Adolescent type II Diabetes in California

Policy Development: Management of Type II Diabetes in Adolescents
As mentioned in the basic policy development, the burden of type II diabetes in California has risen to alarming rates. In response, the state government has instituted several policies and initiatives to prevent and treat new onset/recently diagnosed type II diabetes.
The first of these policies is the provision of type II diabetes information to the public. Pursuant to the State of California Education Code Section 49452.7, local education agencies are required to provide type II diabetes information to parents and guardians of incoming seventh-grade students since 2010 (California Department of Education, 2020). The information, provided in the form of factsheets, is developed in collaboration with multiple agencies and describes among other things, the causes and risk factors of Type II diabetes, available screening tests, and prevention techniques. Unfortunately, the provision of information to seventh-graders leaves out a huge size of the at-risk population in the state, particularly those living in poverty.
In addition, the state has developed the Diabetes Prevention Program, an evidence-based lifestyle change program designed to assist Medi-cal beneficiaries diagnosed with pre-diabetes to prevent or delay the onset of type II diabetes (DHCS, 2020). The DPP works by providing information on how to achieve weight-loss to participants through trained peer coaches who use a CDC-approved curriculum (DHCS, 2020). Participants who achieve and maintain a minimum weight loss of 5 percent from the first session are eligible to receive ongoing maintenance after 12-month core services period (DHCS, 2020). This is geared at helping them continue healthy lifestyle behaviors. The DPP has been shown to be highly effective, with clinical trials indicating that it reduces the incidence of diabetes by 58 percent and delays onset by about four years (DPP Research Group, 2009). The primary weakness of the DPP, however, is that it focuses on weight loss only, leaving out other risk factors such as poor diets. For instance, the 2010 National Health and Nutrition Examination survey showed that about 29 percent of Americans with type II diabetes were not overweight (Bullard et al., 2013). As such, policies that focus on weight-reduction risk missing out on this group of patients.
The state has also taken steps to increase access to affordable insulin. One move is the regulation enacted in 2000, which requires every healthcare service plan, except specialized healthcare plans, to provide coverage for both insulin and non-insulin diabetes. The greatest strength of this initiative is that it helps to prevent diabetes-related complications and death caused by insulin rationing. However, the policy excludes patients with other forms of diabetes such as gestational diabetes and does not focus on instituting lifestyle changes.
Appropriate Initiatives at Local and State Levels
At the state level, the most appropriate policy would be to expand the diabetes prevention program, which has been shown to reduce the incidence of diabetes by 58 percent and delay onset by 4 years. The policy is more appropriate at the state level as it requires huge chunks of resources and high levels of coordination that may be best executed through state law and state agencies. Another appropriate state-wide policy is the expansion of insurance coverage for pre-diabetes patients to prevent the incidence of diabetes or delay onset. A possible strategy is to expand Medicaid coverage to cover these patients, thereby increasing access to health information, lifestyle advice, and medication for low-income earners. Dissemination of diabetes information needs to be carried out at the local level through local education agencies to ensure that children in all localities have equal access to the same. However, it may be crucial to expand the audience base beyond seventh graders.
Special Interest Groups and Advocates Instrumental to for the Success of Education, Prevention, and Intervention
Special interest groups that would be crucial for the success of diabetes policies include JDRF, American Diabetes Association (ADA), the International Diabetes Federation, the American Association of Diabetes Educators, and the Diabetes Advocates program (Hilliard et al., 2015). These groups are instrumental in multiple ways. First, through their membership, they could engage in efforts to reduce stigma and misconceptions about diabetes through educating those in their personal networks about diabetes (Hilliard et al., 2015). Further, they could use their influence to lobby government officials and organizations for policy changes that improve access for diabetes patients, such as expanding Medicaid coverage (Hilliard et al., 2015). At the local level, these interest groups could organize awareness campaigns to educate the masses on risk factors and prevention strategies, conduct fundraising drives, and organize supportive programs such as educational events, local sporting activities, and free screening (Hilliard et al., 2015). One strategy is to develop college courses for aspiring healthcare professionals to obtain in-depth simulation experiences and education related to diabetes (Hilliard et al., 2015). This would be crucial in preparing these future healthcare providers to meet the needs of diabetic patients.
In summary, addressing the rising incidence requires the collaborative effort of different stakeholders - from the government, the general public, healthcare professionals, and relevant interest groups.
References
Bullard, K. M., Saydah, S. H., & Imparatore, H. (2013). Secular Changes in US Prediabetes Prevalence Defined by Hemoglobin A1c and Fasting Plasma Glucose: National Health and Nutrition Examination Surveys, 1999-2010. Diabetes Care, 36(8), 2286-93.
California Department of Education (2020). Type 2 Diabetes Information. California Department of Education. Retrieved from https://www.cde.ca.gov/ls/he/hn/type2diabetes.asp
DHCS (2020). Diabetes Prevention Program. Department of Healthcare Services. Retrieved from https://www.dhcs.ca.gov/services/medi-cal/Pages/Diabetes-Prevention-Program.aspx
DPP Research Group (2009). 10-Year Follow-Up of Diabetes Incidence and Weight Loss in the Diabetes Prevention Program Outcomes Study. The Lancet, 374(9702), 1677-86.
Hilliard, M. E., Oser, S. M., Close, K., Liu, N., Hood, K., & Anderson, B. (2015). From Individuals to International Policy: Achievements and Ongoing Needs in Diabetes Advocacy. Current Diabetes Reports, 15(9), doi: 10.1007/s11892-015-0636-z