Governor Mikie Sherrill • Lt. Governor Dr. Dale G. Caldwell

Healthy NJ 2020

Healthy New Jersey

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Diabetes

Diabetes is among the leading causes of death in the U.S. and New Jersey, the number one cause of kidney failure, lower extremity amputations, and adult-onset blindness.  It is also a leading cause of heart disease and stroke.  According to the CDC, 38 million Americans, about 1 in every 10 people, have diabetes and 1 in 5 people are not aware of their condition.  In addition, it is estimated that 98 million American adults, more than 1 in 3, have prediabetes, and of these, more than 8 in 10 are not aware of their condition.1

Objectives

Baseline*
Progress Toward Target
Target*
Assessment is final
Reduce diabetes death rate
 
 
 
 
Reduce lower extremity amputations among those with diabetes
 
 
 
 
Increase dilated eye exams among adults with diabetes
 
 
 
 
Increase percentage of diabetic adults who get a glycosylated hemoglobin (A1C) test at least twice a year
 
 
 
 

Legend

Progress Toward Target

*Figures shown are a mix of counts, percentages, rates, and ratios. Click the Objective statement for more information about the corresponding measure.

Exceeding Target
At/Making progress toward Target
Not progressing toward Target
Negative progression toward Target

2018-2023

Projects
  • The CDC cooperative agreement Improving the Health of Americans Through Prevention and Management of Diabetes, Heart Disease, and Stroke (2018-2023) supported state investments in the implementation and evaluation of evidence-based strategies to prevent and manage diabetes and cardiovascular disease in high-burden populations and communities, thereby contributing to improved health outcomes. Half of these funds were allocated to diabetes interventions. Specific diabetes strategies included:
  • The CDC cooperative agreement DP23-0020, A Strategic Approach to Advancing Health Equity for Priority Populations with or at Risk for Diabetes, a 5-year (2023-2028) cooperative agreement to support the prevention or delay onset of type 2 diabetes among adults with prediabetes and improve self-care practices, quality of care, and early detection of complications among people with diabetes will support grantees implementing strategies including: 
    • Strengthen self-care practices by improving access, appropriateness, and feasibility of Diabetes Self-Management Education and Support (DSMES) services for priority populations.
      • Increase access to and participation in the American Diabetes Association (ADA)-recognized and Association of Diabetes Care and Education Specialists (ADCES)-accredited DSMES services among priority populations with diabetes.
      • Increase access to and participation in complementary diabetes support programs and services.
    • Support the development of multi-directional e-referral systems that support the electronic exchange of information between health care providers and Community-Based Organizations (CBOs).
    • Improve the sustainability of Community Health Workers (CHWs) by building or strengthening a supportive infrastructure to expand their involvement in evidence-based diabetes prevention and management programs and services.
    • Improve the capacity of the diabetes workforce to address factors related to the social determinants of health (SDOH) that impact health outcomes for priority populations with and at risk for diabetes.
    • Prevent diabetes complications for priority populations through early detection.
      • Increase diabetic retinopathy screening in priority populations with diabetes.
      • Improve early detection of chronic kidney disease (CKD) in priority populations with diabetes.
    • Expand availability of the National Diabetes Prevention Program (DPP) Lifestyle Change Program as a covered benefit for Medicaid beneficiaries at high risk for diabetes.  
  • In accordance with statute, N.J.S.A. §26:2-142.1, the New Jersey Department of Health (NJDOH), in consultation with the New Jersey Department of Children and Families (DCF) and the New Jersey Department of Human Services (DHS), is required to develop a Diabetes Action Plan, that details the impact of diabetes in the State of New Jersey. The plan includes a set of actionable items for consideration by the Legislature, to reduce the incidence of diabetes in New Jersey, improve diabetes care, and control complications associated with the disease.
  • The NJDOH Diabetes Prevention and Control Program (DPCP) partners with the NJ FamilyCare Office of Medicaid to expand access to the National DPP to Medicaid beneficiaries.
Policies and Legislation
  • P.L.2023, c. 105 limits cost sharing for health insurance coverage of insulin.
Outreach
  • Outreach is done through NJDOH Diabetes Prevention and Control Program grantees listed below.
Grants given by NJDOH
  • To increase awareness, access to, and utilization of American Diabetes Association-accredited Diabetes Self-Management Education and Support (DSMES): Diabetes Foundation Inc., Zufall Health Center, Visiting Homemaker Services of Passaic County, Ocean County Board of Health, and Middlesex County
  • To increase enrollment and participation in the National Diabetes Prevention Program (DPP): Shore Memorial Hospital, YMCA of Montclair, New Jersey YMCA State Alliance, and Ocean County Board of Health
  • To increase the engagement of pharmacists in the provision of medication management therapy or DSMES for people with diabetes: Zufall Health Center, Ocean Health Initiatives, and Pharmacist Institute of New Jersey
  • To assist health care organizations in implementing a system to identify people with prediabetes and refer them to CDC-recognized lifestyle change programs: New Jersey Academy of Family Physicians
  • To increase access to free eye examinations for uninsured or underinsured residents with diabetes by deploying mobile vision services to hard-to-reach areas: New Jersey Department of Human Services’ Diabetic Eye Disease Detection Program
  • To provide telephone-based screening and referrals to diabetes programming:  NJ 211
  • To increase access to and utilization of DSMES and DPP: Rutgers University, CentraState Healthcare System, and New Jersey Academy of Family Physicians
Grants received by NJDOH
Assets/resources
  • Diabetes Self-Management Education and Support (DSMES) is a critical element of care for all people with diabetes. DSMES offers participants the knowledge, skills, and ability necessary for diabetes self-care, as well as activities that assist in implementing and sustaining the behaviors needed to manage the condition on an ongoing basis. NJ211 offers a list of recognized DSMES programs across New Jersey. 
  • The Diabetes Foundation offers free lifestyle education, emergency insulin, diabetes supplies, self-management education, and social support.  
  • The National Diabetes Prevention Program (NDPP) is a research-based program that focuses on healthy eating and physical activity for people with prediabetes. The NDPP offers a list of providers across New Jersey.
Challenges
  • According to the CDC, overall incidence of type 1 and type 2 diabetes have significantly increased among children and adolescents. 
  • Social determinants of health, including income, education, housing, and access to healthy foods contribute to the development and progression of type 2 diabetes. 
  • The most common complications for people with diabetes include cardiovascular disease, chronic kidney disease, diabetic retinopathy and neuropathy, and teeth and gum disease.  
Disparities/inequities
  • Diabetes prevalence is highest among Hispanic and Black persons and the mortality rate among Blacks is about double that of other racial/ethnic groups.  
  • The lower extremity amputation rate is highest among Black persons with diagnosed diabetes, followed by Whites.
  • Hemoglobin screening and eye exams are least common among Hispanic persons with diagnosed diabetes.
Final Assessment
  • The diabetes death rate and A1C testing improved but did not meet targets.
  • There was little to no change in the proportion of adults with diabetes receiving annual dilated eye exams.
  • The lower extremity amputation rate worsened.

 

For more information, please refer to these resources:

Reference:

  1. Diabetes Basics.  CDC.  6/20/24.

 

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