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Arkansas Residents Learn How to Manage Diabetes Through Innovative State Program.

Business Editors/Health/Medical Writers

LITTLE ROCK, Ark.--(BUSINESS WIRE)--Aug. 27, 2003

Arkansans with diabetes are learning how to control their disease instead of being controlled by it.

Diabetes education is now available from an ever-expanding network of diabetes education centers opening all over Arkansas as part of the state's Diabetes Disease Management Program.

These centers will teach thousands of Arkansas residents to make better lifestyle choices to keep their diabetes under control. A select group of 212 Medicaid enrollees educated by the centers is being studied to determine if the education will lead to lower Medicaid costs for the state.

Overall, about 235,000 Arkansans have diabetes, and as many as one-third do not know they have the disease. In addition, more than 800,000 Arkansans have risk factors for diabetes.

The state's multi-faceted diabetes disease management program was developed through a partnership with Arkansas Department of Human Services, Eli Lilly and Company (Lilly), Control Diabetes Services (CDS, a wholly owned subsidiary of Lilly), Arkansas Department of Health Diabetes Prevention and Control Program, Arkansas Foundation for Medical Care, Health Information Design, Arkansas Diabetes Association, Arkansas Minority Health Commission and University of Arkansas for Medical Sciences.

The Department of Human Services Medicaid program alone spends nearly $86 million annually on the direct medical costs of patients with a primary or secondary diagnosis of diabetes. The state believes it can reduce costs by educating people with diabetes on how to keep their disease under control and encouraging them to seek medical help before hospitalization is required.

"From a payer's perspective, this is an opportunity to impact the rising cost of Medicaid," said Kurt Knickrehm, Department of Human Services director. "If we can give Arkansans the tools to manage their disease, they can maintain a better quality of life and at less cost to the state budget."

This education is done in classrooms as well as in one-on-one meetings between nurse educators and patients.

Many factors should be considered in enhancing quality of life and educating people with diabetes, according to baseline data from the 212 Medicaid patients. Not only do the patients suffer from diabetes, but they have a number of other health conditions that contribute to the disease.

This first cut of the data shows:

-- Depression - Sixty-eight percent screened positive for

depression, which may make patients less likely to follow a

diet and medication regimen.

-- Hypertension - Seventy percent are above the recommended

guidelines for people who have diabetes. Heart disease is the

leading cause of diabetes-related deaths.

-- Dental health - Sixty-nine percent never or rarely visit a

dentist. Good dental hygiene is important to be able to

consume some of the healthy foods on a diabetic diet.

-- Microalbuminuria - Twenty-seven percent screened positive on

this measurement for kidney disease. Diabetes and kidney

disease also are linked.

-- HbA1c: The average was 8.01 while the range was 4.9 to 16.7.

(Four to six is average for the non-diabetic population.)

HbA1c, which is a measure of the average blood sugar level

during the past six to eight weeks, is the standard clinical

criteria for monitoring changes in patients with diabetes.

With proper nutrition and care, patients may be able to lower

this number and thus experience fewer complications.

-- Obesity: Eighty-one percent have a body mass index of 30 or

greater, indicating a significant weight problem. Obesity has

been linked with a number of diseases, including heart disease

and diabetes.

-- Quality of life: People with diabetes scored significantly

lower in all eight areas of the standard QOL SF-36 test that

rates a person's well-being. A low quality of life has been

associated with poor health outcomes.

High blood sugar also has a major impact on the health of these individuals, the data shows. Ninety-four percent of the Medicaid patients enrolled in the program who sought treatment at the hospital were treated for high blood sugar, while 87 percent of the emergency department visits for these patients have been because of the same cause.

"Arkansans with diabetes face a variety of other health issues," said Gov. Mike Huckabee. "In most cases, getting the diabetes under control will improve their overall health. That's why we're putting an emphasis on this program. Education will enable us to improve the health of Arkansans by minimizing the effects of other diseases associated with diabetes."

The first step in the Arkansas Diabetes Disease Management Program - Phase I - consisted of locating the 212 Medicaid patients (58 percent Caucasian, 41 percent African-American), who were randomly selected to undergo education through an experienced American Diabetes Association-approved organization. They were asked to attend diabetes education classes covering such diverse topics as medications, the importance of exercise, stress, nutrition and how and when to talk to your doctor. They also were given personalized meal plans and glucose meters to help them monitor their glucose levels.

The Medicaid patients enrolled in the study have completed their education and now are coming in for mid-year visits. Screenings will be performed to learn if their control over their diabetes has improved. They also will come in for year-end visits, with additional health data analyzed to see if they are keeping the diabetes under control. In addition, the researchers will study Medicaid data to compare the patients' health care costs one year prior to the education and one year after.

Phase II of the program, which also is under way, consists of the establishment of additional American Diabetes Association recognized Diabetes Self-Management Education Centers throughout the state to service Arkansas' diabetic population. The new centers are located in counties with the highest number of patients suffering from diabetes and where education centers currently do not exist. Many are in the eastern, southeastern and southern counties of the Mississippi Delta, where diabetes causes extremely high rates of blindness and amputation. These centers are open to anyone wanting to learn how to control their diabetes.

Also in Phase II, the regional sites will work with adjoining counties to develop similar programs.

"We are doing a lot of teaching and offering them the basic tools. Many are learning about the importance of limiting their carbohydrates. They also are learning about the importance of testing and doing something about it," said Claire Borroho, a registered nurse from St. Vincent's Hospital in Little Rock. "Many have called us with questions. They also call in to check class schedules, because they don't want to miss any."

In Phase III, targeted outreach through the established county education centers will reach sub-populations with a higher incidence of diabetes.

"This has been a very exciting process. We already can tell that we are helping people live healthier lives, and that is extremely rewarding to us. One woman called CDS and told them that they saved her life. We believe that we are providing answers that matter for the residents of Arkansas," said Josh Smiley, director of Lilly's Public Health Sector division. "The program is changing people's lives for the better."

One woman told CDS she had been praying for a program like this. "I just really needed a coach," the Arkansan said to program coordinators.

Ashley Herring, R.N., Baptist Medical Center in Heber Springs, said people in her classes have said they needed the information 10 years ago. Some are seeing improvement during their time in the class. "We teach a lot of diabetes self-management skills. ... We want them to feel in control instead of diabetes controlling them."

Control is available through education, because the individuals can learn how to keep their glucose levels as close as possible to the normal range. This, in turn, affects their health in many ways.

For example, the Diabetes Control and Complications Trial found that when glucose was kept within that normal range:

-- Risk of eye disease was reduced by 76 percent.

-- Risk of nerve disease decreased by 60 percent.

-- Risk of kidney disease decreased by 56 percent.

Although financial data is not yet available, diabetes education programs do have a history of saving money. According to a study reported in the Journal of Clinical Endocrinology and Metabolism, a disease management program saved $50 per month for each participant and reduced hospitalizations by 18 percent.

"As an agency serving more than one million Arkansans annually, you realize that you cannot do it successfully alone," Knickrehm said. "We rely on the public and private partnerships to create an infrastructure that will provide a lasting impact on our clients."

Diabetes is impacting state budgets across the country. According to an ADA study, the nation spends $13,243 annually on each person with diabetes, compared to $2,560 per person for those without diabetes. After adjusting for differences in age, sex and race/ethnicity between people with and without diabetes, the study found that people with diabetes incur medical expenses that are 2.4 times higher.

Overall, the direct medical cost of diabetes is escalating, increasing from $44 billion in 1997 to $91.8 billion in 2002.

"Obviously diabetes takes its financial toll. But the human element is so important. If left untreated, diabetes can lead to life-threatening complications, including heart disease, stroke, high blood pressure, blindness, kidney disease and amputations," Knickrehm said.

The Arkansas Department of Human Services serves more than 1 million people annually and oversees a budget of $3 billion. For more information, visit www.state.ar.us/dhs.
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