The mission of the Indian Health Service Division of Diabetes Treatment and Prevention is to develop, document, and sustain a public health effort to prevent and control diabetes in American Indian and Alaska Native peoples. To support our mission, IHS has taken a leading role in developing Standards of Care and Best Practices for ensuring that AI/AN with diabetes – and those at risk for the disease – receive the best possible care. In each issue of the SDPI E-Update, we will share information and tools to help you deliver quality diabetes care.

Celebrating the 20th Anniversary of IHS’s Standards of Care for Adults with Type 2 Diabetes

In 1986, the Indian Health Service (IHS) Division of Diabetes Treatment and Prevention (DDTP) developed its first IHS Standards of Care for Diabetes. Over the past 20 years, these guidelines have helped health care professionals provide excellence in diabetes care to American Indians and Alaska Natives (AI/AN). This year, we are celebrating the 20th anniversary of the guidelines, marking a major achievement for IHS.

“Developing these standards has been a collaborative and evolving process over the past 20 years,” said Dr. Kelly Acton. “Many people have put hours of hard work into making the standards evidence-based and user-friendly. The trends we have seen in improved A1Cs, lipid levels, and proteinuria most certainly relate to our having these standards in place.”

The updated 2006 Standards of Care (SOC) are specifically focused on ADULTS with type 2 diabetes. A document focusing on Standards of Care for children and adolescents with type 2 diabetes is in the works. Stay tuned to the SDPI E-Update for more information!

To keep the guidelines current with the ever-changing field of diabetes care, the IHS DDTP and the Area Diabetes Consultants (ADCs) have developed the 2006 IHS Standards of Care for Adults with Type 2 Diabetes.
The guidelines:

• Address the unique aspects of care for AI/AN people.
• Enable health care professionals and other members of a diabetes care team to offer consistent quality diabetes care to AI/AN adults with type 2 diabetes.
• Have been developed using a consensus process backed by literature review, guided by consultation with scientific experts, and refined with input from health professionals from many disciplines.
• Reflect and support the concept of a team approach to diabetes care in Indian Health facilities and the communities that surround them.
• Should be used in the context of the whole patient, not just a single disease entity.
• Should be used in the context of a model of care (such as the Chronic Care Model) that includes elements, which in combination, foster productive interactions between informed patients—who play an active role in their care—and providers with resources and expertise.


The updated 2006 Standards of Care are now posted on the DDTP website, visit http://www.ihs.gov/MedicalPrograms/diabetes/IHSDiabetesStandardsofCare2006.pdf
As soon as you click on them, you will see many changes in both content and format that make this a dynamic and interactive tool for patient care. Several new topics have been added to the document, including brief statements on non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH), peripheral arterial disease (PAD), and anemia. The SOC now is organized in three sections.

Part 1, presented in a checklist format, is geared to help identify patient needs at an initial visit and subsequent visits for on-going diabetes care. Guidelines for the initial visit include recommended measurements, essential history and physical exam components, needed referrals, as well as important screenings and assessments that should be conducted on new patients with diabetes being seen for the first time in your facility. The necessary components for each clinic visit for a person with diabetes are included in a second checklist.

Part 2 offers more detailed information on each SOC topic for providers who wish to understand the rationale behind the SOC recommendations. Throughout Part 2, there are links to the IHS Best Practices documents and references.

Lastly, Part 3 provides references and web-based links to support SOC recommendations, allowing further opportunity for health care providers to review supporting documentation and other resources.

The IHS DDTP and ADCs endorse and support the current American Diabetes Association (ADA) Clinical Practice Recommendations as the foundation of excellence in diabetes. The 2006 IHS Standards of Care for Adults With Type 2 Diabetes differ from the ADA clinical practice recommendations by bringing focus to the specific care issues of AI/AN people with diabetes and placing greater emphasis on the prevention of complications that are most notable in the AI/AN population.

“I hope all SDPI grant programs will make sure they are familiar with these standards, use them in their everyday practice to provide excellence in diabetes care, and share them with their colleagues,” said Dr. Acton.

 

 

IHS Diabetes Best Practices: Making Strides in Diabetes Care and Prevention

The Indian Health Service Diabetes Best Practices are consensus-based approaches that everyone in clinical and community settings can use to improve diabetes care and implement successful diabetes prevention, treatment, and education practices in American Indian and Alaska Native communities. They were developed by Indian health experts who know and understand AI/AN diabetes care.

“The Diabetes Best Practices are based on findings from the latest scientific data, evidence, research, outcomes studies, and successful experiences of diabetes programs,” said Dr. Kelly Moore, Clinical Consultant, IHS Division of Diabetes Treatment and Prevention. “Recognized by a group of experts as standards of excellence, they have led to improvements in diabetes clinical care as measured by the diabetes audit and can potentially help reduce diabetes health care disparities in American Indian and Alaska Native communities,” according to Dr. Moore.

The Diabetes Best Practices provide IHS, Tribal, or Urban (I/T/U) diabetes programs with relevant, evidence-based information on caring for AI/AN with diabetes or at risk of developing diabetes. They can be locally adapted and used by people and programs at all levels of a diverse organization. In addition, they can help diabetes care teams assess what works and what doesn’t work, as well as reduce duplication of effort and resources.

 

Development of the Indian Health Diabetes Best Practices

To develop the first set of Indian Health Diabetes Best Practices, the IHS Division of Diabetes Treatment and Prevention convened a Best Practices Workgroup in February 2001. The Workgroup included experts from the IHS, Tribes and Tribal organizations, urban Indian organizations, the IHS Model Diabetes Programs, and project coordinators from Special Diabetes Program for Indians grant sites.

The 2001 Workgroup developed 14 for successful diabetes prevention, treatment, and education practices in American Indian and Alaska Native communities. A second Best Practices Workgroup was formed in August 2005 to update the original 14 Best Practices and to develop four new Best Practices. This group improved and standardized the format of the Best Practices and determined how chronic care could be applied to applicable best practice models.

 

The 18 Indian Health Diabetes Best Practices

Adult weight management* Depression care* Kidney care
Breastfeeding* Diabetes and pregnancy Nutrition and physical activity
Cardiovascular disease Diabetes self-care education Oral health
Case management* Diabetes systems of care Pharmaceutical care
Community advocacy Eye care School health
Community screening Foot care Youth and type 2 diabetes

* indicates new in 2006.


How You Can Use the Diabetes Best Practices

Your diabetes program can use the Best Practices to help:

• Understand which diabetes prevention, treatment, and education activities have been shown to be effective.
• Learn from the experiences of others.
• Identify strengths and gaps in your local diabetes services and resources and determine the best practice models which can be practically implemented in your community.
• Establish your program’s priorities.
• Get an effective program up and running.
• Begin a work plan to develop your own local best practice models.
• Implement Best Practices that have been shown to result in measurable improvement.

There is a short and long version of each of the 18 Best Practices. The short (two-page) version enables you to see if your program is ready to consider adopting the best practice. The long version provides detailed information, including references and potential contacts that your program will need when ready to implement the best practice. Most of the long versions contain descriptions of real world examples, including contact information for programs that have implemented the recommended best practice.

“We are using the Best Practices for treating appropriately for stroke and cardiac issues, monitoring A1c and microalbumin, and providing educational classes,” said Virginia Hernandez, Program Director of the Journey of the Heart Healthy Heart Project in San Diego. “Our patients would not get this kind of care anywhere else!”

 

To Find Out More About the Diabetes Best Practices

Visit the IHS Division of Diabetes Treatment and Prevention website to review and download the Diabetes Best Practices. The website offers information and tips on:

• Real world examples to help you apply the Best Practices,
• Approaches to monitoring and evaluating your program, and
• Strategies for conducting community needs assessments.