Earlier this year, BlueCross BlueShield of South Carolina announced a bold initiative to confront diabetes in South Carolina. The effort, Diabetes Free SC (DFSC), is a long-term commitment to reduce health care disparities and improve the health status of all South Carolinians affected by diabetes.
The ultimate goal is to reduce the incidence and prevalence of diabetes and its complications in South Carolina.
Dr. Timothy Lyons, BlueCross’ executive medical director for DFSC, an endocrinologist and professor of medicine at MUSC, and Noreen O’Donnell, program director, offer insight into the effort.
Q: One of the first strategies of DFSC is improving pregnancy outcomes for women who have diabetes. Why start the focus there?
Lyons: To address long-term stresses on the human body, early intervention is key. In a woman with diabetes (either Type 1, Type 2 or gestational), there is now abundant evidence that poor blood sugar control during pregnancy can impair health — her own and that of her baby — not only in the short term but also decades later. The damage caused by elevated blood glucose is cumulative over time. As with high blood pressure, high cholesterol, or smoking for decades, high blood sugar causes damage that is often ‘silent’ until something catastrophic happens. And by then, there is structural damage to the tissues of the body, difficult or impossible to reverse. Pregnancy is a critically important focus for our work: setting the stage for long-term future health for both mother and child.
Another consideration is the ‘durable benefit’ of metabolic health early in life. For the baby, a well-managed ‘diabetic pregnancy’ followed by a healthy childhood and early adulthood sets a foundation for life-long health. And for a young mother with diabetes, whether Type 1 or Type 2, we now know that a period of good sugar control in her 20s and 30s reduces future risks dramatically, even if things get out of control later on.
Finally, pregnancy represents a window of opportunity to educate young women about good diabetes management. We know that young women are highly influential — setting standards for their children, husbands, partners, parents and friends — and thus they are effective at reducing diabetes risk throughout communities.
Q: What are some common misunderstandings or myths about diabetes?
Lyons: People sometimes have a fatalistic view of a diabetes diagnosis. “It happened to my mother or my aunt. They got kidney failure and died in their 60s, and it's going to happen to me. There’s nothing I can do about it.” The fact is, today, there's all kinds of things you can do about it.
Q: How is South Carolina doing when it comes to diabetes prevention or management?
Lyons: It's very difficult to measure how much diabetes is in the community unless you have universal testing of every individual in that community. Even so, South Carolina is regularly in the 10 percent of states most severely affected by diabetes. That means there is a lot of room for improvement.
Q: Can you share any information about the programs already underway?
Lyons: We have three pregnancy centers up and running. They are doing multidisciplinary pregnancy care for women with diabetes. That means at one location the mother will see, not just the specialist obstetrician, but a diabetes doctor and a diabetes educator, a dietitian, and an ophthalmologist for retina screening. Behavioral psychology is checked, too. We ask about home and social circumstances. If necessary, we can connect women to food share programs to enable access to a healthy diet.
For many moms with diabetes, it’s a huge challenge to find the time and resources to get multidisciplinary care that’s needed. Yet with good management, a pregnancy can be just as healthy for a woman with diabetes as for anyone else — but without it, complications are much more likely. The problems may be obvious, or they may have effects on the child that can’t easily be seen, including increased risk of heart disease and Type 2 diabetes later in life. In other words, the imprint of the diabetic pregnancy may carried with a child for the rest of its life. We can't undo that. We really need to help people get the pregnancy care they need both for their own sake, for the sake of the child and for the sake of the state in the future.
O’Donnell: Another strategic focus for DFSC is reduction of the lifelong risk for diabetes in children. Through a grant from the BlueCross BlueShield of South Carolina Foundation, we have funded the Boeing Center for Children's Wellness, which is part of the Medical University of South Carolina, and the Alliance for a Healthier Generation. Both organizations have vast experience developing school-based wellness policies and promoting systems and environmental changes to schools and school districts. Both now are able to expand their reach through new partnerships with districts and schools statewide, in turn leading to improvements in school environments, particularly in relation to nutrition and physical activity. As mentioned, this early-life intervention will have durable effects in preventing future diabetes, setting the stage for healthy adulthood.
The third focus of our work is the prevention of diabetes and its complications in adults. One way we are tackling this issue is through support to FoodShareSC. This organization addresses food insecurity by distributing fresh produce and specifically targeting people with Supplemental Nutrition Assistance Program benefits. The program is currently active in seven counties and — through the support of DFSC and a grant from the BlueCross Foundation — will expand to 34 counties over a five-year period. That will increase access to fresh fruits and vegetables and increase messaging around the importance of healthy eating and active living.
Q: Are you working with any other organizations on this effort?
Lyons: This is truly a BlueCross initiative in collaboration with the BlueCross Foundation. The Alliance for a Healthier South Carolina and the South Carolina Department of Health and Environmental Control were involved in the initial planning group to help us form the vision and the mission of our efforts. These groups are also represented in an Advisory Council, helping us make sure the work we do is in line with other efforts in the state.
Q: What do you want people to know about DFSC?
O’Donnell: There are others who are doing good work in this space, but through DFSC, BlueCross is taking a big step out in front to try to put enough resources toward the issue. We know this is a long-term initiative. This isn't something that's going to last one or three or five years. Many of the things that we're talking about require shifts in our ingrained structures and culture. This is visionary of BlueCross to step out in front to take this on.
We also want to make sure it is clear that this isn’t something exclusively for people with health insurance. DFSC is an effort that is for the whole state, with a major emphasis on disparities and the underserved, and reaching people whose care is currently inadequate. We hope to fund population level interventions that will have statewide impact. This is our stake in the ground to make South Carolina healthier.