DPH: DPCP Overview
Chronic Disease

Diabetes Prevention and Control Program

 

The mission of the Connecticut Diabetes Prevention and Control Program (DPCP) is to create a comprehensive system of care for the prevention and treatment of diabetes.  Our goal is to reduce the incidence or delay the onset of diabetes and its complications and enhance the quality of life for people affected by diabetes.

 

History: Since 1994, with the funding and support of the Centers for Disease Control and Prevention, (CDC), the CT DPCP has worked with partners to increase diabetes awareness to the residents of Connecticut and to provide diabetes information to health care professionals. These efforts are aligned and coordinated with the Ten Essential Public Health Services and the Chronic Care Model.

 

Program Goals: The Connecticut DPCP serves as a convener of the diabetes public health system. The CT DPCP strives to provide networking opportunities to members of the diabetes system of care in order to examine diabetes issues statewide and to share program successes.

Specific goals are based on priorities established by the CDC and include:

  • Promote awareness of and programs for pre-diabetes among people at high risk for type 2 diabetes
  • Promote participation in American Diabetes Associatin (ADA) recognized  or American of Diabetes Educators (AADE) accredited and/or Stanford licensed diabetes self-management education (DSME) programs
  • Increase use of chronic disease self-mangement programs in community settings

    

Administrative goals for the DPCP include:
  • Collaboration and coordination with other chronic disease programs.
  • Provision of training and technical assistance to health care workers, community based organizations and others working on diabetes projects and policy.
  • Promotion of social, environmental and systems approaches to diabetes prevention and control.
The CT DPCP goals and work plan are aligned with priorities of the CDC

Division of Diabetes Translation.  These include:

  • Improve access to effective lifestyle interventions.
  • Increase diabetes preventive behaviors.
  • Enhance community and environmental strategies to prevent diabetes.
  • Improve the health behavior and self management practices of people with diabetes.
  • Enhance the access and delivery of effective preventive healthcare services.
  • Improve community and environmental strategies to support people with diabetes.
  • Improve the science of health and healthcare disparities related to diabetes.
  • Prioritize and disseminate public health strategies to eliminate disparities.
  • Build capacity for communication, evaluation, marketing, policy, and partnerships.
Diabetes Statistics Overview in Connecticut
An estimated 9.2% of the Connecticut adult population or approximately 257,000 adults age 18 years and older have been diagnosed with diabetes (2011 data).  An additional 85,000 Connecticut adults are estimated to have undiagnosed diabetes.
 

Approximately 79 million Americans (or 35% of U.S. adults aged 20 and older) have prediabetes.  When this national percentage is applied to Connecticut’s population, more than 930,000 Connecticut adults aged 20 years and older are estimated to have prediabetes.

For more information about Diabetes in Connecticut.
 
 

Costs for Connecticut

According to the American Diabetes Association, diabetes cost Connecticut an estimated $2.92 billion in direct and indirect costs in 2012.  In 2011, approximately $163.8 million was billed for hospitalizations due to diabetes as a principal diagnosis and $60.5 million for diabetes with a lower extremity amputation

For additional statistics see the Diabetes Surveillance Page.

 

Contact information:

Connecticut Department of Public Health

410 Capitol Ave MS 11APV

Hartford, CT 06134

P: (860) 509-7737

F: (860) 509-7855

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FOR MORE INFORMATION:

 

For Consumers :

What is Diabetes?

Diabetes, as defined by the American Diabetes Association (ADA), is a group of diseases characterized by high levels of blood glucose (sugar). Diabetes results when the body is not able to produce or properly use insulin. Insulin is a hormone that acts like a key to get the glucose from food into the cells. Without enough insulin the glucose stays in the blood stream. The consequences of too much sugar in the blood is that over time, several organs in the body are affected including the kidney, the eye, nerves and the cardiovascular system.

 

Types of Diabetes

Type 1 diabetes is an auto-immune disease, which destroys the beta cells of the pancreas, which normally produce insulin. Therefore, the person with type 1 diabetes must take multiple daily insulin injections. Type 1 diabetes accounts for 5-10% of diabetes cases.

Warning Signs for Type 1 diabetes: (usually come on suddenly)

  • Frequent thirst and urination
  • Unexplained weight loss
  • Extreme fatigue
  • Blurry vision
  • Weakness
  • Nausea and vomiting
  • Fruity odor on breath
Type 2 is the most common type of diabetes. It accounts for 90-95% of diabetes cases. Type 2 diabetes occurs when the body fails to make enough insulin or properly use it. Aspects of type 2 diabetes include:
  • Gradual onset often with few or no symptoms.
  • Some people with type 2 diabetes can control their blood sugars through meal planning and exercise. Others will need medication, including insulin or other injectable medications.
  • Most people with type 2 diabetes are over age 40; however, it is becoming increasingly more common among children and young adults.
Risk factors for type 2 diabetes include:        
  • Overweight
  • Family history of diabetes
  • High blood pressure/cholesterol
  • History of Gestational diabetes
  • Being African American, Native American, Asian, Hispanic American or Pacific Islander 
  • Pre-diabetes
  • Polycystic ovary syndrome
Warning Signs for type 2: (often develop gradually)
  • Any warning sign listed for type 1 above
  • Vaginal yeast infections in women
  • Frequent infections
  • Cuts that are slow to heal
  • Tingling or numbness in feet or hands
Often, no symptoms are present, and diabetes can be unnoticed for several years. Meanwhile, the damaging effects of high blood sugar are beginning.
 

Gestational diabetes is a form of diabetes that occurs in 4.1% of pregnancies in Connecticut. Gestational diabetes usually requires treatment only during pregnancy but puts the mother, and the child, at high-risk for later development of diabetes. Treatment involves meal planning, physical activity, and in some cases insulin. Treatment to bring the mother’s blood sugar into a healthy range helps prevent complications in the infant. These include low blood sugar at birth and larger size (greater than 9 lbs.).

 

Risk factors for Gestational diabetes include:

  • Overweight
  • Being an ethnic minority
  • Having a family history of diabetes
Pre-diabetes is a condition in which a person’s blood sugar levels are higher than normal, but are not high enough to be considered diabetes. This means a fasting blood sugar of 100-125 mg/dl or a value of 140-199 mg/dl two hours after a glucose tolerance test. Prediabetes can also be diagnosed with a A1c value (the three month average blood sugar) of 5.7-6.4% People with pre-diabetes do not often exhibit any symptoms. They are, however, at greater risk for developing diabetes and having a heart attack or stroke.  Research conducted on people with pre-diabetes in the Diabetes Prevention Program at National Institutes of Health demonstrated that a 5-7% weight loss could prevent or delay diabetes. For more information.
 

Diagnosis of Diabetes The diagnosis of diabetes is made when the symptoms described above are present and there is a random blood sugar greater than or equal to 200 mg/dl, or when a fasting blood sugar is greater than or equal to 126 mg/dl.  Diabetes can also be diagnosed with a two-hour glucose tolerance test. This test involves drinking a sugary beverage and checking blood sugars. A result of greater than or equal to 200 mg/dl two hours after the drink also means a diagnosis of diabetes. In addition, a A1c value (the three month average of blood sugar) that is 6.5% or higher also means diabetes.

                

Diabetes as a Self-Managed Disease Research has shown that good blood sugar control can help avoid many complications associated with diabetes. The Diabetes Control and Complications Trial  (DCCT) conducted with individuals with type 1 diabetes, and the United Kingdom Prospective Diabetes Study of people with type 2 diabetes, among others, have demonstrated that achieving good blood sugar control can decrease complications. Control of blood pressure and cholesterol levels is also important.

 

DCCT Study Findings:

Intensive blood glucose control reduces risk of:

  • Eye disease by 76%
  • Kidney disease by 50% 
  • Nerve disease by 60%

When the DCCT ended in 1993, researchers continued to study more than 90 percent of the participants. The follow-up study, called Epidemiology of Diabetes Interventions and Complications (EDIC), is assessing the incidence and predictors of cardiovascular disease events such as heart attack, stroke, or needed heart surgery, as well as diabetic complications related to the eye, kidney, and nerves. The EDIC study is also examining the impact of intensive control versus standard control on quality of life. Another objective of the study is to evaluate the cost-effectiveness of intensive control.

 

EDIC Study Findings:

Intensive blood glucose control reduces risk of:

  • Any cardiovascular disease event by 42%
  • Nonfatal heart attack, stroke, or death from cardiovascular causes by 57% 

Diabetes Self-Management

Treatment of diabetes varies with the type of diabetes, but many aspects are the same. Diabetes is very much a self-managed disease. Successful self-management requires knowledge, skills and a willingness to modify food choices, increase physical activity, perform blood sugar monitoring, take medications, and see a health care provider regularly. In addition to controlling blood sugars, blood pressure and cholesterol control is important.

 

People with diabetes should request a referral to a Diabetes Self-Management Education Center to learn about the disease. There are twenty-six centers in Connecticut.  Connecticut based insurance plans are required by law to cover diabetes self-management education (DSME). Medicare, Part B also covers DSME: you pay 20% of the Medicare approved amount after the yearly Part B deductible.  There are also many free, community based diabetes education programs offered at senior centers, senior housing, community centers and other venues.

Call 1-800-994-9422 to find a class. For more information.

 

Diabetes Disaster Information (brochure)

 

Chronic Disease Self-Management Program

People with diabetes that have taken a diabetes self-management education course may also benefit from the LIVE WELL: Chronic Disease Self-Management Program. This class enhances the diabetes specific material in DSME. For more information:

For more information about: Stanford Chronic Disease Self-Management Program

Live Well Workshop Brochure

 

Diabetes Health Concerns

Diabetes can affect many parts of the body causing serious health problems. If you have diabetes you need to be aware of these risks and take care of yourself to prevent complications.

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How can diabetes effect the heart and brain?

Diabetes puts people at greater risk for heart disease and stroke. In fact, heart disease and stroke are the most common complications of diabetes.  Controlling blood glucose levels (A1c), blood pressure, and cholesterol can help prevent heart disease/stroke. Ask your health care provider about your ABCs (A1c, blood pressure and cholesterol). Also, losing weight if necessary, and not smoking can all help decrease heart disease/stroke risk.

For more information on heart disease and stroke:  American Heart Association / American Stroke Association

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How can diabetes effect the eyes?


Diabetic eye disease or retinopathy causes damage to the blood vessels in the retina. This can cause severe vision loss or blindness. To reduce this risk good blood glucose and blood pressure control is important.

If you have diabetes, most doctors recommend a yearly-dilated eye exam.  A dilated eye exam means eye drops are used to enlarge your pupils. This allows the inside of your eyes to be checked for signs of disease.

Diabetes also puts people at higher risk of cataracts (clouding of the lens of the eye) and glaucoma (increase in pressure inside the eye that leads to optic nerve damage and loss of vision).

For more information contact: National Eye Institute 

How can diabetes effect the kidneys?

High blood glucose levels can damage the kidneys. Kidney disease (nephropathy) can lead to kidney failure. Diabetes is the most common cause of kidney failure. Steps to reduce the risk or slow kidney damage include: Achieving good glucose control, having your urine tested for protein in the urine (microalbuminuria) yearly and achieving good blood pressure control (130/80).  For more information contact: National Kidney Foundation

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How can diabetes effect the feet?

Over time people with diabetes can damage the nerves in all parts of the body. This is called neuropathy. Nerve damage in the feet is the most common. It can lead to numbness or pain although some people have no symptoms. If a person has numbness in their feet they may not feel a cut or blister which can go on to become infected.   The longer a person has diabetes, the greater the risk of having nerve problems. However, when type 2 diabetes is diagnosed, half of the people already have signs of nerve damage in the feet. To prevent foot problems h have a foot exam each year by a physician or trained health care provider.  Ask your doctor to show you how to care for your feet at home and if you smoke, quit.

For more information contact: American Podiatric Medical Association 

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How is diabetes related to depression?

Depression is more common in people with diabetes. Depression can make you want to “give up” or not care anymore about things, including diabetes.   This can make the control of your diabetes more difficult. Be sure to talk with your healthcare provider who can refer you for help.

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How is diabetes related to oral health?

People with diabetes are more likely have gum disease, which can result in tooth loss.  Disorders in the mouth may also lead to heart disease in people with diabetes. Keep your mouth free of disease and your heart will benefit too.

It is important to get dental check-ups twice a year, and floss and brush daily.

For more information contact: American Dental Association

  

Diabetes and Tobacco

Smoking has many bad health effects. The best-known effect is that it causes cancer but it also damages the blood vessels and nerves. Diabetes may also damage the blood vessels and nerves. Lower your chances of damage to the blood vessels and nerves by not smoking. For help to Connecticut residents you can call the Quitline at 1-800-784-8669.

Diabetes and Flu or Pneumonia

If you have diabetes a flu shot could save your life. People with diabetes are more likely to get very sick from the flu and are more often hospitalized and more likely to die from flu. Ask your doctor if the flu or pneumonia shot is right for you.

To find a clinic giving flu shots in your area of Connecticut contact the American Lung Association of Connecticut.  They have a web-based searchable database for public seasonal flu clinics. Please be sure and check the details section of each listing for any special requirements for the clinic. Or call 1-800-LUNG-USA, Monday-Friday 9am-3pm.

Short-term problems

There are also short-term concerns associated with diabetes. These include hypoglycemia, (low blood sugar) diabetic ketoacidosis, and very high blood sugars called hyperglycemic hyperosmolar states. Work with your health care team to learn how to prevent these. In addition, when blood sugars are higher than recommended, people tend to feel tired and run down.

 

 

 

WHERE DO I GO FOR HELP?

To find a diabetes education program that has achieved American Diabetes Association Recognition: Connecticut ADA Recognized Education Centers

 

To find a diabetes educator as well as some helpful, short diabetes videos: www.diabeteseducator.org

 

Choosing a physician who can help manage diabetes properly is important.  To find a physician who has achieved National Committee for Quality Assurance Diabetes Physician Recognition Status go to: http://recognition.ncqa.org/PSearchResults.aspx?state=CT&rp=3

Note: NCQA does not review sites or advertisements linked into or out of the Web Site and such linking does not constitute an endorsement or sponsorship thereof by NCQA.  NCQA is not liable for any third party advertising, information, goods, services, content or for transactions you may enter into as a result thereof, off-site or stored pages, or old or expired links.  You hereby waive any claim against NCQA as a result of any of the foregoing to the maximum allowed by applicable law. 

 

Community Health Centers (CHC's)

People without insurance can contact a Community Health Center (CHC)

CHCs work on a sliding fee scale.  Many hospitals also have clinics that can help.

Diabetes and Chronic Disease Self-Management Programs in Connecticut

       

      For Healthcare Professionals:

      The Connecticut Diabetes Prevention and Control Plan

      Connecticut Diabetes Data

       

      Ongoing Diabetes Prevention Control Program Projects

       

      Diabetes State Plan 

      The creation of a diabetes prevention and control state plan involved the input from seventy-three partners from various sectors of the diabetes care system.  The goal was to develop a coordinated approach to diabetes in Connecticut.  The organizations represented came from community based organizations, schools, professional organizations, health care, diabetes education, managed care, community health centers and others.

      Five workgroups including diabetes prevention, disease management, education/awareness, access/policy and surveillance were formed.  The groups, under the direction of the executive committee, were able to reach consensus on problems facing the diabetes care system and strategies to address these problems.  One issue identified in the planning process is a lack of funding for diabetes prevention and care.  Therefore, new funding sources are being pursued to support the implementation phase.

       

      State Diabetes Plan Updates:    2008          2009          2010   

       

      Expected impact: The plan represents a coordinated effort of diabetes organizations in the state.  It will demonstrate to the legislature and to foundations the need for diabetes funding to accomplish the strategies laid out in the plan.

       

      Expected outcomes: The plan will result in a more coordinated system of diabetes care throughout the state with organizations partnering together to accomplish the objectives.

       

      Diabetes Awareness and Education Materials

      The National Diabetes Education Program can provide bulk copies, patient education materials in a variety of languages for your patients.  To obtain copies contact www.ndep.nih.gov

      Low literacy materials are available to download at www.learningaboutdiabetes.org 

      The Connecticut Department of Public Health has developed diabetes low literacy materials.

      For more information

       

      Smoking Cessation Assistance for Patients - CT Quitline

       

      Referrals to Diabetes Self-Management Education

      Several studies have demonstrated the effectiveness and cost savings of diabetes self-management education.  According to the American Diabetes Association, diabetes self-management education (DSME) is a critical element of care for all people with diabetes and is necessary in order to improve patient outcomes.  Receiving diabetes self-management education has been shown to be positively associated with higher levels of comprehensive diabetes clinical care which in turn can help prevent the costly complications of diabetes. (1) Other studies have shown costs can be reduced by referrals to DSME, specifically in disadvantaged areas.  (2) Currently CT based insurances and the Medicare program cover DSME.

      1. Johnson, et.al. Association between Self-Management Education and Comprehensive Diabetes Clinical Care.  Diabetes Spectrum, winter 2010, 41-46. 

      2. Duncan, et al. Assessing the Value of Diabetes Education. The Diabetes Educator 35(5) 752-760. 

       

      For a list of Connecticut ADA Recognized Education Centers

       

       

      Other Diabetes Prevention Control Program (DPCP) Projects

      The Diabetes Prevention and Control program works closely with partners from the State Department Aging to coordinate the Stanford Chronic Disease Self-Management program and Diabetes Self-Management Programs.  These six week class is available in English and Spanish and are appropriate for patients with diabetes, (as well as a variety of other chronic diseases).  They are  intended to enhance, not replace diabetes self-management education.  For more information: 

       

      The DPCP also is involved with the following projects (2010):

      • Work with Community Health Centers on quality improvement efforts.
      • Healthy Interactions Diabetes Conversation map grant from the National Association of Chronic Disease Directors.
      • Participation in the development of Connecticut's plan for Heart Healthy, Smoke Free and Physically Fit Communities.         

      National Agencies and Organizations:

       

      Centers for Disease Control and Prevention - Includes basic information on diabetes as well as extensive statistics on the disease.

       

      National Diabetes Education Program - Provides a variety of diabetes materials for consumers and professionals. Consumer information is provided in a variety of languages.

      American Diabetes Association - Contains diabetes information for consumers and practitioners including local Connecticut program information. www.diabetes.org
       
      Connecticut Department of Education - Contains the Connecticut School Guide for Diabetes.
       
      Juvenile Diabetes Research Foundation - Includes resources for children and families with type 1 diabetes
       
       
      Department of Public Health Contact Information:
      Connecticut Diabetes Prevention and Control Program (DPCP)
      410 Capitol Ave, MS 11APV
      Hartford, CT 06134
      P: (860) 509-7737
      F: (860) 509-7855




      Content Last Modified on 1/2/2014 10:46:40 AM