World Health Day is April 7, 2016
World Health Organization (WHO) is focusing the next World Health Day, on 7 April 2016, on diabetes because:
- The diabetes epidemic is rapidly increasing in many countries.
- A large proportion of diabetes cases are preventable. Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. Maintaining normal body weight, engaging in regular physical activity, and eating a healthy diet can reduce the risk of diabetes.
- Diabetes is treatable. Diabetes can be controlled and managed to prevent complications. Increasing access to diagnosis, self-management education and affordable treatment are vital components of the response.
- Efforts to prevent and treat diabetes will be important to achieve the global Sustainable Development Goal 3 target of reducing premature mortality from non-communicable diseases (NCDs) by one-third by 2030. Many sectors of society have a role to play, including governments, employers, educators, manufacturers, civil society, private sector, the media and individuals themselves.
Background
In 2008, an estimated 347 million people in the world had diabetes and the prevalence is growing, particularly in low- and middle-income countries.
In 2012, the disease was the direct cause of some 1.5 million deaths, with more than 80% of those occurring in low- and middle-income countries. WHO projects that diabetes will be the 7th leading cause of death by 2030.
Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin, a hormone that regulates blood sugar, gives us the energy that we need to live. If it cannot get into the cells to be burned as energy, sugar builds up to harmful levels in the blood.
There are 2 main forms of the diabetes. People with type 1 diabetes typically make none of their own insulin and therefore require insulin injections to survive. People with type 2 diabetes, the form that comprises some 90% of cases, usually produce their own insulin, but not enough or they are unable to use it properly. People with type 2 diabetes are typically overweight and sedentary, 2 conditions that raise a person’s insulin needs.
Over time, high blood sugar can seriously compromise every major organ system in the body, causing heart attacks, strokes, nerve damage, kidney failure, blindness, impotence and infections that can lead to amputations.
The hemoglobin A1c test, also called HbA1c, glycated hemoglobin test, or glycohemoglobin, is an important blood test that shows how well your diabetes is being controlled. Hemoglobin A1c provides an average of your blood sugar control over the past 2 to 3 months and is used along with home blood sugar monitoring to make adjustments in your diabetes medicines.
HPSJ on beating Diabetes
In HEDIS MY2015, in San Joaquin County, we had an eligible population of 7,991 members that were diagnosed with diabetes and only 6,122 of them had their HbA1c testing done within the measurement year. Which means 1,869 members did not get this test done. Which means HPSJ’s HEDIS rate of 76.61% below the State MPL and NCQA 25th percentile of 83.19. As a result of our HEDIS rate being below the State MPL, for three years in a row, DHCS has issued a corrective action plan (CAP) which includes a Performance Improvement Project (PIP), to assess and improve the quality of a targeted area of services provided to Medi-Cal managed care members. As the global goal is to reduce premature mortality from non-communicable diseases (NCDs) by one-third by 2030; it is our goal to improve Diabetes right here in our community. We are collaborating with San Joaquin General Hospital to increase the rate of HbA1c testing for HPSJ members assigned to SJGH from 76.67% to 83%, within the next fiscal year.
Testing is especially important because early in the disease diabetes has no symptoms. Although no test is perfect, the A1c and blood glucose tests are the best tools available to diagnose diabetes—a serious and lifelong disease. Testing enables health care providers to find and treat diabetes before complications occur and to find and treat prediabetes, which can delay or prevent type 2 diabetes from developing.
Some Barriers identified were:
- Members not seeing their doctor
- Inaccurate demographic information in the HPSJ database
- Lack of member knowledge regarding the test
- Behavioral Health aspects of self-care
Some Interventions include:
- Identify members that have not initiated care with SJGH PCP
- Cross reference demographic information between SJGH registration information and HPSJ information
- Access HPSJ Social Services/Health Navigators and Community Partners for educational resources and social programs to address educational needs
- PCP along with HPSJ CM/DM and Social Services and Beacon Strategies to facilitate referrals for Mental Health Counseling.
Resources
- World Health Day 2016: Beat Diabetes. http://www.who.int/campaigns/world-health-day/2016/event/en/
- The Hemoglobin A1c (HbA1c) Test for Diabetes. http://www.webmd.com/diabetes/guide/glycated-hemoglobin-test-hba1c
- The A1c Test and Diabetes. http://www.niddk.nih.gov/health-information/health-topics/diagnostic-tests/a1c-test-diabetes/Pages/index.aspx