By Krista White (JD ’16)
North Carolina has the 13th highest diabetes prevalence in the United States, and if current trends continue, diabetes is on track to cost the state $17 billion by 2025. Together with committed advocates from every sector in North Carolina, the Center for Health Law and Policy Innovation (CHLPI) at Harvard Law School hopes to reverse the diabetes epidemic. To that end, CHLPI released a report in May 2014 entitled The Diabetes Epidemic in North Carolina: Policies for Moving Forward. The report was part of the Providing Access to Healthy Solutions (PATHS) project, funded by Bristol Myers Squibb Foundation. The recommendations in the report included increasing access to needed services for people with diabetes, including the Diabetes Prevention Program (DPP) and diabetes self-management education (DSME).
Responding to recommendations from CHLPI and concerns from decision makers throughout the state, the NC Diabetes Advisory Council (DAC) convened on October 3rd, 2014 to form DPP and DSME workgroups. These groups were tasked with drafting and implementing Action Plans to improve access to both the DPP and DSME in the state. I was fortunate to be able to attend the DAC meeting in Raleigh, North Carolina, along with CHLPI clinical instructor Sarah Downer and fellow clinical student Anup Myneni. Hosted at the NC Division of Public Health (DPH), the meeting convened a wide range of stakeholders in the diabetes community. Attendees hailed from all parts of the state, from groups including universities, hospitals, community organizations, health care organizations, and nonprofits.
Workgroups were presented with draft Action Plans developed by the Diabetes Advisory Council and the Community and Clinical Connections for Prevention and Health (CCCPH) branch of DPH. Workgroup members then refined the objectives of each Action Plan and discussed how to move forward in making key changes to the Plans and taking the first steps toward implementation.
For example, the DPP workgroup discussed the four main objectives of the DPP Action Plan. The first objective is to promote awareness of prediabetes among people at high risk for type 2 diabetes. Many North Carolinians do not know they have prediabetes, and knowledge of their condition would alert them to the changes in diet and physical activity necessary to minimize risk of developing diabetes. The second objective is to increase referrals to CDC-recognized lifestyle change programs for the prevention of type 2 diabetes. The workgroup envisions easier and more commonplace referrals to the DPP by healthcare providers. The third objective is to increase and expand reimbursement for CDC-recognized lifestyle change programs for type 2 diabetes prevention. Stakeholders are pushing for the DPP to be covered by the State Health Plan, Medicaid, and private insurance. The fourth and final objective is to expand access to CDC-recognized lifestyle change programs. This could include offering the DPP at worksites, offering employees incentives for participating in the DPP, and embedding DPPs into primary care facilities.
The energy and enthusiasm in the room for progress in meeting these goals was overwhelming. Several of the workgroup members run DPPs at YMCAs across the state, and they were enthusiastic about the prospect of expanding access and reimbursement for the lifestyle change program. The group also expressed a desire to invite other stakeholders into the dialogue, including insurers.
In coming together to develop these Action Plans, the state is sending a clear message to decision-makers both in North Carolina and nationally that expanding access to these key diabetes services is a vital step in addressing the type 2 diabetes epidemic, and that support for investing resources in realizing these Action Plans is strong and widespread. Both workgroups will meet several times over the near year to finalize and implement the Action Plans.
I believe North Carolina is lucky to have such fierce public health advocates among its population – advocates dedicated not just to policy-making, but to action. Public health is a multifaceted endeavor, and stemming the diabetes epidemic will depend on organizations like the NC DAC that work to bring stakeholders together.