D025 Prediabetes Policy Brief PDF

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Targeting Prediabetes to Reduce the Incidence of Type 2 Diabetes in Florida

Western Governors University D025: Essentials of Advanced Nursing Roles and Interprofessional Practice August 9, 2020

2 Targeting Prediabetes to Reduce the Incidence of Type 2 Diabetes in Florida

Executive Summary There are 2 million Floridians currently suffering from diabetes (Centers for Disease Control and Prevention, 2018). The incidence of diabetes has nearly doubled in Florida over the past 20 years. Florida’s average incidence of diabetes is greater than the national average of diabetes. Currently 38% of Florida’s population is prediabetic but are unaware of it yet. That statistic does not include the 5.8 million Floridians already diagnosed with prediabetes (Florida Diabetes Advisory Council, 2019). According to the CDC, the target population affected by diabetes in Florida is primarily people over the age of 65, people who have not received a college education, and African American individuals (Centers for Disease Control and Prevention, 2018). Diabetes is a major problem for Florida. In 2012, the estimated cost of diabetes totaled $24.3 billion dollars in Florida (Florida Diabetes Advisory Council, 2019). In 2017, the total DSGI claims cost for diabetic patients in Florida was $20.7 million dollars (Florida Diabetes Advisory Council, 2019). Diabetic patients have medical expenses that are on average 2.3 times higher than those without diabetes. This not only puts a burden on Florida’s healthcare system, but also contributes to loss of quality of life for these patients (Florida Diabetes Advisory Council, 2019). This is a problem that needs to be addressed, and I think I have a new policy change to help with this problem. My proposed policy focuses on organizing free mobile health stations where people can come and have their blood pressure and blood sugar checked for free. Afterwards we can provide them with education based on their results and follow up information. We would also require that each individual tested will be included in our follow up program, and they would receive 3 follow up phone calls within a 3 month period to determine whether or not they

3 have sought treatment for their abnormal testing and how their care is going so far. This data would be compiled, and we will be able to determine how many people who have received follow up care. This intervention is intended to intervene at the level of prediabetes to therefore reduce the rate of diagnosed diabetes in Florida. It is our intention to eventually long-term see a decline in the rate of diabetes and diabetes related hospitalizations in Pinellas County. The success of early screening to detect prediabetes is supported by the American Diabetes Association and has been shown to provide major success in reducing the onset of diabetes. This would affect the residents of Pinellas County by providing a free opportunity for them to take advantage of to better be able to manage their own health. We would advertise these free mobile health stations on social media to promote awareness and hopefully engage a large portion of our community. We would utilize these health stations in 5 different locations over one week during a Monday through Friday period, hosting the station at one location per day for a total of 8 hours. If this policy intervention is successful, we will be able to reduce the overall cost of diabetes in the state of Florida. In addition to the financial benefits, we will be able to impact the quality of life for many Floridians. In 2019, one out of six Floridians with diabetes reported their mental health was not good for two or more weeks throughout the past month (Florida Diabetes Advisory Council, 2019). In 2019, more than one out of four people with diabetes reported that their physical health was not good for two or more weeks throughout the past month (Florida Diabetes Advisory Council, 2019). It is important to intervene early and help promote a better quality of life for this vulnerable population. This would require some financial assistance from the state of Florida to get this project running, however the long-term benefits would far outweigh the initial cost.

4 Context and Scope Social Determinant of Health (SDOH) in My Community 10% of Florida’s population is plagued by diabetes, and almost 38% suffer from undiagnosed prediabetes. That approximates to about 2 million people in Florida who suffer from diabetes (Centers for Disease Control and Prevention, 2018). The incidence of diabetes has nearly doubled in Florida over the past 20 years. Florida’s average incidence of diabetes is greater than the national average of diabetes, affecting older people the most. This is a major concern for Florida which has the second largest population of adults aged 65 or over in the country (Florida Diabetes Advisory Council, 2019). Three Characteristics of Target Population Affected by SDOH According to the CDC, the target population affected by diabetes in Florida is primarily people over the age of 65, people who have not received a college education, and African American individuals (Centers for Disease Control and Prevention, 2018). Identification of Appropriate Policy Maker(s) or Legislator(s) I will share this policy brief with Governor Ron Desantis who has the final say on healthcare legislation. Contact Information: The Capitol 400 South Monroe Street Tallahassee, FL 32399 850-717-9337 Can be emailed through www.flgov.com

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I will also share this policy with the Clearwater Department of Health which is an extension of the Florida Department of Health. The FDOH assists with self-education and support programs for diabetics. Contact Information: 310 N Myrtle Avenue Clearwater, FL 33755 727-469-5800 Why the SDOH Requires the Policy Maker’s Attention This deserves policy makers attention because people with diabetes are twice as likely to suffer a heart attack or stroke than those without diabetes. Individuals with diabetes have a lower overall health status than those who do not. In addition, 45% of Floridian diabetics reported in a survey that their health is fair or poor (Florida Diabetes Advisory Council, 2019). This increases the amount of hospital stays and financial burden on these patients as well as the state of Florida. Diabetes is also the seventh leading cause of death for Floridians. Current Policy or the Effect of Not Having a Current Policy Currently, the Florida Department of Health and the Bureau of Chronic Disease Prevention promotes information on prevention and management of diabetes. They promote their education with physicians in the state of Florida. Their current focus regarding diabetes is implementing interventions in healthcare systems and promoting their education in community affiliated groups that are linked to the healthcare system in some way. Within the healthcare system, they promote their education and evidence-based practices to healthcare professionals to prevent early disease, reduce risk factors, and better manage complications. They also work to

6 establish appropriate referrals at discharge to evidence-based diabetes programs. Within the community, they look to establish and strengthen connections between community support groups and clinical healthcare access. A community-based approach is intended to help diabetics at home and make sure they have the supplies and resources they need outside the hospital. Ethical Implications of Current Policy or Absence of Existing Policy The ethical implications of the current policy are centered on the wellbeing of the patient. The FDOH and Bureau are focusing their efforts on prevention, management, and minimizing complications for these patients in the hospital, but also at home. I think ethically they have a very sound foundation for healthcare promotion and promotion of wellbeing. I do think there is room for improvement, which is what I plan on focusing my policy on. One ethical implication of the current policy is that it does not focus enough attention on the patients and their selfmanagement skills. The current policy focuses mainly on working with healthcare providers; however, it is important to involve diabetic and prediabetic patients directly in their own care to promote better long-term outcomes. In addition, the current policy focuses on intervening with diabetic patients directly in hospitals and through community-based resources, however it does not directly address intervening at the level of prediabetes. I think this is an ethical disservice to prediabetics, and that more attention is warranted in that specific area.

7 Demographics Table Diabetes in

Statistics/facts

Summary of

Source for

Florida Demographic

Diabetes in Florida is

statistics/facts Diabetes is more

statistics/facts (Centers for Disease

Information

most common in

common in those

Control and

people without a high

without a high school

Prevention, 2018)

school education.

education than those who have graduated

Risk Factors

Diabetes in Florida

college. Diabetes in Florida

(Centers for Disease

affects more men than

affects more men than

Control and

women. One risk factor for

women. One risk factor for

Prevention, 2018) (Centers for Disease

diabetes is increasing

diabetes is increasing

Control and

age. One risk factor for

age. One risk factor for

Prevention, 2018) (Centers for Disease

diabetes is being

diabetes is being

Control and

overweight. Diabetes was the most

Prevention, 2018) (Hayes & Farmer, 2020)

overweight. Trends in SDOH Diabetes became the Over Recent

most expensive

expensive chronic

Year(s)

chronic health

health condition in the

condition in the nation

United States in 2017.

in 2017 costing about 327 billion dollars. The average list price

As insulin list prices

(Hayes & Farmer,

of insulin increased by

are raised it correlates

2020)

8 11% each year from

with a raise in the out

2001 to 2018. This

of pocket patient cost

drives patient costs up

for the medication.

because the insurance companies raise their prices based on the list price of the medication.

9 Policy Proposal and Implementation Plan Two Policy Alternatives to Address the SDOH 1. One alternative policy to combat the high rate of diabetes in Florida could focus on organizing free mobile health stations where people are able to come and have their blood pressure and blood sugar checked for free. Afterwards we can provide them with education based on their results and follow up information. We would also require that each individual tested will be included in our follow up program, and they would receive 3 follow up phone calls within a 3 month period to determine whether or not they have sought treatment for their abnormal testing and how their care is going so far. This data would be compiled, and we will be able to determine how many people successfully received follow up care. This intervention is intended to intervene at the level of prediabetes to therefore reduce the rate of diagnosed diabetes in Florida. We would hope to eventually long-term see a decline in the rate of diabetes and diabetes related hospitalizations in the local area where we offer health station services. The success of early screening to detect prediabetes is supported by the American Diabetes Association. A study published by the ADA in 2015 showed that early screening can provide major benefits and can reduce the onset of diabetes (Herman, et. al., 2015). 2. Another alternative policy to combat the high rate of diabetes in Florida would be to use a small group of hospitals as a test group to try out newly developed educational materials. Rather than give these materials to the physicians and nurses, we would make these educational materials in layman’s terms and give them to diabetic patients at discharge instead. These educational materials would include things that would primarily help diabetics at home, such as pharmacy discount coupons and a journal tailored to patients

10 keeping track of their daily blood sugars and insulin. We would track the progress by looking at the rate of hospitalizations related to diabetes in those specific hospitals over a three-month period. A decrease in hospitalizations related to diabetes over a three-month period would show that this intervention is successful. A study done in 2018 by the Bristol-Myers Squibb Foundation found that diabetes self-management education was able to reduce the participant’s A1C by almost 2% (Bluml, Kolb & Lipman, 2019). Preferred Policy I think the first policy option is better because it is very different than the current policy enforced within the hospital system by the FDOH and Bureau. The current policies address education within the hospital system for patients already diagnosed with diabetes. However, by using my proposed policy we can hopefully engage some prediabetics and prevent them from becoming full diabetics. Through early identification of prediabetes, we can reduce the overall rate of diabetes in Florida. Currently, almost 38% of Florida’s population has prediabetes but they are not aware of it yet (Centers for Disease Control and Prevention, 2018). This is a very large percentage of our overall population and I think it is important to address. It has been proven that early detection of diabetes can have major benefits in reducing the onset of diabetes (Herman, et. al., 2015). How the Desired Results of the New Policy will Optimize Health in Community The desired results of the proposed policy would be to identify prediabetics and intervene early enough to prevent them from becoming actual diabetic patients. By doing this, we can reduce the overall rate of diabetes in Florida and promote healthier lifestyles. Currently, Florida holds 10% of the nation’s diabetics, and almost 38% of Florida’s population has prediabetes and is unaware of it (Centers for Disease Control and Prevention, 2018). The high number of

11 diabetics in Florida contributes to elevated medical costs, increased hospitalizations due to diabetes, and the seventh leading cause of death in the state (Florida Diabetes Advisory Council, 2019). Diabetes is also a major risk factor for stroke, cardiac failure, and kidney failure. By identifying prediabetic patients early and intervening to help them prevent the onset of diabetes, this policy can help to reduce the overall incidence of diabetes in the state. If we were able to achieve a downward trend in newly diagnosed diabetic patients, we would be able to reduce the amount of diabetes related hospitalizations. Financial Costs and Benefits of Proposed Policy Alternative In 2012, the estimated cost of diabetes totaled $24.3 billion dollars in Florida. In 2017, the total DSGI claims cost for diabetic patients in Florida was 20.7 million dollars (Florida Diabetes Advisory Council, 2019). Diabetic patients have medical expenses that are on average 2.3 times higher than those without diabetes. This not only puts a burden on the healthcare system, but also contributes to loss of quality of life for these patients (Florida Diabetes Advisory Council, 2019). It is estimated that there are over 5.8 million Floridians with prediabetes. The Florida Department of Health supports prevention based educational programs for diabetes with evidenced based research showing that early intervention can prevent the development in type 2 diabetics for high risk patients (Florida Diabetes Advisory Council, 2019). The Florida Department of Health conducted a project that focused on weight reduction in prediabetic patients. The results of this study found that participants who followed the program showed progress with their weight loss and therefore reduced their risk of developing type 2 diabetes by 58-71% depending on the age group (Florida Diabetes Advisory Council, 2019). This evidence proves that prevention-based programs for diabetes has a direct effect in reducing the number of newly diagnosed diabetic patients. My proposed policy would include hiring nurses and other

12 secretarial personnel to help with the flow of patients and registration. It would also include the cost of the tent, supplies used, cost of renting a space or parking lot to set up the temporary tent. It would be costly to set up this prevention policy program, however I think in the long run we will see a decrease in the overall cost of diabetes for Florida because we will be reducing the amount of newly diagnosed diabetic patients. By reducing the amount of newly diagnosed diabetic patients in Florida, we will be able to decrease the overall cost of diabetes related hospitalizations. Two Ethical Implications of Proposed Policy Alternative One ethical implication of the proposed policy would be positive in that it is a direct intervention at the level of prediabetes, whereas the current policy mainly focuses on intervening once patients have already been diagnosed as diabetic. By intervening at the prediabetic level, we can hopefully prevent patients from becoming diabetic and alleviate them from future pain, suffering, and healthcare debt. I think since Florida’s currently policies regarding diabetes focus on patients once they are already diabetic, that it is our duty as healthcare workers to provide an outlet for prediabetics to receive treatment before their condition progresses. Another ethical implication would be positive in the sense that we are focusing and allocating resources towards promoting a better quality of life for people. It has been shown that dealing with the chronic illness of diabetes reduces the overall physical and mental health for people. In 2019, one out of six people with diabetes reported their mental health was not good for two or more weeks throughout the past month. In 2019, more than one out of four people with diabetes reported that their physical health was not good for two or more weeks throughout the past month (Florida Diabetes Advisory Council, 2019). It is important to intervene early and help promote a better quality of life for this vulnerable population.

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Barriers to Implementation of Proposed Policy Alternative A potential barrier to the implementation of my policy would be funding. We would need to file for a grant from the Florida Department of Health or the CDC. Another potential barrier to the implementation of my policy would be finding people to participate in the study. Plenty of people would probably come for free testing, however it might be a challenge to gain full participation in the follow up phone calls to collect important data. Another potential barrier would be finding appropriate places to set up the tent for an 8-hour period. It would be ideal to find places that are free to set up at or would be willing to donate their land for a short period of time, such as churches. Communication Methods used to Introduce the Proposed Policy I plan on sharing this policy with Governor Desantis and the Clearwater Department of Health. I plan to initially introduce the policy with an email to the Governor and to the Clearwater Department of Health. The email will include a summary of the proposed policy, including the cost of the expenditure and why the long-term benefits will outweigh the cost. I will include supporting evidence showing that prevention programs have been shown to have a significant impact on the rate of newly diagnosed type 2 diabetic patients. In addition to email, I would also submit the same information in a paper copy to each location. I will deli...