A Strategic Approach to Advancing Health Equity for Priority Populations with or at Risk for Diabetes - Arkansas has historically been a state with high burdens of diabetes and its related complications. As a current recipient of the Centers for Disease Control and Prevention (CDC) 1815 award, Arkansas successfully moved the needle for diabetes prevalence across the state with Diabetes Prevention Programs (DPPs) and Diabetes Self-Management Education and Support (DSMES) programs as evidenced by key indicators for diabetes. Behavioral Risk Factor Surveillance System (BRFSS) data show Arkansas dropped its nationwide rank for highest diabetes mellitus prevalence from 10th in 2017 to 13th in 2021. Arkansas’s national prevalence rank for prediabetes changed from 19th in 2017 to 18th in 2021, and the state’s obesity prevalence changed from 7th in 2017 to 6th in 2021. These ranks indicate a downward shift in the burdens of diabetes as a disease state to diabetes pre-disease states, namely prediabetes and obesity. CDC Wide-ranging ONline Data for Epidemiologic Research (WONDER) data show Arkansas’s overall, age-adjusted mortality rate for diabetes mellitus held a nationwide rank of three for highest mortality both in 2017 and 2021 with a 17.5% increase from baseline to the current time. This increased mortality is most likely because of the impact of the coronavirus disease 2019 (COVID-19) pandemic that began in early 2020 and this virus’s proclivity to cause serious illness and death in persons with pre-existing chronic diseases. Despite the negative impact of COVID-19 on public health and healthcare systems, Arkansas added 20 new DSMES sites and four new DPPs through the 5-year period of 1815. Arkansas also successfully developed community health worker (CHW) infrastructure for certification and licensing of CHWs in Arkansas and is currently certifying and licensing CHWs in the state. Arkansas also expanded medication therapy management (MTM) services to improve diabetes medication adherence by 20% in 18 high-disparity, rural counties of Arkansas under the 1815 grant. DP-23-0020 funding for Component A will enable the ADH Chronic Disease Prevention and Control Branch to expand and innovate upon accomplishments of the 1815 grant to improve diabetes outcomes with an emphasis on targeting health-disparate, priority populations, namely, women, Hispanics, African Americans, Marshallese, and other groups with low utilization of diabetes programs. Arkansas will focus on the following DP-23-0020, Component A strategies: Strategy 1: strengthen self-care practices by improving access, appropriateness, and feasibility of DSMES services for priority populations; Strategy 4: improve acceptability and quality of care for priority populations with diabetes through a team-based care approach; Strategy 5: increase enrollment and retention of priority populations in the National DPP lifestyle intervention and the Medicare DPP by improving access, appropriateness, and feasibility of programs; Strategy 9: increase and sustain DSMES and National DPP delivery sites within pharmacy networks and chain pharmacies to improve reach to priority populations; Strategy 12: improve the sustainability of CHWs by strengthening infrastructure to engage them in evidence-based diabetes prevention programs; and Strategy 13: improve the capacity of the diabetes workforce to address factors related to social determinants of health (SDOH) that impact health outcomes for priority populations with and at risk for diabetes. Based on Arkansas’s 2021 diabetes prevalence of 10.9% and current statewide reach of DSMES programs at 32,000 adults with diabetes, the ADH in collaboration with statewide partners will make strong efforts to reach approximately 50,000 of the diabetes population under the DP-23-0020 grant. Collaborative efforts will also be made to reach approximately 10,000 persons with prediabetes based on Arkansas’s prediabetes prevalence of 1.5% and current statewide reach of DPPs at 2,800 persons with prediabetes.
