CDC Official Says State-Level Partnerships Can Bring Education to More With Diabetes

Last month, CDC reported that the number of Americans with diabetes has passed 30 million. Despite this rise, getting people with diabetes enrolled in education programs can be challenging, putting some programs in jeopardy.

It doesn’t have to be this way, said Magon Saunders, DHSc, MS, RDN, LD, a program development consultant in CDC’s National Center for Chronic Disease Prevention and Health Promotion. Some states have figured out what she called “the secret sauce” of leveraging CDC funds to open diabetes self-management education and support (DSMES) programs and keep them running.

Saunders, who spoke Saturday at the annual meeting of the American Association of Diabetes Educators (AADE), meeting in Indianapolis, Indiana, said DSMES is a priority in 45 states because it works—evidence shows it helps bring down glycated hemoglobin (A1C), and each 1% reduction is associated with a 21% reduction in diabetes-related deaths, a 14% reduction in heart attacks, and a 37% reduction in eye and kidney damage.

Numbers like these are why HHS’ Healthy People 2020 goals call for getting 62.5% of people with diabetes into education programs, up from 58% who had ever had any contact with a DSMES program. But instead of getting more people into diabetes education, very recent trends show a fall-off in enrollment, Saunders said.

Reaching more people means overcoming transportation barriers, or scheduling classes at times that are convenient for patients, not the program operators. DSMES, she said, “is not about us. It is about the patients we see.”

By far, the biggest threat to DSMES programs is figuring out how to pay for them. “If you have a program but you’re not being reimbursed, you won’t be sustained for long,” Saunders said. By contrast, “If you have a referral champion, you won’t have room in your office.”

This is where connecting with state health departments and AADE can make the difference, she said. At the state level:

• CMS has initiatives for state health officials to pay for DSMES accreditation, using CDC funds, and to get providers to promote education.
• Medicaid coverage for DSMES has reached 37 states.
• State health officials are responsible for building referral networks to get patients into DSMES.
• Some states are training diabetes educators in proper billing techniques to make sure they are getting the right level of Medicaid reimbursement.

Reimbursement problems have so distorted the DSMES landscape that there are shortages of educators in rural areas where they are most needed. Saunders was the co-author of a CDC paper earlier this year that found 62% of rural counties lacked a diabetes education program, and counties that were low-income and largely minority were most likely to lack educators.

If the Healthy People 2020 goals are to be achieved, this is a key place to start, Saunders said. “Rural people are Americans,” she said. “They should be included.”

In states with the strongest partnerships between health officials and educators, active Diabetes Councils have a voice in the state legislature and work with AADE chapters to develop state-level action plans. These actions have increased the number of states with Medicaid reimbursement. Contact with lawmakers is extremely important, Saunders said. “If you’re not at the table you become the meat!”

Finally, she encouraged educators to find creative ways to market diabetes education. In some places, patients picking up diabetes prescriptions get a flier in the bag, or they connect with programs at the podiatrist. “If patients don’t know what to ask for, they won’t do it,” she said.