The impact of diabetes is well known. In a little over a decade, it’s estimated 54 million people in the United States will be affected, up to 385,800 Americans will die each year and total annual costs associated with diabetes are expected to climb to $622 billion by 2030. Texas is particularly hit hard, as approximately 14% of the adult population have diabetes.
So perhaps it is not surprising that throughout my nursing and public health career in Texas, I have seen first-hand the impact of this disease and how it destroys lives and families, in particular among disproportionately affected and underserved patient populations.
In order to address the diabetes epidemic, we need innovative, cost-effective solutions tailored to the needs of the populations most affected. I am sharing the story of what we did in Denton County, where I work, as others in Texas and elsewhere work to take control of the growing diabetes epidemic.
In Denton County, we are making a real difference in the lives of our diabetes patients, improving health outcomes, and reducing health care costs through a culturally-grounded program designed to make diabetes care more comprehensive and accessible.
Home to about 859,000 people, Denton County has a large Hispanic community, which makes up about 20% of the overall population. In the United States, diabetes prevalence is more than double among Hispanics compared to white non-Hispanics (17% vs. 8%). Hispanics also suffer greater rates of complications from the disease, and are 40% more likely to die from diabetes compared to white non-Hispanics.
With these factors in play, we knew Denton County was facing a significant health crisis. With funding obtained through the Delivery System Reform Incentive Payment (DSRIP) program, part of the Texas Healthcare Transformation Quality Improvement Program, we created a care cycle to ensure culturally appropriate health care service delivery tailored to this disproportionately affected patient population.
A cornerstone of the program was the implementation of point-of-care testing, or lab tests performed at or near the patient and at the site where care or treatment is provided. With point-of-care instruments and technology from Siemens Healthineers, we were able to test our patients’ hemoglobin A1c (HbA1c) levels to check how well their diabetes was being managed. This allowed us to monitor for early kidney disease—and importantly— to review the results with our patients, provide culturally and linguistically appropriate diabetes education, and discuss any impact on their treatment plan—all in the same visit.
This was incredibly important for our patients, most of whom live below the Federal Poverty Level and who have limited access to healthcare. By eliminating the need for multiple office or lab visits, we were able to promote health equity in our community by reducing common barriers to care and compliance, such as transportation challenges, the need to take several days off from work, and fear or loss of wages.
In addition to point-of-care testing, patients also received retinal scanning and met with nurses trained to perform foot exams and assist in wound care, all during the same visit. By involving all staff—case managers, community health workers, and nurses—in direct patient care, we strengthened the bond of trust between our staff and the community we serve, which is a critical component for ensuring optimal patient outcomes.
As a result of this program, Denton County Public Health achieved its required DSRIP goals and gained funding for seven more years. We saw our patients’ HbA1c levels drop on average from a baseline of 11.7% to 7.9%. Further, over 75% of DCPH patients’ HbA1cs dropped below 9.0%, and 44% of patients dropped below the American Diabetes Association’s (ADA) recommended 7.0%. Cheering our patients on through their health successes became the highlight of our workdays.
This ultimately translated to reduced potential for complications and reduced healthcare costs of approximately $778,231.
There is no doubt that this program has made a meaningful impact in lives of people with diabetes in Denton County. By providing teaching moments and culturally-appropriate diabetes counseling with rapid results, our diabetes care cycle empowered patients to take control of their disease while reducing the cost of complications. I strongly believe the Denton County Public Health model could be replicated throughout public health organizations in Texas and beyond.