Diabetes and Chronic Disabling Conditions

Background

West Virginia ranked ninth in the nation in diabetes prevalence according to 1991-93 data from the Behavioral Risk Factor Surveillance System (BRFSS), with an average prevalence of 5.7%, compared to 4.9% in the nation as a whole. In 1993 the state ranked second in the nation in diabetes deaths. The state mortality rate for diabetes mellitus in 1993 was 30.6 deaths per 100,000 population, 46% higher than the national rate of 20.9. Showing no sign of decline, diabetes was the seventh leading cause of death in both West Virginia and the U. S. in that year.

The Centers for Disease Control and Prevention (CDC) estimate that only about half of all persons with diabetes have actually been diagnosed. There are many people at increased risk of diabetes due to the factors of age, obesity, and sedentary lifestyle. Approximately 450,000 West Virginians are at risk for the disease.

The majority of persons with diabetes in the state have Type II or non-insulin dependent diabetes, with 5% to 10% having Type I or insulin-dependent diabetes. However, one-third of those persons with Type II now take insulin.

Complications from diabetes include blindness, kidney failure, amputations, perinatal mortality, and congenital anomalies.

The Objectives

OBJECTIVE 17.1 Reduce the most severe complications of diabetes as follows: end-stage renal disease (1.4/1,000), blindness (1.4/1,000), lower extremity amputation (4.9/1,000), perinatal mortality (2%), and major congenital malformation (4%).

UPDATE Limited baseline data are available for this objective. Estimates from the CDC for state incidence rates (new cases reported within a calendar year) of end-stage renal disease, lower extremity amputation, and blindness for 1992 and 1994 are shown in Figure 1. Aggregated data from 1992-94 BRFSS surveys estimate overall state prevalence rates (total cases reported) of 19.0 lower extremity amputations per 1,000 diabetic population and 9.0 persons on kidney dialysis per 1,000 diabetic population.

impacts seriously the quality of life with such symptoms as fatigue, blurred vision, irritability, exaggerated emotional reactions, and a lowered resistance for infection. Persons with diabetes are more likely to develop heart disease or to suffer a stroke than are nondiabetic individuals, and have a higher risk for developing hypertension.

To work with the WV Diabetes Control Program (WVDCP), West Virginia Bureau for Public Health (WVBPH), in developing a plan to control the effects of diabetes and address the objectives, the Commissioner of Public Health appointed the WV Diabetes Advisory Committee in the fall of 1991.

OBJECTIVE 17.2 Increase to at least 40% the proportion of people with chronic and disabling conditions who receive formal patient education including information about community and self-help resources as an integral part of the management of their condition.

UPDATE Data on this objective are limited to persons with diabetes. In 1993, West Virginia had 36 certified diabetes educators in 17 counties (30.9% of the state's 55 counties). By 1996, this had increased to 66 certified diabetes educators in 21 counties (38.2% of total counties). Given this rate of increase, the objective of 40% of the diabetic population having access to formal patient education by the year 2000 is expected to be achieved. Figure 2 shows the location of certified diabetes educators and registered dietitians throughout the state in 1996.

OBJECTIVE 17.3 Increase to at least 75% the proportion of worksites with 50 or more employees that have a voluntarily established policy or program for the hiring of people with disabilities.

UPDATE State baseline data are not currently available for this objective. However, data collection is scheduled to begin in the spring of 1997 through a statewide worksite survey conducted under the auspices of West Virginia University.

Meeting the Objectives

The WV Diabetes Control Program, with the 25-member WV Diabetes Advisory Committee (WVDAC), has been developing the plan by which to address the objectives. The channels that are listed in the box on the previous page will be used to target the communities. The committee includes consumers and health professionals and provides technical assistance and advice to the WVDCP and the Commissioner. The mission of the WVDAC is to "increase the quality of life for persons with diabetes in West Virginia by decreasing preventable problems resulting from diabetes." The Program Manager of the WVDCP is the contact person for plan development and implementation.

In 1993, the Diabetes Control and Complications Trial (DCCT), a 10-year study conducted by the National Institutes of Health, provided the scientific evidence that intensive therapy keeping blood sugar levels consistently as close to normal as possible delayed the onset and progression of retinopathy, nephropathy, and neuropathy. Risk reductions from 40% to 75% were experienced by Type I patients, with testing currently underway with Type II patients.

Strict control of blood sugar requires significant self-management skills. Because of this, the WVDAC identified the shortage of diabetes management specialists as a deterrent to reducing the complications of diabetes. Recommendations were made to increase the supply, distribution, and quality of certified diabetes educators; the WVDCP began support of a diabetes educators program.

In order to overcome the financial barriers to applying the methods recommended by the DCCT, i.e., supplies, equipment, and reimbursement for diabetes education, the Center for Rural Health Development, Inc. formed an independent Diabetes Coalition in August 1995. The coalition worked with the WV Legislature to help remove these barriers. West Virginia became the 6th state in the United States to enact diabetes insurance reform when Senate Bill #312 was passed in April 1996. The legislation requires most health insurance plans and health maintenance organizations to provide coverage of prescribed medications, supplies, equipment, and diabetes education to the same extent they cover the treatment of other diseases.

The Americans with Disabilities Act (ADA) passed in 1990 recommends that employers who have over 50 employees appoint one individual as the pivotal point person on addressing issues on employment barriers and complaints. The ADA was not fully implemented until 1994, and many employers are still not aware of their legal obligations. The American Diabetes Association can counsel persons with diabetes on their rights under ADA. To facilitate the adoption of ADA recommendations in West Virginia, the WV Division of Rehabilitation Services has developed a technical assistance service to provide information on the components of the ADA, as well as training, assistance, and counseling.

New legislation has also been passed to initiate new provisions for physical and vocational rehabilitation for injured workers. WV Workers' Compensation now offers services to employers to assist in the implementation of job modifications to accommodate injured workers.

Diabetes and Chronic Disabling Conditions - Meeting the Objectives

Lead Entity:
West Virginia Diabetes Control Program

Collaborating Entity:
West Virginia Diabetes Advisory Committee

Plan Coordinator:
Shawn Harris Chillag, MPH, CHES
Program Manager, WVDCP
Division of Health Promotion, WVBPH
(304) 558-0644 / FAX (304) 558-1553

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