabetes Action Plan is a new way to help ensure legislators and other policymakers are strategically taking steps toward reducing the prevalence of diabetes in their state. Kentucky and Texas passed Diabetes Action Plan legislation in 2011, while seven other states—Illinois, Louisiana, New Jersey, North Carolina, North Dakota, Oregon and Washington—passed legislation in 2013.

“This is legislation that aims to establish a collaborative process across state agencies,” said Marti Macchi, senior consultant for diabetes for the National Association of Chronic Disease Directors. She was one of the featured speakers for a recent CSG webinar, “Preparing States for Diabetes Action Plan Legislation.”

Macchi said three state agencies are typically included in the legislation—agencies that house the Medicaid program, the state Department of Health, usually the diabetes program staff. and the agency responsible for state employee health benefits.

“Really what the law requires is that these agencies come together and develop a collaborative plan of action,” Macchi said. “This is a biannual report that provides a very narrowly focused look, highlighting the problems and the costs associated with diabetes. … It does foster collaboration among state agencies to make very specific policy recommendations for people with and at risk of diabetes that are actionable for the state legislature to consider. … Those recommendations should include a blueprint for cost and no-cost strategies.”

Connie White, deputy commissioner for clinical affairs at the Kentucky Department of Health, said the legislation—KRS 211.752—was a challenge at first.

“The legislation very clearly said what partners would be at the table for this report, this plan,” White said. “It was really not the classic diabetes folks at the table you would expect if you’re writing a diabetes plan. We were scratching our heads a little bit, looking at all the requirements of the legislation and thinking, ‘Oh wow, this is going to be a challenge.’”

Meetings began in June 2011. Since Kentucky was one of the first states to adopt the Diabetes Action Plan, it took a while to figure out what the report should look like.

The data section proved to be a particular challenge, since “a lot of people had a lot of data, but how do you take that data beyond numbers and actually turn that into a thought process that can be helpful and actually move the state forward,” said Theresa Renn, manager of the Kentucky Diabetes Prevention and Control Program, who headed up the project. The first report was completed and delivered to the legislature in January.

Renn said the group very purposefully called the new document the Kentucky Diabetes Report.

“We really didn’t want to say we were writing a new plan because we had a plan,” she said. “We wanted to make recommendations that would work with those plans. I should also mention (Healthy People) 2020 was happening at the same time. We had a chronic disease plan, a diabetes plan, a 2020 plan and this thing all kind of happening at the same time.

“We really had to think about that a lot. The good thing about that was we got to make those things (all of the different plans) align as we were working. That was actually a good thing.”

 The final report offered a variety of recommendations, including continuing support for existing state plans, such as the Coordinated Chronic Disease State Plan, which supports local communities in implementing evidence-based interventions. It also recommended expanding the use of an evidence-based lifestyle change program called the National Diabetes Prevention Program, currently offered through only two YMCAs in the state. The report also recommended improving surveillance systems to get a better idea of how many people in the state have diabetes and how well they are managing their disease.

“This is not just another report,” White said. “This is not something that collects dust on a shelf. … This is our think tank. This is our wish list. This is what we want the legislators to know about diabetes in the state of Kentucky.”

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