S u m m i t
G r a n t e e
2 0 1 3
2013 Together on Diabetes
U.S. Grantee Summit
February 25-27, 2013
Atlanta, Georgia
TABLE OF CONTENTS
About BMS Foundation and NNPHI
1
Acknowledgement
2
Map of Emory Conference Center Hotel
3
Together on Diabetes™ Background
4
Speaker Biographies
9
Workshop Descriptions
20
Participant List
23
Resources
30
Notes
50
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CDC Diabetes Report Card
About the Bristol-Myers Squibb Foundation
The Bristol-Myers Squibb Foundation is an independent 501(c)(3) charitable organization whose mission is to
promote health equity and improve health outcomes for people disproportionately affected by serious diseases
around the world.
For more information about the Bristol-Myers Squibb Foundation, please visit www.bms.com/foundation or
follow us on Twitter at www.twitter.com/bmsnews
About the National Network of Public Health Institute
The National Network of Public Health Institutes (NNPHI) was formed in 2001 to recognize and enhance the
work being done in public health by independent, nonprofit collaborative entities. Many states and local
jurisdictions have formed these multi-sector organizations with their unique partnerships with government, the
business community, academia, and other nonprofits. NNPHI members share certain characteristics of fostering
innovation, creating efficient administrative structures, and reaching out to partners outside of the usual
governmental arena. The leaders of the individual institutes recognize they share common goals and
objectives, which can be enhanced through a formal collaborative network, working in partnership with national
public health partners.
NNPHI is a 501(c) 3 organization funded primarily by member dues, a cooperative agreement with the Centers
for Disease Control and Prevention, and grants from the Robert Wood Johnson Foundation. NNPHI is a
membership-driven organization that accomplishes its mission of fostering innovations that improve health
through: educational teleconferences; training workshops; collaborative research and information exchange;
support for emerging institutes; a bi-monthly newsletter; a website; and meetings such as this one.
To learn more about NNPHI, including its members, programs and governance, please visit
http://www.nnphi.org.
1
2013 Together on Diabetes Grantee Summit — ACKNOWLEDGEMENTS
Planning Committee
The National Network of Public Health Institutes and the Bristol-Myers Squibb Foundation would like
to acknowledge the 2013 Together on Diabetes™ Grantee Summit Planning Committee. As part of
this year’s planning for the Together on Diabetes™ Grantee Summit the following grantees provided
valuable feedback to help shape the content of this year’s Summit.
Nadia Ali, MPA
Camden Coalition of Healthcare Providers
Maggie Morgan, JD
Harvard Law School Center for Health Law
and Policy Innovation
Alison Barlow, MPH, MA
Johns Hopkins Center for American Indian
Health
Shelia Plogger
Marshall University Center for Rural Health
Ben Bluml, RPh
American Pharmacists Association Foundation
Kim Prendergast, RD, MPP
Feeding America
Jay Greenberg, ScD
National Council on Aging
Diana Urlaub, MPH
Peers for Progress Program Development
Center
Jenna Hunter-Skidmore, MPH
Kansas Universit
Anna Lyn Whitt, LMSW, MPH
Mississippi Public Health Institute
Michelle Lyn, MBA, MHA
Duke University Medical Center
Continuing Education Providers
The National Network of Public Health Institutes and the Bristol-Myers Squibb Foundation would also
like to thank the Michigan Public Health Institute for providing continuing education credits for the
2013 Together on Diabetes™ Grantee Summit.
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Together on Diabetes™ is a five-year, $115 million initiative launched in November 2010 by the
Bristol-Myers Squibb Foundation to improve health outcomes of people living with type 2
diabetes in the United States, China and India by strengthening patient self-management
education, community-based supportive services and broad-based community mobilization.
Consistent with the Bristol-Myers Squibb Foundation’s mission to reduce health disparities, this
initiative will target adult populations disproportionately affected by type 2 diabetes.
Our Focus
The initiative will target adults living with type 2 diabetes – both diagnosed and
undiagnosed – who are disproportionately affected by type 2 diabetes. There are
three focal points for funding and partnership:
−
Help adults living with type 2 diabetes to better self-manage their disease and
navigate care with sustained and relevant support for the course of their disease
journey
−
Help communities to build, integrate and coordinate medical, non-medical and
policy efforts, and expand the base of community organizations actively involved in
and bringing their know-how, reach, influence and assets to the fight against type 2
diabetes
−
Foster a radical rethink and test new ideas about how diabetes control efforts are
approached, designed, implemented and measured given the current and future scale
of the epidemic and the long duration of the disease journey
Together on Diabetes® Partners and Projects in the United States (visit the
interactive map at www.togetherondiabetes.com)
JANUARY 2013 4
•
American Academy of Family Physicians Foundation, in partnership with
Peers for Progress, National Council of La Raza and the University of North
Carolina’s Gillings School of Global Public Health, received $5,234,876 for a fouryear effort to incorporate patient self-management education, peer support and
community outreach for low-income Hispanics and African Americans into the
patient-centered medical home model.
•
American Association of Diabetes Educators received $400,000 for a 12month pilot study of the effectiveness and sustainability of a flexible, multi-level
diabetes education and support team that serves minority populations and utilizes
professional and lay health workers.
•
American Pharmacists Association Foundation, working with government
agencies, professional associations, pharmacy chains, health centers and others,
received $4,384,210 for a four-year effort to adapt and expand the evidence-based
Asheville Project model to patients covered by public and private health insurance in
25 communities heavily affected by diabetes.
•
Camden (N.J.) Coalition of Healthcare Providers and the Cooper Foundation
received $3 million over five years to strengthen community-based components of its
Camden Citywide Diabetes Collaborative care model by focusing on patient selfmanagement, education and support, care coordination, food access and physical
activity programs, and behavioral health and community engagement activities in
order to bend the curve on the diabetes burden and health care costs in the city.
•
Duke University Medical Center and the Durham County (N.C.) Department of
Health and Human Services received $6.25 million over five years to create a data
sharing system and geospatial map of the diabetes problem in the county and
develop, pilot and implement a series of coordinated community-based interventions
to improve diabetes self-management, health outcomes and quality of life.
•
Feeding America, in partnership with three member food banks in Texas, Ohio
and California, received $3.1 million over three years to create and pilot bidirectional food bank-health center partnerships that will provide diabetes screening,
care coordination, nutrition and disease management education, and healthy foods
to adults who are living with type 2 diabetes and food insecure.
•
Harvard Law School Center for Health Law and Policy Innovation
received $981,862 over four years to advise Together on Diabetes on policy and
advocacy issues and develop comprehensive state-level policy recommendations for
eliminating barriers to care, improving outcomes and enhancing health care policy
for patients with type 2 diabetes as part of the Center’s Providing Access to Healthy
Solutions (PATHS) initiative.
•
Marshall University Center for Rural Health, in partnership with the U.S.
Centers for Disease Control and Prevention and the Appalachian Regional
Commission, received $2.61 million over five years to build the capacity of 10
community diabetes coalitions to implement evidence-based programs that support
long-term behavior change and improve the health of people living with type 2
diabetes. The 10 communities are: Louisa, Kentucky; Robbinsville, North Carolina;
Georgetown, Ohio; Decatur, Tennessee; Williamson, West Virginia; Murray County,
Georgia; Winona, Mississippi; Pomeroy, Ohio; Altamont, Tennessee; and Athens,
Tennessee.
•
Mississippi Public Health Institute, in partnership with the Mississippi
Department of Health, University of Mississippi Medical Center and the Mississippi
Division of Medicaid, received $484,000 to develop a coordinated, evidence-based,
community approach to systematically lower the incidence and severity of diabetes in
JANUARY 2013 5
the Delta Region by integrating existing medical and non-medical systems of care,
supporting the creation of patient-centered medical homes and developing policies
that positively impact environmental and social determinants of health related to
type 2 diabetes.
•
National Council on Aging received $4.87 million over three years to
demonstrate a nationally scalable model for delivering the Stanford Diabetes SelfManagement Program on-line and in community settings in partnership with the
YMCA-USA, OASIS Institute, WellPoint and Stanford University.
•
National Network of Public Health Institutes (NNPHI) received $197,027 to
develop and host a two-day grantee summit in February 2013 and support an
ongoing Learning Collaborative for grantees. NNPHI also will leverage its expertise
and network to inform the annual summit and learning community activities,
provide leadership and professional development opportunities for grantees, and
enhance relationships between grantees and the broader public health practice
community.
•
Sixteenth Street Community Health Center in Milwaukee, Wisconsin, received
$163,907 over three years to help Hispanic patients with type 2 diabetes who have
fallen out of a doctor’s care for their diabetes to reconnect to care, drawing lessons on
linkage-to-care models used for people living with HIV/AIDS.
•
United Hospital Fund received $2,845,967 over three years to work with the New
York City Department of Health and Mental Hygiene and the Department for the
Aging to develop and test an integrated, community-based diabetes control strategy
for seniors living in “naturally occurring retirement communities” (NORCs) and the
surrounding neighborhoods.
•
University of Kansas received $2,885,944 over five years to develop and
implement an online documentation and support system that will help the
Foundation evaluate and understand what is being accomplished by Together on
Diabetes at the individual project and overall initiative levels, while also helping to
improve the individual and collective performance of Together on Diabetes grantees
and their projects.
2011 Special Focus Population: African American Women
African American women represent one of the highest-risk groups of type 2 diabetes in terms of
prevalence and disease burden. In November 2010, Together on Diabetes issued a special
request for proposals to encourage, identify and promote new and evidence-based approaches to
empowering African American women to control their diabetes while taking into account the
opportunity they have to impact the health of their families and communities. Each of the
following organizations received two-year, $300,000 grants:
•
•
•
University of Virginia received a grant to undertake a comparative study to evaluate
the effectiveness of the Call to Health model, which includes supportive text messaging,
“buddies,” group visits in clinic and community-based settings and community resource
referral and mobilization in partnership with the Charlottesville-Albemarle Community
Obesity Task Force.
East Carolina University received a grant to implement a behaviorally centered
"small changes" approach and care navigation delivered by lay health worker teams in
four rural communities in eastern North Carolina.
Whittier Street Health Center working with the Boston Housing Authority and
Boston YMCA, received a grant to connect African-American women living in public
housing with comprehensive diabetes management, including health education and
JANUARY 2013 6
•
•
support by a certified diabetes educator and peer supporter, nutritional counseling by a
dietitian, social service navigation, and a tailored program for physical activity in
Roxbury.
Black Women's Health Imperative working with clinical and faith-based partners
received a grant to implement a comprehensive self-management, social support and
empowerment program for African American women age 40 and older and their families
living in three wards in the District of Columbia.
United Neighborhood Health Services received a grant to implement a
comprehensive diabetes self-management program in Nashville, Tennessee, that
includes clinical care, case management, nutrition counseling, fitness instruction and
counseling, structured physical activity, social supports, and stress and behavioral
counseling.
2012 Special Focus Population: American Indians in the Southwest
American Indians and Alaska Natives suffer the highest rates of diabetes in the nation. Rates are
as high as 33.5% in areas of the southwest – Arizona and New Mexico. In November 2011,
Together on Diabetes announced a partnership with Johns Hopkins Center for American
Indian Health (JHCAIH), 3 Navajo communities and 1 White Mountain Apache community to
adapt and implement community evidence-based diabetes practices and a Family Coach model
to improve the health outcomes of 250 families in the Southwest. JHCAIH received a grant of
$2,173,360 for this two-year demonstration project that will also draw on Native American
traditions and identity that support a healthy diet and physical activity.
Working with Hispanic Communities
According to the U.S. Centers for Disease Control and Prevention, 11.8 percent of Hispanics are
diagnosed with type 2 diabetes, compared to the national rate of 8.3%. Lifetime risk estimates
for developing diabetes are higher for both Hispanic men and women than for other ethnic
groups. Diabetes is also the fifth-leading cause of death among Hispanics in the U.S.
Since the start of Together on Diabetes in 2010, the initiative has been supporting projects to
develop comprehensive and effective solutions that leverage the strengths of Hispanic
communities, culture and health traditions such a promotoras de salud to improve health
outcomes and reduce the burden of diabetes in 12 U.S. communities with significant Hispanic
populations.
2012 Expansion to China and India
In May 2012, Together on Diabetes® announced a $15 million, five-year expansion to China and
India, developing nations with rapidly growing numbers of type 2 diabetes patients.
The International Diabetes Foundation (IDF) reports that more than 90 million people in China
– 9.3 percent of the population – had type 2 diabetes in 2011, the most of any country. That
figure is projected to grow to 129.7 million, or 12.1 percent of the population, by 2030.
India, which has 61.26 million people diagnosed with type 2 diabetes (8.3 percent of the
population), ranks second only to China in total cases and third behind the United States (10.9
percent) and China in terms of prevalence. By 2030, India will have 101.2 million people with
type 2 diabetes, IDF projects.
JANUARY 2013 7
The initial partners of Together on Diabetes in China are:
•
Chinese Center for Disease Control and Prevention received US $709,016
over three years to enhance the capacity of rural health care providers to manage
and prevent type 2 diabetes at the village level in Western China, where diabetes is
growing faster than in China’s cities and where rising medical costs are an
important factor leading to poverty.
•
Shanghai Charity Foundation received US $522,797 over three years to create
an efficient and effective community-based, block-by-block approach for
managing type 2 diabetes in Shanghai, a mega-city of 23 million people.
The initial partners of Together on Diabetes in India are:
•
Mamta Health Institute for Mother and Child received US $706,995 over
three years to pilot a study to determine the feasibility of involving India’s lay
community health workers (Accredited Social Health Activists) and integrating
various systems of medicine, including modern and AYUSH, to prevent and control
non-communicable diseases, especially type 2 diabetes.
•
All India Institute of Diabetes and Research and Swasthya Diabetes
Hospital received US $465,685 over two years to provide medical education about the
diagnosis and management of uncomplicated type 2 diabetes to medical officers working
in public and community health clinics.
•
Sanjivani Health and Relief Committee received US $426,374 over four years
to conduct a household-by-household study in 348 villages to identify type 2
diabetes and ensure early diagnosis of undetected diabetes among those with prediabetes or at high risk of developing diabetes. The study also will determine the
prevalence of type 2 diabetes and related complications among the rural poor.
Grant and Partnership Development
Funding for US, China and India grantees is being awarded to non–profit organizations through
proactive partnership development and invited requests for proposals.
The Bristol-Myers Squibb Foundation and Together on Diabetes® welcome and seek
opportunities to join forces and resources with other foundations and charities, corporate social
responsibility and philanthropy initiatives from diverse industries, and government programs
and agencies.
For U.S. program and grant inquiries, please contact Patricia M. Doykos via email at
patricia.doykos@bms.com. For China and India program and grant inquiries, please contact
Phangisile Mtshali at phangisile.mtshali@bms.com. For comprehensive program information,
visit our web site www.togetherondiabetes.com.
For media inquiries, please contact Fred Egenolf via email at frederick.egenolf@bms.com
JANUARY 2013 8
2013 Together on Diabetes Grantee Summit — Speaker Biographies
Featured Speakers
Ann Albright, PhD, RD
Director, Division of Diabetes Translation
Center for Disease Control and Prevention
Ann Albright, PhD, RD, has served as director of the Division of Diabetes Translation since January 2007. As director, Dr. Albright leads a team of professionals who strive to eliminate the preventable burden of diabetes. Dr. Albright received her doctoral degree in exercise physiology from Ohio State University.
She completed an NIH postdoctoral fellowship in nutrition at the University of California, Davis and a
clinical internship in nutrition at University of California, San Francisco (UCSF).
Before joining CDC, Dr. Albright served as Chief of the California Diabetes Program for the California Department of Health Services and held an academic appointment in the Institute for Health and
Aging at UCSF, a position she held since 1995. From 2003-2004, Dr. Albright served as the Senior
Health Policy Advisor in the Office of the United States Surgeon General and led the Secretary of
Health’s Diabetes Detection Initiative.
Dr. Albright lectures and is published in several areas, including exercise, nutrition, and public health
practice in diabetes prevention and control. Dr. Albright has served as the American Diabetes Association President for Health Care and Education and has held other leadership roles with the American Association of Diabetes Educators, the American Dietetic Association and the American College
of Sports Medicine.
9
Dr. Ann Bullock, M.D.
Chief Clinical Consultant for Family Medicine
Indian Health Service
Ann Bullock, MD is a board-certified Family Physician who has worked with
the Indian Health Service and the Eastern Band of Cherokee Indians since
1990. From 2000-2009, she was the Medical Director for the tribe's Health
and Medical Division and now serves as its Medical Consultant. She is also
the Clinical Consultant for the IHS Division of Diabetes Treatment and Prevention. Her main interests are related to diabetes prevention and treatment,
including the role of prenatal and early life risk factors in the development of
chronic disease. She has been an author on a number of IHS Diabetes Best Practices, Standards
of Care, and Clinical Guidelines. Dr. Bullock is interested in the development of interdisciplinary
programs, including complementary approaches and integrating services which address stress,
trauma and depression. She is the course director for Indian Health’s annual primary care conference, “Advances in Indian Health”, which occurs each spring in Albuquerque. All Indian Health
System clinicians are invited to attend—check the IHS calendar or the University of New Mexico
Office of CME website for information on the current year’s conference. Dr. Bullock is an enrolled
member of the Minnesota Chippewa Tribe and a member of the Association of American Indian
Physicians. She is a Fellow of the American Academy of Family Physicians.
Pedro Greer, Jr., MD
Assistant Dean of Academic Affairs
Florida International University
Dr. Pedro J. Greer has an unwavering commitment to and is an advocate for
those without access to health care. Throughout his career, Dr. Greer has
received numerous awards and Honorary Doctoral degrees. Most recently,
he was recognized as a 2009 Presidential Medal of Freedom honoree, and
in 1993, he was honored as a MacArthur Foundation "Genius Grant" Fellow.
Dr. Greer is board certified in Medicine and Gastroenterology and has been practicing in Miami,
Florida since 1991. He established Camillus Health Concern and Saint John Bosco in Miami,
Florida, health care centers for persons who are homeless, undocumented, uninsured, and low
income. Better known as "Joe," Dr. Greer wrote Waking up in America, an autobiographical account of caring for persons who are homeless.
In July 2007, Dr. Greer joined the newly established Florida International University Herbert
Wertheim College of Medicine as Assistant Dean for Academic Affairs. He led the creation of the
Department of Humanities, Health, and Society, and in January 2009 became its Founding Chair.
Dr. Greer and the department faculty have spearheaded a unique undergraduate medical education program to prepare physicians to assess and address the social determinants that affect
health care access and health outcomes. The goals are to educate highly skilled, ethical, and
culturally competent physicians attuned to the complex health and social needs of South Florida’s
diverse populations. Dr. Greer currently serves in various capacities for a multitude of national,
state, and local organizations. He is a Trustee at the RAND Corporation (America’s oldest and
largest think tank) and is the current Chair of the Pardee RAND Graduate School Board of Governors. Additionally, Dr. Greer served as Chair for the Hispanic Heritage Awards Foundation from
2002 to 2012. He is a member of Alpha Omega Alpha National Medical Honor Society and a fellow in the American College of Physicians and the American College of Gastroenterology.
10
Harrison Jim Sr.
Traditional Healer– Navajo Blessing
Harrison Jim, Sr. is Dine’. His clans are:
Maternal clan - Haltsooi, ei nilii
Paternal clan – Kinyaa’aani, ei yashchiin
Maternal grandfather’s clan - Tsi’naajinii, ei da’bi cheii.
Paternal grandfather’s clan - Tsi’naajinii, ei da’bi nali
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Harrison is a lifetime resident of the community of Red Rock, New Mexico located near Gallup, New
Mexico with exception of the years 1974 through 1977, during which time he completed a tour of duty
with the United States Navy. He is certified as a CADC-II and ICADC with the Southwest Certification
Board; certified with the Dine’ Hat’aali Association of Window Rock, Arizona as a Traditional Counselor and Consultant; and a certified Peacemaker with the Navajo Nation. He is the Co-founder of the
renowned Traditional Program - Hinaa’h Bits’os Society (HBS) of the Na’nizhoozhi Center, incorporated in Gallup, New Mexico.
He was employed as a Traditional Practitioner, Counselor and Cultural Teacher with the Navajo Area
Indian Health Service Unit - Fort Defiance Indian Hospital Adolescence Care Unit in Ft. Defiance,
Arizona. Ft. Defiance SU-ACU is the first hospital based residential program of its kind for the Indian
Health Service, and seeks to integrate traditional and western approaches to healing. He is currently
employed as a traditional Practitioner, Traditional Counselor, and Cultural Teacher with Northern
Navajo Medical Center. He is a strong advocate for integration of cultural teachings and healing, Ceremonies into the delivery of patient services of Residential Treatment, Outpatient Treatment Centers,
Educational, and Counseling Programs.
Honors received by Harrison:
 Becoming a recipient of the fellowship award with the Robert Wood Johnson’s Developing Leadership in Reducing Substance Abuse in 2002, Harrison is the only full blooded Native American
to receive the distinguished award through out the nation.
 Being assigned by the Mayor of the City of Gallup, as chair person of the Blue ribbon Task Force
in addressing alcoholism within City of Gallup in 2004.
 Serving as a consultant to Behavioral Health Organizations throughout the country, including
schools and Communities located within the Navajo Nation; past to present date.
 Receiving recognition as a Native Scholar from the University of New Mexico in year 2000.
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Robert E. Ratner, MD, FACP, FACE, Chief Scientific & Medical Officer
Chief Scientific & Medical Officer
American Diabetes Association
Dr. Ratner provides leadership and oversight of scientific and medical activities including research, clinical affairs, program recognition and certification,
medical information and professional education. In this capacity, he oversees the Association's support of a broad range of professional education
activities and the development of the American Diabetes Association Clinical
Practice Recommendations, clinical consensus reports and expert opinions.
Prior to joining the American Diabetes Association, Dr. Ratner was a Professor of Medicine at
Georgetown University Medical School and Senior Research Scientist at the MedStar Health Research Institute in metropolitan Washington, DC. He recently completed a sabbatical as a Robert
Wood Johnson Foundation Health Policy Fellow, having served as the study director for the Institute of Medicine Comparative Effectiveness Research Priorities Committee, and a program examiner for health reform in the Health Division of the U.S. Office of Management and Budget.
He received his MD from Baylor College of Medicine in Houston, Texas where he also completed
his Internal Medicine training. He underwent fellowship training in Endocrinology and Metabolism
at Harvard Medical School and the Joslin Diabetes Center in Boston. He recently completed six
years of service on the Steering Committee of the National Diabetes Education Program (NDEP),
representing the American Diabetes Association. He has served on the Board of Directors of the
National Certification Board for Diabetes Education and the American Association of Diabetes
Educators, and is Past-President of the Washington Area Affiliate of the American Diabetes Association. He has served as the Chair of the Government Relations Committee and the Pregnancy
Council of the American Diabetes Association.
He is a Principal Investigator for the Diabetes Prevention Program (DPP) and DPP Outcomes
Study of the National Institutes of Health (NIH) and serves on the Steering Committee for the project nationwide. At Georgetown University, he served on the University Research Committee, and
co-chaired the Joint Oversight Committee for Clinical Research.
He is currently an Associate Editor of the Journal of Clinical Endocrinology and Metabolism. His
research interests include diabetes therapeutics and complications, with an emphasis on translational efforts from controlled trials into community-based practice. He is the author of more than
120 original scientific articles and 20 book chapters.
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Expert Faculty of Panel Sessions
Leonard Jack, Jr., PhD, MSc, CHES
Director, Division of Community Health
Centers for Disease Control and Prevention
Dr. Leonard Jack, Jr., currently serves as the Director of the Division of Community Health at the Centers for Disease Control and Prevention. Prior to his
employment at the Centers for Disease Control and Prevention, he served as
the Director, Center for Health Minority Health & Health Disparities Research
and Education; Endowed Chair of Minority Health; and Professor in the Division of Clinical and Administrative Services in the College of Pharmacy at Xavier University of Louisiana.
Dr. Jack also held the Jim Finks Endowed Chair of Health Promotion and was Professor of Behavioral and Community Health Sciences at the Louisiana State University Health Sciences Center’s
School of Public Health. Dr. Jack also served as Associate Dean (the Dean) of the School of Health
Sciences and Interim Chair, Department of Behavioral and Environmental Sciences at Jackson State
University. He worked for 14 years at the Centers for Disease Control and Prevention in Atlanta,
Georgia where he served as Team Leader of Applied Behavioral Research, Epidemiology, and Evaluation; and Chief of Community Intervention in the Division of Diabetes Translation.
Dr. Jack’s areas of research and public health practice include: psychosocial aspects of disease
management, health disparities, men’s health, family, and community-based research. Dr. Jack has
several years of teaching experience and has held numerous research/professional positions. He
has delivered over 95 professional presentations and published over 80 peer reviewed publications
and/or book chapters.
He serves on several editorial boards of peer reviewed journals and is Editor-in-Chief of the Health
Promotion Practice Journal. Dr. Jack is Editor and contributing author of his recently published
book, “Diabetes in Black America: Public Health and Clinical Solutions to a National Crisis”. He also
served as Editor of the National Commission for Health Education Credentialing seven chapter study
guide, The Health Education Specialists: A Companion Guide for Professional Excellence, 6th Edition. Dr. Jack is the recipient of the Society for Public Health Education’s 2011 Distinguish Fellow
Award, the society’s highest award given in recognition of an individual’s national contributions to the
profession of public health and public health education.
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Dominic H. Mack, MD
Assistant Professor, Deputy Director,
National Center for Primary Care, Morehouse School of Medicine
Dominic Mack, a native of Augusta, Georgia, earned his Bachelor of Science degree from Paine College in Augusta, GA and his Medical Doctorate from Meharry
Medical College in Nashville, TN. He completed his residency in Family Medicine
at Morehouse School of Medicine in Atlanta GA. Dr. Mack practiced at Southside
Community Health Center in Atlanta for 11 years where he served as Chief Medical Officer during his tenure, then returned to Morehouse School of Medicine in
2001 as an Assistant Professor in the Department of Family Medicine.
While at Morehouse he served as the Medical Director for the Family Medicine Department and later
became the Associate Chair of Clinical Affairs. In 2003, he graduated from Kennesaw State University with a Master of Business Administration degree. In 2006, Dr. Mack served as the Associate Director for the National Center for Primary Care and Project Director for the Regional Coordinating
Center for Hurricane Response at Morehouse School of Medicine. He later took the position of Chief
Medical Officer for AmeriCorp Holdings/The AeroClinic which has opened airport clinics in Hartsfield
Jackson Atlanta Airport and the Philadelphia International Airport. He is also the founder and past
president of Mack Medical Consultants, a company dedicated to the improvement of business practices in medical organizations. Dr. Mack currently serves as the Deputy Director of the National Center for Primary Care at Morehouse School of Medicine, and as the Executive Medical Director, Principal Investigator of the Georgia Health Information Technology Regional Extension Center (GAHITREC).
Phangisile Mtshali-Manciya
Director of Corporate Philanthropy
Bristol-Myers Squibb
Phangisile Mtshali-Manciya is the Director of the Bristol-Myers Squibb Foundation,
responsible for Secure the Future™, Delivering Hope™ and Together on Diabetes ™
initiatives in southern Africa and Asia respectively. In this role, she supervises
community outreach and education programs funded by Bristol-Myers Squibb
Foundation to support HIV and Aids in Africa, Hepatitis B & C in China, Taiwan,
India and Japan and Diabetes in China and India. She is based in Johannesburg,
South Africa. Prior to joining the Bristol-Myers Squibb Foundation initiative in 1999, she was a managing
director of SIMEKA TWS Communications in Johannesburg. She previously operated her own communications consulting firm and held a position as a corporate public relations officer. Earlier in her career,
Ms. Mtshali Manciya served as a television news editor and a newspaper feature writer and editor.
Mtshali-Manciya’s academic background includes studies in journalism, public relations and project
management. She holds a Post graduate Diploma in Project Management from Cranefield College of
Programme and Project Management.
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Jerry Schultz, Ph.D.
Co-Director of Work Group for Community Health and Development
University of Kansas
Dr. Schultz holds a Ph.D. in cultural anthropology from the University of Kansas.
His work is focused on building the capacity of communities to solve local problems, understanding community and systems change, evaluating community
health and development initiatives, and developing methodologies for community
improvement. He is part of the Community Tool Box (CTB) development team, a
global online resource for community building. His responsibility includes both
content and design development for the CTB. Dr. Schultz has authored numerous articles on evaluation, empowerment, and community development. He has been a consultant to several foundations,
community coalitions, and state agencies. Dr. Schultz was given the Society for Community Research
and Action Award for Distinguished Contribution to the Practice of Community Psychology in 2007. He
is a Fellow of the Society for Applied Anthropology.
15
Evaluation Workshop Leads
Kaston Anderson-Carpenter, MA, MPH
Graduate Research Assistant, Applied Behavioral Science
University of Kansas
Kaston Anderson-Carpenter is graduate research assistant and doctoral student
in applied behavioral science. He holds graduate degrees in experimental psychology/applied behavior analysis and public health. His previous research focused on behavioral interventions in increasing adherence to medical regimens,
particularly related to sleep disorders. A board-certified behavior analyst
(BCBA), Kaston has experience developing, implementing, and evaluating behavioral interventions with children and adults who have Autism Spectrum Disorder and other developmental delays. His current research focuses on primary
prevention and health promotion, program planning and evaluation, and social and environmental
determinants of health.
Vicki Collie-Akers, M.P.H, Ph.D.
Associate Director of Health Promotion Research
University of Kansas Work Group for Community Health and Development
Dr. Collie-Akers holds a Ph.D. in Behavioral Psychology from the University of
Kansas, and a Masters of Public Health with a concentration in Behavioral Science and Health Education from Saint Louis University. Her research is primarily
focused on applying a community-based participatory research orientation to
working with communities to understand how collaborative partnerships and coalitions can improve social determinants of health and equity and reduce disparities in health outcomes.
Throughout her career, Dr. Collie-Akers has worked to promote health through research and practice, including assisting in research projects that studied coverage of prevention research in small
market media, environmental assessments of walkability for children, mammography usage among
African American women, and promoting involvement of neighborhood and faith-based organizations in a CDC-funded REACH 2010 project in Kansas City, Missouri. In her position at the KU Work
Group, she directs several evaluation projects that support partners, such as the Medical Legal Partnership of Western Missouri, who are working to promote health through their comprehensive initiatives. Additionally, she serves as principle investigator or co-investigator on several projects promoting health equity and reduction in health disparities in the Kansas City metropolitan area. Dr. CollieAkers has provided consultation to a number of community initiatives on topics such as evaluation,
logic model development, and sustainability. She has also been active in capacity building through
trainings and webinars of individuals including public health practitioners and grass-roots community
representatives.
16
Evaluation Workshop Leads (cont.)
Steve Fawcett, Ph.D
Co-Director of Work Group for Community Health and Development
University of Kansas
Dr. Stephen Fawcett (sfawcett@ku.edu) is Kansas Health Foundation Distinguished Professor of Applied Behavioral Science at the University of Kansas. He
is also Director of the Work Group for Community Health and Development http://
communityhealth.ku.edu/, a World Health Organization Collaborating Centre at
the University of Kansas. A former VISTA volunteer, he worked as a community
organizer in public housing and low-income neighborhoods in the United States.
In his work, he uses behavioral science and community development methods to
help understand and improve conditions that affect population health and health
equity.
Dr. Fawcett is co-author of nearly 200 articles and book chapters and several books in the areas of
health promotion, participatory research, capacity building, and community-based research and intervention. He is co-developer of the Community Tool Box http://ctb.ku.edu/, a widely used Internetbased resource for promoting community health and development. A former Scholar-in-Residence at
the Institute of Medicine of the National Academy of Sciences, he served as a member of the IOM’s
Board on Population Health and Public Health Practice. A former visiting scholar at the World Health
Organization, he serves as a member of the World Health Organization Expert Panel on Health Promotion.
Policy and Advocacy Workshop Leads
Robert Greenwald, JD
Director, Clinical Professor
Harvard Law School Center for Health Law and Policy Innovation
Robert Greenwald is Clinical Professor of Law and Director of the Center for
Health Law and Policy Innovation (CHLPI) at Harvard Law School. As Director of
CHLPI, Robert oversees the work of Harvard Law clinical staff and students engaged in state and national research, policy development and advocacy to improve the health of underserved populations, with a focus on the needs of lowincome people living with chronic illnesses and disabilities. Robert and the CHLPI
team work with consumers, advocates, community-based organizations, health
and social services professionals, food providers and producers, government officials, and others to
expand access to high-quality healthcare and nutritious, affordable food; to reduce health disparities;
to develop community advocacy capacity; and to promote more equitable, and effective healthcare
and food systems. Robert is currently serving as a member of the Presidential Advisory Council on
HIV/AIDS, as a co-convenor of the Chronic Illness and Disability Partnership, and as a member of the
board of the Bessie Tart Wilson Initiative for Children and the Technical Assistance Collaborative for
Housing.
17
Policy and Advocacy Workshop Leads (cont.)
Emily Broad Leib, JD
Associate Director, Food Law and Policy Clinic
Harvard Law School Center for Health Law and Policy Innovation
Emily Broad Leib is Associate Director of the Harvard Law School Center for
Health Law & Policy Innovation and Associate Director of the Center's Food
Law and Policy Clinic. The Food Law and Policy Clinic works with nonprofit
organizations and government agencies to recommend food laws and policies
aimed at increasing access to healthy foods, reducing obesity and diet-related
disease, and assisting small farmers and producers in participating in food markets. Emily supervises Harvard Law students engaged in these projects and co
-teaches (with Clinical Professor Robert Greenwald) a course entitled “Food: A Health Law and Policy Seminar.” Prior to her current position, Emily served as the Joint Harvard Law School/Mississippi
State University Delta Fellow and worked with community members and outside partners to forge
programmatic and policy responses aimed at improving public health and economic opportunity in
the Mississippi Delta, with a focus on the food system. Emily received her B.A. from Columbia University in 2003 and her J.D. from Harvard Law School, cum laude, in 2008. She is a licensed member of the bar of New York.
Maggie Morgan, MA, JD
Clinical Fellow
Harvard Law School Center for Health Law and Policy Innovation
Maggie Morgan is a Clinical Fellow at the Center for Health Law and Policy Innovation at Harvard Law School, where she works on national and state-based
health law and policy initiatives to increase access to care for low-income Americans suffering from diabetes, HIV and other chronic conditions. Currently, Maggie serves as the project lead for the BMS-sponsored PATHS project in North
Carolina, and is also working on projects involving HIV policy in Louisiana, and
immigrant and global health. In addition to her independent work, Maggie supervises Harvard Law students working on these projects. Prior to her work with
the Center, Maggie clerked for the Honorable Nanette K. Laughrey in the Western District of Missouri. She received her A.B. from Harvard College in 2004, her M.A. in International Relations from
the University of Chicago in 2007, and her J.D. from Harvard Law School in 2011. She is licensed to
practice law in the state of New York.
18
Rapid Cycle Quality Improvement Workshop Lead
George Rust, MD, MPH
Director, National Center for Primary Care
Morehouse School of Medicine
Dr. George Rust is a Professor of Family Medicine and Director of the National
Center for Primary Care at Morehouse School of Medicine. He has dedicated
his career as a family practice physician to improving healthcare access, quality,
and outcomes for low-income and uninsured segments of the population. He is
a graduate of Loyola University School of Medicine, and completed family medicine residency training at Cook County Hospital in Chicago, and a Master’s of
Public Health degree from University of Illinois -Chicago. He then worked with
farm workers and other low-income populations for six years as Medical Director of the West Orange
Farm-workers’ Health Association in Apopka, Florida.
Since 1991, Dr. Rust has been a physician, teacher, researcher, and leader at the Morehouse School
of Medicine. He is board-certified in both Family Practice and Preventive Medicine, and is a Profesor
of Family Medicine with a joint faculty appointment in the Dept. of Community Health and Preventive
Medicine. Dr. Rust led the development of the National Center for Primary Care at Morehouse School
of Medicine. He is also the founding director of the Morehouse Faculty Development program.
Over the past two decades, he has built bridges between the academic arena and the front lines of
primary care by developing training programs and health quality-outcomes research partnerships between Morehouse School of Medicine and networks of community and migrant health centers. Dr.
Rust is board chair of the At-lanta Community Access Coalition and co-chair of Georgia’s Minority
Health Advisory Council, where he played a key role in development of the Georgia Health Disparities
Report in 2008. He also received the 2007 national leadership award from the Disease Management
Association of America (DMAA), and the 2009 ACT award from the Georgia Asian Pacific Islander
Community Coalition (GAAPICC). Dr. Rust is the author of over 50 peer-reviewed publications related
to primary care, health disparities, and underserved populations.
19
Evaluation Workshop Description
Participatory Evaluation of the Together on Diabetes Initiative: Overview and Early Lessons
Skill Building Morning Workshop– Participatory Evaluation Training
A. Population Health Learning Collaborative
Trillum Boardroom
B. Innovative Interventions Learning Collaborative
Basswood Room
Skill Building Afternoon Workshop– Participatory Evaluation Training
A. African American Women’s Collaborative
Trillium Boardroom
B. Open Evaluation Session
Basswood Room
Workshop Lead, Population Health Learning Collaborative: Jerry Schultz, Work Group for Community Health
and Development, University of Kansas
Workshop Lead, Innovative Interventions Learning Collaborative: Vicki Collie-Akers, Work Group for Community
Health and Development, University of Kansas
Workshop Lead, African American Women Learning Collaborative: Steve Fawcett and Kaston AndersonCarpenter, Work Group for Community Health and Development, University of Kansas
Workshop Lead, African American Women Learning Collaborative: Steve Fawcett, Work Group for Community
Health and Development, University of Kansas
The Together on Diabetes™ initiative is using a participatory evaluation approach to help understand what is
being accomplished—by individual projects and the overall Together on Diabetes initiative—and to improve our
efforts. An online monitoring and evaluation system provides real-time information about project activities, progress on intended outcomes and factors that may be facilitating or constraining our efforts. This workshop offers
an introduction to the monitoring and evaluation approach as well as the online documentation and support system (ODSS) used to gather and make sense of information about accomplishments.
This workshop will provide training in using the monitoring and evaluation system. Grantees will learn to document and characterize their Together on Diabetes™ activities and accomplishments such as services provided,
advocacy efforts, and other important grantee activities and outcomes. Information entered into the ODSS will
be readily available in a dashboard of data displays for key measures of success. We will also review how the
data can be used to enable systematic reflection – what we are seeing, what it means, and implications for adjustment.
The session will be enriched by guidance and lessons learned from pilot sites that already are using the participatory evaluation system. This introductory workshop will focus on how to access and navigate the ODSS, document project activities and accomplishments, and characterize the data by types of contribution. Project staff
who are responsible for documenting activities and using the information for decision making and reporting are
particularly encouraged to attend.
Presented by:
20
Policy & Advocacy Workshop Description
The Affordable Care Act in 2013: Strategies for State-Based Advocacy on Behalf of People Living
with Diabetes
Peachtree Creek Room
Workshop Leads:
Robert Greenwald, Harvard Law School Center for Health Law and Policy Innovation
Maggie Morgan, Harvard Law School Center for Health Law and Policy Innovation
Emily Broad Leib, Harvard Law School Center for Health Law and Policy Innovation
The Affordable Care Act offers the most promising opportunity in decades to strengthen access to quality preventive care and treatment for people with chronic conditions, including the approximately 26 million Americans
living with diabetes and the millions more estimated to be pre-diabetic. Several provisions in particular stand to
benefit low-income Americans with diabetes, including 1) expansion of Medicaid coverage to all persons below
138% of the federal poverty line; 2) removal of cost-sharing for recommended preventive services (including
diabetes screenings); and 3) creation of a Medicaid state benefit plan establishing health homes for people with
chronic conditions. However, as state Medicaid programs are not required to offer these benefits, there is a critical need and opportunity in 2013 for state-based policy advocacy on behalf of people with diabetes and comorbid conditions.
This workshop will address the major diabetes-related decisions which states are facing in 2013 as the Affordable Care Act is implemented, with a focus on the benefits, challenges and opportunities for policy advocacy in
the three areas described above. The workshop will first highlight the key provisions at stake, their potential
impact on people with diabetes, and the status of implementation of these measures across states. The workshop will next explore the key challenges at the state level to full implementation of these provisions. Participants will then actively participate in identifying advocacy opportunities and strategies for influencing decisionmaking in their states so that all Americans with diabetes (and other chronic conditions) can receive full access
to the care, treatment, and prevention services offered by the ACA, regardless of geography. Finally, the workshop will serve as an opportunity to update participants on the latest policy work being performed in North Carolina and New Jersey as a part of the Center for Health Law and Policy Innovation’s Together on Diabetes policy project, “Providing Access to Healthy Solutions” (PATHS).
Presented by:
21
Rapid Cycle Quality Improvement Workshop Description
Rapid Cycle Quality Improvement
Starvine Ballroom
Workshop Lead:
George Rust, Morehouse School of Medicine
Rapid-cycle improvement is a quality improvement method that identifies, implements and measures changes
made to improve a process or system. Rapid cycle improvement implies that changes are made and tested
over a short time period rather than the standard eight to twelve months. This method is import as it enables
clinical settings and population health settings to continually improve how to use health information technology,
workflow and workforce changes, and continually implementing improvements that will better serve patients,
achieve business goals, realize the benefits of health information technology, and improve the quality of services.
This workshop will provide training in utilizing the rapid cycle quality improvement method. Grantees will learn
to use the Plan-Do-Study-Act (PDSA) cycle strategy. The PDSA cycle is a rapid-cycle quality improvement
strategy that has four stages:
 Plan: Identify an opportunity to improve and plan a change or test of how something works
 Do: Carry out the plan on a small number of patients
 Study: Examine the results.
 Act: Use results to make a decision, incorporate changes into your workflow, and establish future quality
improvement plans.
Workshop leads will help grantees think through how to incorporate rapid cycle quality improvement methodology into their current Together on Diabetes™ project.
Presented by:
22
Participant List
Speakers and Summit Guests
Ann Albright
Director, Division of Diabetes Translation
Center for Disease Control and Prevention
Atlanta, GA
aga6@cdc.gov
Pedro Greer, MD
Assistant Director of Academic Affairs
Florida International University
Miami, FL
greerp@fiu.edu
Harrison Jim
Traditional Healer
Indian Health Service- Navajo Nations
Shiprock, NM
Harrison.jim@ihs.gov
Phangisile Manciya
Director of Corporate Philanthropy
Bristol-Myers Squibb Foundation
Johannesburg, South Africa
Phangisile.mtshali@bms.org
Robert E. Ratner, MD
Chief Scientific and Medical Center
American Diabetes Association
Alexandria, VA
rratner@diabetes.org
George Rust
Director, National Center for Primary Care
Morehouse School of Medicine
Atlanta, GA
grust@msm.edu
Steve Wosahla
Managing Director, Corporate Alliances and Cause Related Marketing
American Diabetes Association
Alexandria, VA
swosahla@diabetes.org
Grantees
American Academy of Family Physicians Foundation
Juana Ballesteros
Project Manager
Alivio Medical Center
Chicago, IL
jballesteros@aliviomedicalcenter.org
Edwin Fisher
Global Director, Peers for Progress
University of North Carolina at Chapel Hill
Chapel Hill, NC
edfisher@unc.edu
Lizette Martinez
Health Promoter
Alivio Medical Center
Chicago, IL
lmartinez@aliviomedicalcenter.org
Manuela McDonough
Program Manager
National Council of La Raza
Washington, DC
mmcdonough@nclr.org
Phyllis Naragon
Director, Foundation Programs
American Academy of Family Physicians Foundation
Leawood, KS
pnaragon@aafp.org
Diana Urlaub
Program Manager
American Academy of Family Physicians Foundation, Peers for
Progress (UNC Chapel Hill)
Chapel Hill, NC
diana_urlaub@unc.edu
2013 Together of Diabetes Grantee Summit
February 25-27, 2012
Atlanta, GA
Registered Participants as of February 7, 2013
23
Participant List
(by Grantee Teams)
American Association of Diabetes Educators
Laura Downes
Chief Operating Officer
AADE
Chicago, IL
ldownes@aadenet.org
Ruth Lipman
Chief Science and Practice Officer
American Association of Diabetes Educators
Chicago, IL
rlipman@aadenet.org
American Pharmacists Association Foundation
Benjamin Bluml
Vice President Research
APhA Foundation
Washington, DC
bbluml@aphanet.org
Kelly Goode
Professor
VCU School of Pharmacy
Richmond, VA
jrgoode@vcu.edu
James Kirby
Clinical Coordinator
Kroger Pharmacy
Cincinnati, OH
james.kirby@kroger.com
Lindsay Watson
Director, Applied Innovation
American Pharmacists Association Foundation
Washington, DC
lwatson@aphanet.org
Black Women’s Health Imperative
Angela Ford
Health Program Manager
Black Women's Health Imperative
Washington, DC
afford@blackwomenshealth.org
Samantha Griffin
Program Assistant
Black Women's Health Imperative
Washington, DC
sgriffin@blackwomenshealth.org
Valerie Rochester
Director of Programs
Black Women's Health Imperative
Washington, DC
vrochester@blackwomenshealth.org
Belinda Whittle
Health Ministry Coordinator
Covenant Baptist United Church of Christ
Washington, DC
Bmw6619@aol.com
The Camden (NJ) Coalition of Healthcare Providers
Nadia Ali
Project Manager, Camden Citywide Diabetes Collaborative
Camden Coalition of Healthcare Providers
Camden, NJ
nadia@camdenhealth.org
Victoria DeFiglio
Nurse Care Manager
Camden Coalition of Healthcare Providers
Camden, NJ
victoria@camdenhealth.org
Francine Grabowski
Lead Diabetes Educator
Camden Coalition of Healthcare Providers
Oaklyn, NJ
grabowski-francine@cooperhealth.edu
Andrew Katz
Program Assistant
Camden Coalition of Healthcare Providers
Camden, NJ
andrew@camdenhealth.org
Steven Kaufman
Staff Endocrinologist
Camden Coalition of Healthcare Providers
Camden, NJ
kaufman-steven@cooperhealth.edu
24
Participant List
(by Grantee Teams)
Duke University Medical Center
Lisa Davis
Senior Project Manager
Duke University
Durham, NC
lisa.p.davis@duke.edu
Ashley Dunham
Project Leader
Duke University School of Medicine
Kannapolis, NC
Ashley.Dunham@duke.edu
Michele Easterling
Nutrition Director
Durham County Health Dept. / Durham County Government
Durham, NC
measterling@durhamcountync.gov
Michelle Lyn
Division Chief
Duke University Medical Center
Durham, NC
Michelle.Lyn@duke.edu
Pamela Maxson
Research Director
Duke University/University of Michigan
Durham, NC
pm12@duke.edu
East Carolina University
Doyle Cummings
Professor, Brody School of Medicine
East Carolina University
Greenville, NC
cummingsd@ecu.edu
Bert Hambidge
Program Coordinator
East Carolina University Center for Health Disparities Research
Greenville, NC
hambidgeb@ecu.edu
Johnnie Jordan
Community Ambassador
East Carolina University Center for Health Disparities Research
Greenville, NC
dtcc@embarqmail.com
Kerry Littlewood
Assistant Professor
East Carolina University, School of Social Work
Greenville, NC
littlewoodk@ecu.edu
Feeding America
Georgina Bradshaw
Diabetes Program Coordinator
Food Bank of Corpus Christi
Corpus Christi, TX
gbradshaw@feedingamerica.org
Kathy Garrison
Program Manager
The Ohio State University
Columbus, OH
kgarrison59@gmail.com
Amy Headings
Director of Nutrition
Mid Ohio Foodbank
Grove City, OH
Kgarrison59@gmail.com
Katie Hilliard
Registered Diatitian
Food Bank of Corpus Christi
Corpus Christi, TX
khilliard@feedingamerica.org
Kimberly Prendergast
Consulting Project Manager
Feeding America
Sudbury, MA
kprendergast@feedingamerica.org
Morgan Smith
Diabetes Wellness Project Lead
Redwood Empire Food Bank
Santa Rosa, CA
morgansmith@refb.org
Elaine Waxman
VP of Research & Partnerships
Feeding America
Chicago, IL
ewaxman@feedingamerica.org
25
Participant List
(by Grantee Teams)
Harvard Law School Center for Health Law and Policy Innovation
Emily Broad-Leib
Clinical Instructor & Lecturer
Harvard Law School Center for Health Law and Policy Innovation
Boston, MA
ebroad@law.harvard.edu
Robert Greenwald
Director
Harvard Law School Center for Health Law and Policy Innovation
Jamaica Plain, MA
rgreenwa@law.harvard.edu
Maggie Morgan
Clinical Fellow
Harvard Law School Center for Health Law and Policy Innovation
Boston, MA
mmorgan@law.harvard.edu
Johns Hopkins Center for American Indian Health
Alison Barlow
Associate Director
Johns Hopkins Center for American Indian Health
Baltimore, MD
Abarlow@jhsph.edu
Jeff Powell
Medical Officer
Johns Hopkins Center for American Indian Health
Shiprock, NM
Jeffery.powell@jhsph.edu
Raymond Reid
Study Physician
Johns Hopkins Center for American Indian Health
Shiprock, NM
rreid@jhsph.edu
Rachel Storm
Project Coordinator
Johns Hopkins Center for American Indian Health
Baltimore, MD
rstrom@jhsph.edu
Gerilene Tsosie
Shiprock Site Coordinator
Johns Hopkins Center for American Indian Health
Shiprock, NM
gtsosie@jhsph.edu
University of Kansas Work Group for Community Health and Development
Kaston Anderson-Carpenter
Graduate Research Assistant
University of Kansas
Lawrence, KS
kandersonjr@ku.edu
Vicki Collie-Akers
Assistant Research Professor
University of Kansas
Lawrence, KS
vcollie@ku.edu
Stephen Fawcett
Director
University of Kansas
Lawrence, KS
sfawcett@ku.edu
Ithar Hassaballa
Graduate Research Assistant
University of Kansas
Lawrence, KS
ithar@ku.edu
Jenna Hunter-Skidmore
Evaluation Project Manager
University of Kansas
Lawrence, KS
jmhunter@ku.edu
Jerry Schultz
Co-Director
University of Kansas
Lawrence, KS
jschultz@ku.edu
Charles Sepers
Graduate Research Assistant
University of Kansas
Lawrence, KS
csepers@ku.edu
26
Participant List
(by Grantee Teams)
Marshall University Center for Rural Health
Richard Crespo
Professor
Marshall University School of Medicine
Huntington, WV
crespo@marshall.edu
Rick Davis
Executive Director, Graham Revitalization Economic Action Team
Marshall University Center for Rural Health
Robbinsville, NC
great@email.dnet.net
Sara Davis
Coalition Member, Graham Revitalization Economic Action Team
Marshall University Center for Rural Health
Robbinsville, NC
great@email.dnet.net
Marie Graverly
Rural Health Coordinator
Marshall University Center for Rural Health
Leon, WV
graverly3@marshall.edu
Shelia Plogger
ADCTP Project Coordinator
Marshall University Center for Rural Health
Gordon, WV
splogger@marshall.edu
Patricia Thompson-Reid
Community-based Health System Specialist
Centers for Disease Control and Prevention
Atlanta, GA
pet0@cdc.gov
Eric Stockton
Health Program Manager
Appalachian Regional Commission
Washington, DC
estockton@arc.gov
Mississippi Public Health Institute
Ricky Boggan
Deputy Director
Mississippi Public Health Institute
Madison, MS
ricky.boggan@gmail.com
Stephanie Evans
Medicaid Liaison
Mississippi Public Health Institute
Madison, MA
evans.stephanie.j@gmail.com
Ellen Jones
Executive Director
Mississippi Public Health Institute
Madison, MS
elljax@aol.com
Clinton Smith
Medical Consultant
MS Public Health Institute
Madison, MS
clinton39@hotmail.com
Anna Lyn Whitt
Project Manager
MS Public Health Institute
Brandon, MS
annalyn.whitt@gmail.com
National Council on Aging
Kathy English
Director, Public Health Policy
Wellpoint
Denver, CO
Kathy.English@anthem.com
Jay Greenberg
Senior Vice President-Social Enterprise & Online Consumer Services
National Council on Aging
Washington, DC
jay.greenberg@ncoa.org
Julie Kosteas
Senior Director, HASE
National Council on Aging
Washington, DC
Julie.kosteas@ncoa.org
Valerie Lawson
Manager, Program Development
YMCA of the USA
Chicago, IL
Valerie.lawson@ymca.net
27
Participant List
(by Grantee Teams)
Kate Lorig
Professor Emeritus/Director Patient Education Research Center
Stanford University
Palo Alto, CA
lorig@stanford.edu
James Teufel
National Health Director
OASIS Institute
St. Louis, MO
jteufel@oasisnet.org
Sixteenth Street Community Health Center
Kelly Barboza
Diabetes Educator Specialist- Linkage To Care
Sixteenth Street Community Health Center
Milwaukee, WI
Kelly.barboza@sschc.org
Holly Nannis
Director, Diabetes & Asthma Programs
Sixteenth Street Community Health Center
Milwaukee, WI
holly.nannis@sschc.org
Wina Zorro
Director, Grants and Program Development
Sixteenth Street Community Health Center
Milwaukee, WI
wina.zorro@sschc.org
United Hospital Fund
David Gould
Senior Vice President for Program
United Hospital Fund
New York, NY
dgould@uhfnyc.org
Debbie Halper
Vice-President, Education and Program Initiatives
United Hospital Fund
New York, NY
dhalper@uhfnyc.org
Fern Hertzberg
Executive Director, Director of ARC Ft. Washington Senior Center
Washington Heights/Inwood Council on Aging
New York, NY
fhjefe@aol.com
Tracey Solohoff
Administrator, Isabella Home and Community Based Services
Isabella Geriatric Center
New York, NY
lberritta@uhfnyc.org
Mark Kator
President and CEO
Isabella Geriatric Center
New York, NY
mkator@isabella.org
Fredda Vladeck
Director, Aging In Place Initiative
United Hospital Fund
New York, NY
fvladeck@uhfnyc.org
United Neighborhood Health Services
Nancy Mason
Diabetes Project Director
United Neighborhood Health Services
Nashville, TN
nmason@unitedneighborhood.org
University of Virginia
Natalie May
Project Director
University of Virginia Health System
Richmond, VA
nbmay@verizon.net
Mohan Nadkarni
Professor Internal Medicine
University of Virginia
Charlottesville, VA
mmn9y@virginia.edu
Barbara Yager
Chair
Community Action on Obesity Taskforce
Charlottesville, VA
Barbara.yager@vdh.virginia.gov
28
Participant List
(by Grantee Teams)
Whittier Street Health Center
Osangie Ebekozien
Administrative Officer
Whittier Street Health Center
Roxbury, MA
osangie.ebekozien@wshc.org
Ubah Hashi
Diabetes Case Manager
Whittier Street Health Center
Roxbury, MA
Ubah.Hashi@wshc.org
Linda Hardemon
Diabetes Health Ambassador
Whittier Street Health Center
Roxbury, MA
lhardemon@comcast.net
Patrick Healy
Diabetes Specialist
Whittier Street Health Center
Roxbury, MA
patrick.healy@wshc.org
National Network of Public Health Institutes Staff
Christopher Kinabrew
Associate Director, Government and External Relations
National Network of Public Health Institutes
New Orleans, LA
ckinabrew@nnphi.org
An Nguyen
Program Manager
National Network of Public Health Institutes
New Orleans, LA
anguyen@nnphi.org
Luke Galford
Health Disparities and Equity Intern
National Network of Public Health Institutes
New Orleans, LA
lgalford@nnphi.org
Bristol-Myers Squibb
Lynn Anyaele
Pharm.D. Public Health Resident
Bristol-Myers Squibb Foundation
Plainsboro, NJ
Lynn.anyaele@bms.com
John Damonti
Vice-President
Bristol-Myers Squibb
New York, NY
John.damonti@bms.com
Patricia Doykos
Director
Bristol-Myers Squibb Foundation
Princeton, NJ
patricia.doykos@bms.com
Amy Waschenfelder
Consultant
Bristol-Myers Squibb Foundation
Princeton, NJ
Amy.waschenfelder@bms.com
29
Diabetes Report Card
2012
CS230427
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
30
Purpose of This Report
This report is required under the Catalyst to Better Diabetes Care Act of 2009, which is part of the Patient
Protection and Affordable Care Act (Section 10407 of Public Law 111-148, hereafter called the Affordable
Care Act). The act states that the report card should be published by the Centers for Disease Control
and Prevention (CDC) every 2 years and include data about diabetes and prediabetes, preventive care
practices, risk factors, quality of care, diabetes outcomes, and, to the extent possible, trend and state data.
The Diabetes Report Card 2012 uses 2010 data (the most recent data available) to present a profile of
diabetes and its complications at the national and state level. It includes information about prediabetes
awareness, diabetes outcomes, and risk factors. The estimates in this report were calculated by CDC staff
and are available in more detail at CDC’s National Diabetes Surveillance System Web site at www.cdc.gov/
diabetes/statistics.
Opportunities for Better Diabetes Prevention and Care
in the Affordable Care Act
The Affordable Care Act (the health care law of 2010) includes several provisions that directly address gaps
in diabetes prevention, screening, care, and treatment. The Catalyst to Better Diabetes Care Act of 2009,
which is included in the Affordable Care Act, directs the U.S. Department of Health and Human Services
and CDC to enhance diabetes surveillance and quality standards across the country. In addition, diabetes
is specifically targeted by provisions on administering private health insurance wellness and prevention
programs (Section 2717), Medicaid health homes for enrollees with chronic conditions (Section 2703), the
Medicaid Incentives to Prevent Chronic Disease Program (Section 4108), and the Medicare Independence
at Home demonstration program (Section 3024).
For more information on health care provisions in the Affordable Care Act, visit www.healthcare.gov.
For More Information
Division of Diabetes Translation
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Atlanta, GA
1-800-CDC-INFO (232-4636); TTY: 1-888-232-6348
cdcinfo@cdc.gov
www.cdc.gov/diabetes/pubs/pdf/DiabetesReportCard.pdf
Suggested Citation
Centers for Disease Control and Prevention. Diabetes Report Card 2012. Atlanta, GA: Centers for Disease
Control and Prevention, US Department of Health and Human Services; 2012.
31
Diabetes Overview
Diabetes is a group of diseases characterized by high blood
glucose (blood sugar). When a person has diabetes, the
body either does not produce enough insulin or is unable
to use its own insulin effectively. Glucose builds up in the
blood and causes a condition that, if not controlled, can
lead to serious health complications and even death. The
risk of death for a person with diabetes is twice the risk of a
person of similar age who does not have diabetes.
Diabetes is a major cause of heart disease and stroke. Death
rates for heart disease and the risk of stroke are about 2–4
times higher among adults with diabetes than among
those without diabetes.1 In addition, 67% of U.S. adults
who report having diabetes also report having high blood
pressure.1 For people with diabetes, high blood pressure
levels, high cholesterol levels, and smoking increase the
risk of heart disease and stroke.2 This risk can be reduced
by controlling blood pressure and cholesterol levels and
stopping smoking.
Diabetes can also lead to other complications, such as
vision loss, kidney failure, and amputations of legs or
feet. Effective glucose control, as measured by A1c levels,
and blood pressure control can prevent or delay these
complications.1
Average medical expenses are more than twice as high
for a person with diabetes as they are for a person without
diabetes. In 2007, the estimated cost of diabetes in the
United States was $174 billion. That amount included $116
billion in direct medical care costs and $58 billion in indirect
costs (from disability, productivity loss, and premature
death).1
●●
Gestational diabetes develops and is diagnosed as a
result of pregnancy in 2%–10% of pregnant women.3
Gestational diabetes can cause health problems during
pregnancy for both the child and mother. Children
whose mothers have gestational diabetes have an
increased risk of developing obesity and type 2
diabetes.4 Women who have gestational diabetes face a
higher risk of developing type 2 diabetes in the future.
Research has shown that 10–20 years after a woman
has had gestational diabetes, she has a 35%–60%
chance of developing type 2 diabetes.5
Rates for type 2 diabetes rise sharply with age for both
men and women and for members of all racial and ethnic
groups. The prevalence of diagnosed diabetes is about
seven times as high among adults aged 65 years or older
as among those aged 20–44 years. Race and ethnicity also
are risk factors for diabetes. Most minority populations in
the United States, including Hispanic Americans and nonHispanic blacks, have a higher prevalence of diabetes than
their white non-Hispanic counterparts.
Although diabetes prevalence varies widely among popu­
lations and tribes, diabetes disproportionately affects
American Indians and Alaska Natives in the United States,
with diagnosed diabetes rates more than twice as high
as the rates for non-Hispanic whites.1 Asian Americans
are at higher risk of developing type 2 diabetes, despite
having, on average, a substantially lower body mass index
when compared with non-Hispanic white counterparts.6
Diabetes develops at younger ages in racial and ethnic
minority populations, which puts minorities at higher risk of
developing complications at a younger age.7
The most common forms of diabetes are as follows:
●●
●●
Prevalence of Diagnosed Diabetes, 2007–2009
Type 1 diabetes accounts for about 5% of all
diagnosed cases of diabetes. Type 1 is usually first
diagnosed in children and young adults, although it
can occur at any time. To survive, people with type 1
diabetes use insulin from an injection or a pump. Risk
factors for type 1 diabetes can be autoimmune, genetic,
or environmental. At this time, there are no known ways
to prevent type 1 diabetes.1
U.S. Adults, by Agea
20–44 years
2.6%
45–64 years
11.7%
>65 years
18.9%
U.S. Adults Aged >20 Years, by Race and Ethnicityb,c
American Indian and Alaska Native
Type 2 diabetes accounts for about 95% of diagnosed
diabetes in adults. Several studies have shown that
healthy eating and regular physical activity, used
with medication if prescribed, can help control health
complications from type 2 diabetes or can prevent or
delay the onset of type 2 diabetes.1
Asian American
16.1%
8.4%
Hispanic
11.8%
Non-Hispanic black
12.6%
Non-Hispanic white
7.1%
National Health Interview Survey.
National Diabetes Fact Sheet, 2011.
c
Data were age adjusted. See Technical Notes for more details.
a
b
32
Incidence of Diagnosed Diabetes
Figure 1 shows diabetes incidence in the United States,
which is the number of new cases diagnosed each year.
The number of new cases of diabetes changed little from
1980 through 1990, but began increasing in 1992. From
1990 through 2010, the annual number of new cases of
diagnosed diabetes almost tripled. The rise in the incidence
of type 2 diabetes cases is associated with increases in
obesity, decreases in leisure-time physical activity, and the
aging of the U.S. population.7
Prevalence of Diagnosed Diabetes
Figure 2 shows diagnosed diabetes prevalence in the
United States, which is the total number of existing
(including newly diagnosed) cases for each year. Similar to
the incidence, the prevalence of diabetes remained fairly
constant from 1980 through 1990. However, since 1990, the
prevalence has steadily increased. Many people also have
undiagnosed diabetes and are unaware of their condition.
A 2010 CDC study projected that as many as one of three
U.S. adults could have diabetes by 2050 if current trends
continue.8 To avert this increase, the U.S. Department of
Health and Human Services (HHS) has a multipronged
strategy that encompasses population-based prevention
and individual prevention, care, and treatment.
33
Diagnosed Diabetes
Table 1 presents the percentages of U.S. adults who report
that they have ever been told that they have diabetes,
by state. Data for people with undiagnosed diabetes are
not included. The estimates in Table 1 are based on data
from CDC’s Behavioral Risk Factor Surveillance System
(BRFSS). The BRFSS is an ongoing, state-based, household
telephone survey of the U.S. population aged 18 years or
older. Estimates range from 5.8% in Vermont to 11.3% in
Mississippi.
For Figure 3, CDC used data from the BRFSS and the U.S.
Census Bureau to develop model-based county estimates
of adults with diagnosed diabetes. County-level estimates
allow community leaders and health care providers to
identify local areas that would benefit most from diabetes
prevention and control efforts.
Figure 3 shows the distribution of diagnosed diabetes
across the United States, with percentages generally
higher in the Southeast. CDC used these data to define
a geographic area, called the diabetes belt, where the
prevalence of diagnosed diabetes is especially high. This
area includes 644 counties in 15 states.9
Table 1. Percentage of U.S. Adults with Diagnosed
Diabetes, by State, 2010
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Percentage (%)
11.1
6.3
8.1
9.2
8.9
6.0
6.4
7.7
8.0
8.7
9.8
7.8
7.7
8.2
9.1
6.9
8.0
10.1
10.3
7.4
8.9
7.2
9.2
6.2
11.3
8.0
6.2
7.1
8.1
7.0
8.3
8.1
8.4
9.3
6.9
9.4
10.1
7.2
8.7
6.8
9.9
6.4
10.2
9.8
7.1
5.8
8.1
7.4
10.7
7.1
6.6
Data were age adjusted. See Technical Notes for more details.
Source: National Diabetes Surveillance System, Behavioral Risk Factor
Surveillance System data.
34
Prediabetes: A Risk Factor
for Type 2 Diabetes
People with prediabetes have blood glucose levels that are
higher than normal, but not high enough to be diagnosed
as diabetes. Unfortunately, prediabetes can put people at
increased risk of developing type 2 diabetes, heart disease,
and stroke.
Although about 33% of U.S. adults have prediabetes,10,11
awareness of this risk condition is low. Less than 10% of U.S.
adults with prediabetes report that they have ever been
told that they have prediabetes.11
Table 2 presents estimates of the percentage of U.S. adults
who reported ever being told by a doctor that they have
prediabetes. Data for adults with prediabetes who have
never been tested for diabetes or who have not been told
that they are at risk of developing type 2 diabetes are
not included. State estimates of prediabetes awareness
range from 4.4% in Vermont to 10.2% in Tennessee. These
estimates are consistent with analyses of national data that
suggest awareness of prediabetes is low.
Progression to type 2 diabetes among those with
prediabetes is not inevitable. Studies have shown that
people with prediabetes can prevent or delay the onset of
type 2 diabetes by losing 5%–7% of their body weight and
getting at least 150 minutes per week of moderate physical
activity.12
Because awareness of prediabetes is low, we anticipate that
the percentage of people who are aware that they have
prediabetes will rise as diabetes prevention efforts progress.
Table 2. Percentages of U.S. Adults Who Have Ever
Been Told They Have Prediabetes, by State, 2010
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Percentage (%)
7.0
7.0
6.2
NA
8.0
5.7
5.3
6.1
5.5
6.4
5.7
7.5
7.3
5.5
6.2
5.4
6.1
7.2
6.1
6.5
NA
4.8
6.3
6.6
6.7
NA
4.7
5.4
NA
6.8
NA
5.7
5.5
6.1
NA
5.3
6.5
6.1
5.9
NA
6.6
5.2
10.2
6.4
5.1
4.4
5.7
NA
6.1
6.2
4.8
NA = not available.
Data were age adjusted. See Technical Notes for more details.
Source: National Diabetes Surveillance System, Behavioral Risk Factor
Surveillance System data.
35
Preventive Care Practices and Quality of Care
Diabetes complications are debilitating, costly, and
sometimes deadly. Diabetes complications tend to be more
common or more severe among people whose diabetes
is poorly controlled. Diabetes control, achieved through
diabetes care and management and clinical preventive
care practices, keeps people with diabetes healthy and can
improve health outcomes.
Preventive care practices are essential to diabetes
care. Figure 4 shows the percentage of U.S. adults with
diagnosed diabetes who received some of the preventive
care practices recommended for them during the survey
period of 2009–2010. Examples include annual eye exams,
annual foot exams, and daily monitoring of blood glucose.
Several of the national health objectives in Healthy People
2020 call for increasing the percentage of people with
diabetes who are practicing these recommendations.
Table 3 (see next page) presents state-level percentages
of U.S. adults with diabetes who report receiving the
recommended preventive care practices. State-specific
trend data for these services are available at www.cdc.gov/
diabetes/statistics/state.
36
Table 3. Percentage of U.S. Adults Aged >18 Years with Diabetes Who Report Receiving Preventive Care
Practices, by State, 2009–2010a
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Annual
Foot
Exam
Annual
Eye
Exam
A1c Checked
>2 Times
a Year
Daily SelfMonitor of
Blood Glucose
Ever Attended
Diabetes SelfManagement Class
Annual
Flu
Vaccine
71.5
71.3
68.2
NAb
64.9
73.1c
72.7
75.1
81.9
71.1
70.7
74.0
69.3d
72.8
72.9
78.0
69.0
67.5
72.1
85.8
75.8
77.8
70.7
80.9
67.7d
74.2c
73.5
74.5
60.3
80.5
67.5
74.8
75.9
75.9
78.1
70.5
69.5d
72.5
73.4
76.8c
73.0
74.9d
70.9
68.0
71.3
81.6
74.4
74.2c
67.5
77.4
64.7
66.2
58.3
67.2
NA
65.4
60.4c
69.4
71.3
74.9
68.5
67.4
68.2
61.9d
61.3
62.6
76.5
68.5
60.2
67.0
73.1
68.1
75.7
68.1
72.6
60.1d
64.6c
60.6
65.1
63.9
72.0
69.7
65.7
67.0
67.2
65.6
65.2
56.2d
61.4
67.2
76.1c
62.8
66.5d
68.6
61.5
62.2
67.2
70.9
66.3c
66.9
72.4
59.4
72.3
72.0
66.5
NA
75.8
69.0c
74.6
66.9
77.3
71.8
74.4
75.0
60.9d
70.9
68.5
78.9
70.8
73.7
71.3
78.8
75.2
74.6
70.5
73.7
72.3d
74.5c
68.3
74.3
63.0
76.7
71.5
73.3
71.4
73.0
67.2
68.0
70.2d
68.4
78.1
72.9c
73.6
73.8d
72.6
67.5
68.7
79.3
72.4
72.1c
69.7
73.5
66.0
68.5
65.9
60.4
NA
58.6
62.2c
58.1
61.4
68.8
60.1
68.9
58.0
59.3d
62.7
66.3
63.9
62.2
68.8
66.6
58.5
61.9
62.0
59.0
60.8
71.9d
60.3c
57.0
65.0
58.3
61.3
59.7
68.4
66.9
63.3
60.5
62.7
60.6d
64.5
63.2
58.7c
65.3
55.0d
73.2
62.4
61.6
60.0
60.1
63.6c
67.9
60.1
59.3
58.1
59.1
52.9
NA
59.5
68.9c
51.3
50.5
65.0
56.8
59.7
52.5
57.2d
60.2
61.7
64.3
59.8
51.7
56.0
62.6
51.2
50.3
53.0
77.1
46.0d
58.2c
63.2
62.7
55.6
63.3
43.7
60.1
40.9
56.1
58.8
56.0
60.7d
67.8
57.3
47.3c
57.1
62.3d
52.1
59.8
62.0
55.2
60.9
65.5c
44.6
59.4
57.7
52.0
62.0
50.2
57.8
51.8
61.5
58.6
57.2
54.4
47.1
50.0
69.3
58.1
49.7
55.2
63.2
55.6
54.8
52.8
66.5
57.5
66.4
55.4
71.4
50.8
61.8
61.0
64.0
48.6
65.4
52.0
63.7
57.6
58.4
63.1
51.9
59.2
54.2
62.0
62.5
50.9
67.1
55.8
54.2
62.4
68.4
58.4
59.8
59.1
62.4
54.5
Data were age-adjusted. See Technical Notes for more details.
Data not available for 2009 or 2010.
c
Only 2009 estimates available.
d
Only 2010 estimates available.
Source: National Diabetes Surveillance System, Behavioral Risk Factor Surveillance System data.
a
b
37
Trends in Diabetes Outcomes
Figures 5, 6, and 7 offer examples of trends in diabetes
complications in the United States over the past 2 decades.
Among adults with diagnosed diabetes, death rates from
hyperglycemic crisis have declined since the mid-1980s.
Diabetic hyperglycemic crises are serious health events
that can occur in people with diabetes, and they can lead
to death. Rates of lower-limb amputation (of legs or feet)
and kidney failure (end-stage renal disease) have declined
since the mid-1990s. These declines may be attributed in
part to improvements in the rates of high blood pressure,
high cholesterol, and smoking in recent decades.10 Other
possible reasons include improvements in blood glucose
control;13 early detection and management of diabetes
complications; and improvements in preventive care,
treatment, and diabetes care management.14, 15
38
CDC and HHS Respond to Diabetes
As the leading public health agency for HHS, CDC has
a unique role in preventing, controlling, and managing
diabetes. CDC provides public health leadership to translate
evidence-based science on what works into practice to
improve health outcomes for people with diabetes and
those at risk of developing type 2 diabetes. The agency also
analyzes data to measure the burden of diabetes, conducts
and funds research, works to reduce health disparities, and
creates a variety of educational resources.
that includes a personalized prevention plan at no
additional cost to beneficiaries.
●●
In its scientific and programmatic activities, CDC works to
reduce differences in health status and health care that are
based on race, ethnicity, economic status, or other factors.
The agency provides information on health disparities to
raise awareness about how diabetes care can reduce health
gaps. CDC partners with national, tribal, territorial, state,
and local organizations to support programs to prevent and
control diabetes.
In addition to CDC’s efforts, HHS works through all of its
relevant agencies and programs to fight the diabetes
epidemic by using a broad range of research, education,
and programs that strengthen the prevention, detection,
and treatment of diabetes. Efforts to address diabetes
across HHS will improve care for people living with diabetes
today and help prevent the onset of diabetes in more
Americans in the future.
●●
Supporting Diabetes Prevention
and Control
Empowering Patients with Tools and Resources
●●
Affordable Care Act and Diabetes Benefits: The
health care law expands insurance coverage, consumer
protections, and access to primary care. For example,
important preventive services are now covered with
no cost sharing in most private plans if the service is
graded A (strongly recommended) or B (recommended)
by the U.S. Preventive Services Task Force (USPSTF).
These services include type 2 diabetes screening, diet
counseling, and blood pressure screening. In addition,
immunizations recommended by the Advisory
Committee on Immunization Practices and other
recommended preventive services that are specifically
for children, youth, and women will also be covered
with no cost sharing by many private health plans.
Beginning in 2013, state Medicaid programs that
eliminate cost sharing for these clinical preventive
services may receive enhanced federal matching
funds. Medicare now covers certain preventive
services recommended by the USPSTF with no
cost sharing, as well as an annual wellness visit
Medicare and Diabetes Preventive Benefits:
Medicare covers diabetes screening tests to identify
beneficiaries with diabetes or at high risk of developing
diabetes. Medicare also covers screening for glaucoma,
which may be a comorbidity of diabetes. Other
Medicare preventive benefits (e.g., diabetes selfmanagement training, medical nutrition therapy)
support beneficiaries in self-care and in making lifestyle
changes to prevent or minimize development of the
comorbidities and complications of diabetes. These
benefits are available both to people with traditional
Medicare and those enrolled in Medicare Advantage
plans. In addition, Medicare prescription drug plans
(Part D) cover insulin and other medications that may
be needed for diabetes self-management.
Medicare Diabetes Special Needs Plans: Within
Medicare Advantage, 36 Special Needs Plans (SNPs)
focused on chronic care, known as chronic condition
SNPs (C-SNPs), are being offered in 2012 specifically
for Medicare beneficiaries with diabetes. These C-SNPs
may offer extra benefits, and they use a model of care
approved by the Centers for Medicare & Medicaid
Services (CMS) that is designed to support and improve
the health status of beneficiaries with diabetes. In
addition, regular Medicare Advantage plans may offer
supplemental benefits that go beyond those covered
by traditional Medicare.
These benefits may include the following:
➢➢Health education for all beneficiaries as a way to
prevent diabetes.
➢➢Extra self-care skills training for those with diabetes.
➢➢Focused disease management programs that
provide care coordination and in-home monitoring
to prevent development of comorbidities and
complications of diabetes.
●●
Medicare’s Everyone with Diabetes Counts Program:
The CMS developed the Everyone with Diabetes Counts
program to help Medicare beneficiaries with diabetes
who are members of vulnerable populations actively
participate in their care. Beneficiaries complete diabetes
self-management education classes that focus on basic
anatomy, healthy lifestyles, healthy nutrition choices,
and the importance of eye exams, foot exams, and
regular laboratory tests such as hemoglobin A1c and
lipid panels. Classes are taught in community locations.
To date, more than 20,000 Medicare beneficiaries have
completed classes through this program.
39
●●
Lower Extremity Amputation Prevention Program
(LEAP): This program is designed to reduce lowerextremity amputations in people with diabetes,
Hansen’s disease, or other conditions that result in loss
of protective sensation in the feet. LEAP is a five-step
program that includes annual foot screenings, patient
education, daily self-inspection, footwear selection, and
management of simple foot problems.
Montana, Nevada, New York, and Texas) are focused
on diabetes management or prevention. The target
population is Medicaid beneficiaries aged 18 years
or older with diabetes. Prevention programs and
incentives focus on demonstrating changes in health
risk and outcomes, including the adoption of healthy
behaviors.
●●
●●
●●
Chronic Disease Self-Management Program: The U.S.
Administration for Community Living, in collaboration
with CDC and CMS, directs this program, which enables
older Americans with chronic diseases, such as diabetes,
to learn how to manage their conditions and take
control of their health. State units on aging and state
health departments work with their state Medicaid
agency and local partners to increase availability and
access to these self-management tools and programs,
especially among low-income, minority, and other
underserved populations. Local partners include senior
centers, meal programs, faith-based organizations,
libraries, YMCAs, YWCAs, and senior housing programs.
Healthfinder.gov: This award-winning prevention
Web site includes tools to help people take steps to
prevent diabetes. Information is based on USPSTF
recommendations, HHS’s Dietary Guidelines for
Americans, 2010 and 2008 Physical Activity Guidelines for
Americans, and other preventive initiatives.
Investing in Opportunities to Combat Diabetes
●●
●●
➢➢Improve health outcomes for people living with
diabetes by preventing health complications
among those most at risk.
➢➢Adopt diabetes care guidelines in health care
settings.
➢➢Help state Medicaid programs monitor quality care
outcomes among people with diabetes.
➢➢Educate health care providers, public health
professionals, and the public about optimal
diabetes care and self-management.
➢➢Involve communities in diabetes prevention and
control activities.
Creating Partnerships to Combat Diabetes
●●
Innovation Awards: The Health Care Innovation
Awards announced by the CMS Innovation Center
include multiple projects that specifically target
diabetes. Examples include projects designed to
improve the care and oral health of American Indians
with diabetes on South Dakota reservations; reduce
death and disability from type 2 diabetes among
underserved and at-risk populations in the southeast
portion of North Carolina; and use community health
workers to help prevent the progression of diabetes in
underserved populations in New Mexico, Pennsylvania,
and the District of Columbia.
Other projects include implementing and testing a care
coordination and health information technology plan
to improve the health of Medicaid-eligible patients
with type 1 and type 2 diabetes in Hawaii and using
collaborative partnerships to address diabetes in a
multicultural, high-risk, high-cost population in San
Mateo County, California.
Medicaid Incentives for the Prevention of Chronic
Diseases: Seven of the ten states that have received
Medicaid Incentives for the Prevention of Chronic
Diseases grants (California, Hawaii, Minnesota,
CDC’s State-Based Diabetes Prevention and Control
Programs: In all 50 states, the District of Columbia, 6
Pacific territories/former territories, Puerto Rico, and the
U.S. Virgin Islands, CDC funding and technical assistance
for diabetes programs support activities to
National Diabetes Prevention Program: The Afford­
able Care Act established CDC’s National Diabetes
Prevention Program (National DPP), a public-private
partnership of community organizations, private
insurers, employers, health care organizations, and
government agencies working together to combat
diabetes. Through this program, people who are at
risk of developing type 2 diabetes work with a lifestyle
coach in a group setting during the year-long program.
The group classes are offered through communitybased organizations, wellness centers, and faith-based
organizations.
The inaugural partners of the National DPP were the
YMCA and UnitedHealth Group. The National DPP’s
goal is to reach 15 million people with prediabetes by
2020 to prevent them from developing type 2 diabetes
or to diagnose them in early stages to avoid long-term
health complications.
●●
National Prevention Strategy: The U.S. Surgeon
General led an effort by 17 federal departments
to develop the first-ever U.S. National Prevention
and Health Promotion Strategy, as directed by the
Affordable Care Act. The goal is to increase the number
of Americans who are healthy at every stage of life
by identifying evidenced-based recommendations
40
to prevent chronic diseases such as diabetes. The
National Prevention, Health Promotion and Public
Health Council, its Advisory Group, and private and
public partners are working together to implement
the strategy at national, state, tribal, and local levels
and to recognize the importance of engaging all
sectors of society in improving the health and wellbeing of communities. Key indicators for successful
implementation are drawn from Healthy People 2020
objectives and targets.
prevention and treatment, Diabetes Prevention and
Healthy Heart Initiative grants, and data infrastructure
improvement for the IHS.
●●
Engaging Communities to Address Diabetes
and Reduce Health Disparities
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HHS Office of Minority Health/American Diabetes
Association Partnership: The Office of Minority
Health and the American Diabetes Association are
collaborating to reduce amputations due to diabetes
in minority populations. The aim of this partnership is
to increase awareness about proper foot care and help
patients of color, who experience higher rates of lowerextremity amputations, access the care they need to
prevent amputations.
Community Transformation Grant Program: Created
by the Affordable Care Act and funded by the Prevention
and Public Health Fund, the Community Transformation
Grant program supports state and community efforts to
address chronic health conditions, including diabetes,
and to reduce chronic disease risk factors. These grants
address a range of chronic diseases (including diabetes)
and risk factors (such as obesity) and are designed to
improve health, reduce health disparities, and control
health care spending.
National Institutes of Health’s (NIH’s) We Can!
Initiative: This national initiative is designed to
give parents, caregivers, and entire communities a way
to help children aged 8–13 years maintain a healthy
weight. It provides parents and caregivers with tools,
activities, and more to help them encourage healthy
eating and increased physical activity. The We Can!
Initiative also offers organizations, community groups,
and health professionals a centralized resource to
promote a healthy weight in youth through community
outreach, partnership development, and media
activities that can be adapted to meet the needs of
diverse populations.
Indian Health Service (IHS) Special Diabetes
Program for Indians: The Special Diabetes Program
for Indians (SDPI) is a $150 million annual program that
provides grants for diabetes prevention and treatment
services to 400 IHS, tribal, and urban health programs
for Native Americans. The SDPI has three major
components: community-directed grants for diabetes
Partnerships Active in Communities to Achieve
Health Equity Program: This Office of Minority Health
program seeks to improve health outcomes among
racial and ethnic minorities through communitybased networks that adopt evidence-based disease
management and preventive health activities and
increase access to and use of preventive health care,
medical treatment, and supportive services. Several
grantees are working to improve the prevention,
detection, and management of diabetes.
Conducting Diabetes Research
Investing in Research to Better
Understand Diabetes
●●
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NIH Diabetes Research: NIH is the primary source
of federal support for diabetes research. The National
Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK) is the lead NIH component for supporting
diabetes research. Diabetes research funded by NIH is
supported by regularly appropriated funds that HHS
receives through the Subcommittee on Labor-HHSEducation Appropriations. It is also supported by the
Special Statutory Funding Program for Type 1 Diabetes
Research, which is a special appropriation to the
Secretary of HHS to pursue research on type 1 diabetes
and its complications. Total NIH funding for diabetes
research is approximately $1 billion.
CDC Diabetes Prevention and Control Research: CDC
studies trends in diabetes, related health outcomes, and
new developments in treatment and prevention. CDC’s
research also plays an important role in determining
which programs are most effective in preventing and
controlling diabetes and which are cost effective or can
even save money. Research findings are used by CDC,
state, territorial, local, and tribal public health programs
and a variety of health care system partners to prioritize
diabetes prevention and control interventions.
CDC’s research in this area includes the SEARCH for
Diabetes in Youth Study (SEARCH) and the Natural
Experiments for Translation in Diabetes (NEXT-D) Study.
SEARCH is a national, multicenter study that is the most
complete examination of diabetes, both type 1 and
type 2, in children and young adults ever conducted
in the United States.16 The NEXT-D Study is a national,
multicenter study that uses an observational approach
to examine which policy changes initiated by health
care systems, business and community organizations,
and legislatures are improving the health of people
41
with diabetes. The research approach is unique, and the
results will help researchers identify which health policy
initiatives and actions are working.17
●●
NIH’s Diabetes Prevention Program (DPP): The results
of this clinical research study, which were published in
2002, contributed to a better understanding of how
type 2 diabetes develops in people at risk and how
they can prevent or delay the development of diabetes
by making behavioral changes that lead to weight
loss. The positive effects of the DPP continue as new
research—building on the study’s results—seeks the
most effective ways to prevent, delay, or even reverse
diabetes. This research provided evidence for programs
being implemented through CDC’s National Diabetes
Prevention Program.
Measuring the Public Health Impact
Tracking Progress
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Mapping the Country
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Providing Management and Support
Educating the Nation About Diabetes
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National Diabetes Information Clearinghouse
(NDIC): The NDIC is a service of NIDDK. Established in
1978, the NDIC provides information about diabetes
to people with diabetes, their families, health care
professionals, and the public. It answers inquiries,
develops and distributes publications, and works
closely with professional and patient organizations
and government agencies to coordinate resources on
diabetes.
National Diabetes Education Program (NDEP): The
NDEP is jointly sponsored by CDC and NIH. It develops
and provides educational tool kits and multimedia
resources for a variety of audiences, including health
care professionals and diabetes educators. It has more
than 200 federal, state, and local partners that work
together to improve the treatment and outcomes for
people with diabetes, promote early diagnosis, and
prevent or delay the onset of type 2 diabetes. Program
audiences include those with and at risk of diabetes,
health care professionals, and employers.
Healthy People 2020: This national health agenda is
tracking progress toward meeting several diabetesrelated objectives during this decade. The overall goal is
to reduce the disease and economic burden of diabetes
and improve the quality of life for all people who have
or are at risk of diabetes.
National Diabetes Surveillance System: Through
this system, CDC analyzes national trends and provides
state and county data. Public health professionals and
communities can use these data to focus their diabetes
prevention and control efforts on areas of greatest
need. CDC connects state and local health departments
across the United States by monitoring disease patterns
and sharing information that improves state responses
to diabetes.
Reducing Disparities and Tracking Quality
●●
National Healthcare Disparities Report and National
Healthcare Quality Report: These reports from the
Agency for Healthcare Research and Quality track the
health care system through quality measures such
as the percentage of U.S. adults receiving care for
diabetes. For example, the 2011 National Healthcare
Quality Report showed that only one of five adults with
diabetes in 2008 had received all four recommended
services (foot exam, dilated eye exam, flu shot, and two
hemoglobin A1c tests) within the calendar year.
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Technical Notes
Diabetes data presented in this report card are from the
U.S. Census Bureau and various CDC surveys and data
collection systems, including the National Health Interview
Survey, the National Hospital Discharge Survey, the
Behavioral Risk Factor Surveillance System (BRFSS), and the
National Vital Statistics System. CDC staff members used
data from these original sources to calculate the estimates
presented in this report. Many of these data appear in
greater detail on CDC’s National Diabetes Surveillance
System Web site at www.cdc.gov/diabetes/statistics.
To make meaningful comparisons between states and over
time, we used the 2000 U.S. standard population to age
adjust our estimated rates. Age adjustment is a statistical
process applied to rates of diseases, injuries, and health
outcomes. It allows comparisons between communities
with different age structures because it proportions rates
to a standard age structure. Three-year moving averages
are sometimes used to improve the precision of estimates.
State estimates in this report card are based on BRFSS data.
Because of the limitations of self-reported data in surveys,
these estimates may underreport the rates of diagnosed
diabetes and prediabetes in the U.S. population.
For more information about the methods used to produce
the estimates in this report, see CDC’s National Diabetes
Surveillance System Web site at www.cdc.gov/diabetes/
statistics.
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CDC Diabetes Web Resources
Diabetes Public Health Resource
www.cdc.gov/diabetes
Provides information to consumers, health organizations,
communities, health professionals, and researchers about
CDC programs, training opportunities, videos, publications,
research, data, and statistics.
Data and Statistics
National Diabetes Fact Sheet, 2011
www.cdc.gov/diabetes/pubs/factsheet11.htm
Prepared in collaboration with several agencies in the
HHS, as well as with other federal agencies, the American
Association of Diabetes Educators, the American
Diabetes Association, and the Juvenile Diabetes Research
Foundation International.
National Diabetes Surveillance System
www.cdc.gov/diabetes/statistics
This interactive Web site provides national and state
information about diabetes and its complications. Users can
choose a variety of customized views.
●●
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State Surveillance Data
www.cdc.gov/diabetes/statistics/state
Allows users to view profiles of diabetes preventive care
practices and other trends by state.
Diabetes Data and Trends
www.cdc.gov/diabetes/statistics
Allows users to view national or state maps of countylevel estimates of diagnosed diabetes.
Populations Especially Affected by Diabetes
www.cdc.gov/diabetes/consumer/groups.htm
Information on how diabetes affects certain populations,
including specific racial and ethnic groups, and information
about gestational diabetes.
Healthy People 2020 Summary of Objectives: Diabetes
www.healthypeople.gov/2020/topicsobjectives2020/pdfs/
Diabetes.pdf
Healthy People 2020 provides science-based, 10-year
national objectives for improving the health of all
Americans. This link provides a list of objectives designed to
improve the health of people with diabetes.
CDC Diabetes Programs
CDC Funding Information and Profiles
www.cdc.gov/about/business/state_funding.htm
Information on CDC funding for state and local health
departments, universities, and other public and private
agencies for a variety of public health programs, including
diabetes programs.
CDC Community Transformation Grants
www.cdc.gov/communitytransformation
The Community Transformation Grants program will
support community efforts to reduce chronic diseases such
as heart disease, cancer, stroke, and diabetes. By promoting
healthy lifestyles, especially among population groups
with the highest rates of chronic disease, these grants will
help improve health, reduce health disparities, and control
health care spending.
National Diabetes Education Program
www.yourdiabetesinfo.org
The National Diabetes Education Program is a partnership
between CDC and the National Institutes of Health. This
Web site provides tools and publications in a range of
languages for people who have diabetes, those who care
for people with diabetes, and those at risk for the disease,
as well as for public health practitioners, community health
workers, and health care professionals.
National Diabetes Prevention Program
www.cdc.gov/diabetes/prevention
A public-private partnership of community organizations,
private insurers, employers, health care organizations, and
governments working together to build a network that
supports the development of evidence-based lifestyle
interventions for people with prediabetes.
Native Diabetes Wellness Program
www.cdc.gov/diabetes/projects/diabetes-wellness.htm
The Native Diabetes Wellness Program helps American
Indian and Alaska Native communities develop effective
strategies for diabetes care and prevention. The Web site
features the Eagle Books, a series of children’s books for
Native American children and others interested in healthy
living. The books promote ways to prevent type 2 diabetes,
such as by being more physically active and eating healthy
foods.
Chronic Kidney Disease Initiative
www.cdc.gov/diabetes/projects/kidney/index.htm
This Web site provides information on activities and data
related to chronic kidney disease from the National Chronic
Kidney Disease Surveillance System.
Vision Health Initiative
www.cdc.gov/visionhealth
This Web site provides the State Data Tool, which is an
interactive map of vision and eye health statistics by state.
States that used the Behavioral Risk Factor Surveillance
System’s vision module can produce reports on vision, eye
health, and eye care.
44
References
1. Centers for Disease Control and Prevention. National Diabetes
Fact Sheet, 2011. Atlanta, GA: Centers for Disease Control and
Prevention, US Department of Health and Human Services;
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pdf. Accessed April 16, 2012.
2. Imperatore G, Cadwell BL, Geiss LS, Saaddine JB, Williams
DE, Ford ES. Thirty-year trends in cardiovascular risk factor
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3. Hunt KJ, Schuller KL. The increasing prevalence of diabetes in
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5. Kitzmiller JL, Dang-Kilduff L, Taslimi MM. Gestational
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type 2 diabetes in Asians versus whites: results from the
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8. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF.
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11. Geiss LS, James C, Gregg EW, Albright A, Williamson DF,
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12. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in
the incidence of type 2 diabetes with lifestyle intervention
or metformin. N Engl J Med. 2002;346(6):393-403.
13. Hoerger TJ, Gregg EW, Segal JE, Saaddine JB. Is glycemic
control improving in U.S. adults? Diabetes Care.
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14. Geiss LS, Engelgau M, Pogach L, et al. A national progress
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15. Saadine JB, Cadwell BL, Gregg EW. Improvements in diabetes
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16. Centers for Disease Control and Prevention. SEARCH for
Diabetes in Youth. Atlanta, GA: Centers for Disease Control
and Prevention, US Department of Health and Human
Services; 2011. http://www.cdc.gov/diabetes/pubs/
factsheets/search.htm. Accessed April 16, 2012.
17. Centers for Disease Control and Prevention. Natural
Experiments for Translation in Diabetes (NEXT-D) Study.
Diabetes Public Health Resource Web site. http://www.cdc.
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diabetes belt. Am J Prev Med. 2011;40(4):434-439.
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2013 Together of Diabetes Grantee Summit
February 25th-27th, 2013
“Notes to Self”
Follow Up Items
Websites to Check Out
Materials to Read or Review
Questions
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