Association of Health Literacy With Poor Diabetes Outcomes
The purpose of this session is to review the relationship between health literacy and health outcomes in patients with diabetes and discover what the potential interventions are to improve such outcomes.
Barriers for Achieving Glycemic Targets
Improved glycemic control in people with diabetes delays the onset and progression of severe microvascular complications of diabetes. Despite advances in pharmacotherapy and diabetes treatment devices and the emphasis placed on treatment adherence over the last decade, National Health and Nutrition Examination Survey (NHANES) data showed 45% of patients with diabetes did not achieve glycemic targets of <7%. Although some patients with diabetes may be undertreated (e.g., inappropriate treatment regimens, psychosocial issues that require adjustment in therapeutic targets), one reason for poor glycemic control is patients’ difficulty in following treatment prescriptions and recommendations for diabetes self-care. This collaborative addresses barriers for achieving glycemic targets and approaches and interventions that assist patients with managing diabetes.
Building an Effective Collaborative Care Team to Address Diabetes in Special and Vulnerable Populations: Tailoring Care for Social Context
This session focused on the necessary elements to develop a high functioning patient-centered team for diabetes prevention, management, and treatment in primary care. The session addressed the roles of all members of the team including the critical role of leadership and clinical champions to building an effective collaborative team. This session laid the groundwork for the full series by engaging participants in a discussion of how to tailor diabetes care for social context. The conversation focused on the key elements needed for treating diabetes in the primary care and community setting with an emphasis on team-based approaches to wellness.
COVID-19 & Diabetes: Challenges & Opportunities to Help Vulnerable Populations
In this learning collaborative session, the National Center for Health in Public Housing and the Health in Public Housing Clinical Quality Work Group discussed the latest challenges faced by PHPCs related to COVID-19 and diabetes care. Best practices and Telehealth concerns associated with health care service delivery were among other topics addressed in this call.
Developing the Role of Community Health Workers and other Support Staff in Diabetes Prevention, Treatment, and Follow-Up
Community Health Workers (CHW) have been shown to be especially successful reaching hard to access populations such as agricultural workers and their families as well as the homeless and residents of public housing. In this session, participants and faculty explored the role of CHWs in the diabetes care team. Case studies and real-world discussion provided examples of both effective and ineffective integration of CHWs into the clinical care team. Participants discussed the scope of practice and most effective roles for CHWs within the diabetes care team as well as the role of clinical champions and leaders in effectively mobilizing the skills of CHWs and other team members.
Diabetes and Eye Exams in Primary Care
The American Academy of Ophthalmology recommends that anyone with diabetes should receive a retinal exam every year. Early detection can reduce the risk of severe vision loss by 90% and significantly reduce long-term healthcare costs. Unfortunately, fewer than 50% of patients with diabetes get a diabetic eye screening annually. During this session NCHPH explored ways to prevent and limit the extent of DR in public housing primary care settings.
Diabetes Continuum of Care: Improving Emergency Preparedness for Diabetes Management
Natural disasters, disease outbreaks, and other emergencies can happen at any moment. Managing diabetes can be difficult during these events because they may cause widespread and long-lasting impacts on supplies, and health services. This four-session learning collaborative listed the frequent barriers that health centers face to provide effective emergency preparedness for patients with diabetes, explored the role of enabling services staff to help diabetic patients during disasters, and identified promising practices for effective personalized diabetes care during emergencies.
Diabetes Continuum of Care: Using Behavioral Health and Substance Use Disorder Integration to Address Older Adults with Cognitive Impairments and Diabetes
This is the second webinar in the continuation of our Diabetes in Special & Vulnerable Populations: A National Learning Series. Diabetes affects more than 30 million people in the United States. Multi-tiered efforts to prevent, treat and manage diabetes are critical in reducing the burden of diabetes, particularly for medically underserved racial and ethnic minority populations. In addition to higher prevalence, ethnic and racial minority patients with diabetes have higher mortality and higher rates of diabetic complications.
Diabetes in Special and Vulnerable Populations
NCHPH partnered with members of the Special and Vulnerable Population Diabetes Task Force to provide a Learning Collaborative (LC) addressing critical issues to improve diabetes control in health centers nationally. NCHPH provided expertise in public housing primary care and provided a more in-depth exploration of strategies, tools, and resources needed to create positive change in diabetes control among health center patients. The LC sessions also provided in-depth knowledge and skills in order to address the unique needs of people experiencing homelessness, residents of public housing, migratory and seasonal agricultural workers, school-aged children, older adults, Asian Americans, Native Hawaiians and other Pacific Islanders, LGBT people, and other vulnerable populations.
Diabetes: Culturally and Linguistically Appropriate Services
Minority groups are affected by diabetes at significantly greater rates when compared to non-Hispanic white Americans for reasons that are multidimensional. Diabetes educators need be mindful of the cultural traditions and customs among all cultural and ethnic groups and to recognize socio-economic challenges that may exist. When diabetes education programs are delivered using culturally appropriate methods in diverse populations, they can result in improved patient health behavior, knowledge, health status, and self-efficacy. During this session, NCHPH explored strategies to provide culturally and linguistically appropriate services to diabetic patients.
Empowerment and Self-Management of Diabetes – The Pharmacist and Diabetes Care Learning Collaborative
The goal of this learning collaborative is to discuss with pharmacists how to integrate diabetes education and management into practice, so patients can make the best use of their medications and achieve the desired therapeutic outcomes.
Expanding Diabetes Prevention and Management Through Health Center Outreach
In this training hosted by the National Center for Health in Public Housing, we addressed diabetes resources for CHWs, explained the roles and competencies of CHWs in diabetes prevention with an emphasis on nutrition, physical activity programs and other lifestyle interventions, and how CHWs can help patients with diabetes crack food insecurity and other social determinants of health through community resources.
This learning collaborative was comprised of a mix of outreach and diabetes educators from at least 10 health centers in or immediately accessible to public housing. Utilizing evidence-based models such as those developed by the Centers for Disease Control and Prevention (CDC), Community Preventive Services Task Force or National Health, Lung, and Blood Institute (NHLBI), the four learning modules allowed for the implementation of process for weight screening and tracking patients with abnormal BMI and HbA1c.
Identifying and Treating People with Prediabetes
Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. According to the Center for Disease Control and Prevention (CDC), approximately 84 million American adults—more than 1 out of 3—have prediabetes. Of those with prediabetes, 90% don’t know they have it. In this session participants discussed statistics of prediabetes and conversion rates from prediabetes to diabetes, identify patients at risk for diabetes, resources to screen and test for prediabetes and the use of EHRs to identify people with prediabetes.
Management, Education and Support, Nutrition, Physical Activity, Smoking Cessation, and Psychosocial Issues
Residents of public housing are particularly at risk of developing diabetes and diabetes-related complications due to the many social factors that impact their health. A recent HUD publication indicates that HUD-assisted adults have the highest prevalence of diabetes diagnosis, with 17.6% reporting ever having been told they had diabetes. During this session NCHPH explored ways to manage diabetes through programs that address education and support, nutrition, physical activity, smoking cessation, and psychosocial issues.
Microvascular Complications and Foot Care
The importance of protecting the body from hyperglycemia cannot be overstated; the direct and indirect effects on the human vascular tree are the major source of morbidity and mortality in both type 1 and type 2 diabetes. Diabetes complications are divided into microvascular (due to damage to small blood vessels) and macrovascular (due to damage to larger blood vessels). In this session, we discuss diabetes barriers to care and best practices to address microvascular complications among diabetic patients.
Nonadherence and Behavior Change: How are You Helping your Patients?
Research studies indicate that diabetes affects around 9% of the U.S. population, and it is a leading cause of heart disease, stroke, kidney failure, lower limb amputations, and blindness among U.S. adults. A recent CDC publication estimated direct medical costs attributable to this disease were $116 billion, and the number of patients with diabetes will more than double by 2050. Thus, diabetes is a highly prevalent disease that is important for both public health and public policy reasons.
Phases of Diabetes Care
Diabetes care can be organized into three phases: pre-visit, intra-visit, and post-visit. Opportunities exist during each phase to introduce practice changes that can help engage and support patients in their diabetes care and management. Health care teams can optimize diabetes encounters by taking a planned, continuous improvement approach to visits, which includes pre-visit preparation (by both patients and practices), intra-visit coordination (among practice team members), and post-visit follow-up (among the practice team and with patients).
Strategies for Diabetes Awareness, Prevention and Control: Focusing on Prediabetes
Increasing awareness and risk stratification of individuals with prediabetes may help physicians understand potential interventions that my help decrease the percentage of patients in their communities in whom diabetes develops. During this session NCHPH discussed strategies for diabetes awareness, prevention and control with a focus on Prediabetes.
The Impact of Nutrition on Diabetes Prevention and Diabetes Management
This presentation will cover best practices for nutrition care, top eating patterns for people with diabetes, and ADA resources that can be used in practice.
The Road to Health: How to Prevent or Delay Type 2 Diabetes in your Community
The epidemic of type 2 diabetes is exacting a staggering toll on individuals, families, and communities in the United States and, increasingly, around the world. In the United States, the burden is disproportionately borne by American Indian and Alaska Natives, African Americans, Hispanic or Latino Americans, and Asian and Pacific Islanders. In this 4-session learning collaborative, NCHPH presented the CDC’s “The Road to Health” toolkit, designed specifically for CHWs who provide outreach education to Hispanic/Latino and African American/African Ancestry communities, groups at higher risk for type 2 diabetes.
Using Information Systems and Technology to Enhance Diabetes Care
Patients and physicians require new tools to manage the growing burden of chronic illness. For providers responsible for the care of diabetic patients, developments in information management, real-time health education and feedback, and new approaches to self-monitoring and insulin delivery hold great promise to improve the quality and safety of diabetes care. In this call, NCHPH and Health Centers participants shared some of the major developments in the field, and the ways these technologies can be integrated into a typical practice.