With a name inspired by the efforts that led to Apollo 11’s moon landing, moonshot projects are ambitious and require thinking beyond the ordinary. With over 110 million Americans who have or are at risk for diabetes, a team from NHRMC has developed a Diabetes Moonshot project involving various partners working to improve access to care, education and support for those with diabetes.
The focus is not only on diabetes treatment but also prevention. “Our ultimate goal is to decrease the actual amount of diabetes in our community by 50 percent,” said Charin Hanlon, MD, FACP. “We call it a moonshot because that seems impossible, but I think if you suspend your disbelief and envision the right care being done, it is extremely possible.”
This diabetes project focuses on accomplishing long-term goals and goals that will yield “quick wins” and have immediate impact.
Uncontrolled and undiagnosed diabetes
The team is working on reducing the number of uncontrolled and undiagnosed cases of diabetes across the region. People with diabetes that is uncontrolled or untreated because they don’t know about it are at higher risk for developing complications.
Hemoglobin A1C, a blood test for diabetes and prediabetes, measures one’s average blood glucose, or blood sugar, level over the past three months. It can also be used to see how well a patient is managing their diabetes. An A1C level above eight percent means a person’s diabetes is not well-controlled, and the person is at higher risk.
In August 2019, nearly 12 percent of patients between ages 18 and 75 diagnosed with Type 1 or Type 2 diabetes had A1C values unknown or greater than nine percent, reflecting a dangerous lack of management of the condition. Blacks and Hispanics were 1.5 and 1.44 times respectively more likely to have A1C values unknown or greater than nine. Additionally, one out of every ten patients with higher risk of diabetes complications did not have a primary care provider identified to help them with their condition.
“Early on, we are hoping to see more control of A1C levels and fewer emergency department visits and hospitalizations for diabetes,” said Dr. Hanlon. “Ultimately, we hope that translates into improvement in long-term complications, meaning fewer wounds, fewer amputations, and less renal failure. Those are the chronic effects of uncontrolled diabetes.”
According to Kimberly Brady, RN, BSN, Population Health Outcomes Manager and coordinator of the Diabetes Moonshot project, 25 departments across the NHRMC system are collaborating on Diabetes Moonshot initiatives.
“I think this is one of the biggest milestones within our network to have all of these departments well represented,” Brady said. “Everybody’s coming together to collaborate, share ideas and use evidence-based guidelines in the care we’re providing.”
“I would definitely say this is an unprecedented collaboration,” said Dr. Hanlon, the director of the NHRMC Internal Medicine Residency Program. “As we analyzed all the work to be done, we knew it would involve looking at the problem differently. So, we gathered people from every discipline that touches the care of the diabetic patient. Every one of our teammates volunteered their time to be a part, collaborating to create a system to improve care in our region. A problem as big as diabetes demands big solutions. When a committed, diverse group of people come together, the impossible becomes possible.”
Lydia Newman, Executive Director of Physician Quality Partners, NHRMC’s Accountable Care Organization, said addressing the problem of diabetes should be important to everyone.
“If you look at the data around diabetes, it’s projected that 30 percent of all people born since the year 2000 will develop diabetes,” Newman said. “If you switch that lens to looking at minorities, it’s 50 percent, and that is something that we should take a stand against.”
Teams working as part of the Diabetes Moonshot are not accepting this projection as inevitable locally as they work to reduce the rate of diabetes in the region.
Improving Diabetes Care
Although the COVID-19 pandemic has impacted long-term goals, the Diabetes Moonshot group focusing on quick wins has accomplished various short-term goals and made significant impact on the diabetes care provided at NHRMC. The team developed a toolkit for primary care providers that includes clinical guidelines for prescribing advanced medication, A1C testing, care planning, standardizing patient education and best practices. They significantly increased access to diabetes classes, started group medical visits with endocrinologists, trained lay health leaders, including bilingual lay leaders, and made it easier for patients to get needed medications at lower prices. Collectively, the hope is providing greater access to care; highly effective, lower cost medicines; and educational supports, both classroom based and from trusted peers across the community, will help reduce the inequities in care and help eliminate the disparities in health outcomes.
“This project is bringing more awareness to the severity and amount of diabetes that’s right here in the community,” said Linda Wooley, RN, MSN, CDE, a certified diabetes educator. “I think it also brings an awareness to providers of the different tools available, and it’s bringing tools to them that are going to streamline interventions for diabetes to make it easier as a practitioner to take care of patients with diabetes.”
Our area doesn’t have a lot of endocrinologists, who specialize in treating conditions including diabetes, so many internal medicine or family medicine practitioners have been caring for diabetes patients without easy access to all the resources and information available.
Providing information to them has been a priority of the project so more patients can get timely help, instead of waiting to see a limited number of diabetes specialists. With ongoing support and a focus on preventative care, patients can prevent complications. “This is really going to help keep people out of the hospital,” said Wooley. “I think we’ll extend patients’ lives, and their health is going to be better.”
The team aims to make NHRMC a diabetes center of excellence, where everyone has access to care, education and support. Part of that also involves helping patients get access to the most affordable medicines. Increasing access to care and reducing complications also brings financial benefits. “That will also reduce costs to us as a health system for unnecessary admissions related to patients not having access to their medication,” Brady said.
“If people have access to care and are on the right meds, you can avoid some longer-term complications that diabetes creates, which make cost of care so much more expensive,” said Newman.
Educating the community about diabetes
Victoria Garner, RN, BSN, CDE, also a certified diabetes educator, is part of the Moonshot team and in addition to her inpatient diabetes care, focuses on reaching people in the community who lack access to care, including those who may be uninsured.
“My part in this project was to introduce the Diabetes Empowerment Education Program (DEEP),” Garner said. “I’m training community members to be peer educators on diabetes management and putting all of this complex information where it can be easily understandable and accessible to residents in the community.”
Garner has trained 10 community peer educators thus far, including one who is bilingual, and helping to promote the DEEP program to Spanish-speaking residents. Due to COVID-19, the group has been providing virtual classes.
“If we can reach people by different routes and different means to really educate about diabetes, that’s a game changer,” said Dr. Hanlon. “If Victoria can create an army of people teaching about diabetes, then we multiply ourselves.”
For more information about diabetes care or education at NHRMC, visit nhrmc.org/diabetes. If your organization is interested in DEEP training, please contact Sarah Arthur at 910-667-9411.