2012 -- H 7234

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LC00608

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2012

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A N A C T

RELATING TO HEALTH AND SAFETY - DIABETES SCREENING AND RISK

REDUCTION PILOT PROGRAM

     Introduced By: Representatives Naughton, E Coderre, Diaz, Silva, and Morrison

     Date Introduced: January 25, 2012

     Referred To: House Health, Education & Welfare

It is enacted by the General Assembly as follows:

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     WHEREAS, Undiagnosed type 2 diabetes has become a common condition in the United

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States, compromising one-third (1/3) of all cases of the disease. We believe that screening for and

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detection of undiagnosed type 2 diabetes is an important endeavor. Diabetes is a condition that is

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appropriate for population screening and detection; and

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     WHEREAS, Type 2 diabetes is a significant health problem. It affects more than twenty-

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three million adults in the United States and places these individuals at high risk for serious

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complications of the eyes, nerves, kidneys, and cardiovascular system.

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     WHEREAS, There is a latent phase before diagnosis of type 2 diabetes. During this

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period of undiagnosed disease, risk factors for diabetic micro and macro-vascular complications

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are markedly elevated and diabetic complications are developing; and

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     WHEREAS, Diagnostic criteria for diabetes have been established and are based on

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plasma glucose values. These criteria define a group of individuals with significant

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hyperglycemia who also have a high frequency of risk factors for micro and macro-vascular

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disease; and

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     WHEREAS, The natural history of type 2 diabetes is understood. In most patients,

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diabetes proceeds inexorably from genetic predisposition, through the stage of insulin resistance

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and hyperinsulinemia, to beta cell failure and overt clinical disease; and

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     WHEREAS, There are effective and acceptable therapies available for type 2 diabetes

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and its complications. Treating hyperglycemia to prevent complications is more effective than

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treating these complications after they have developed. Furthermore, guidelines for treatment to

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prevent cardiovascular disease in people known to have diabetes are more stringent than in those

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individuals who are not known to have diabetes; and

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     WHEREAS, There is a suitable test for screening for undiagnosed type 2 diabetes that

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has a high sensitivity and specificity-measurement of fasting plasma glucose. Guidelines for

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identifying persons at high risk for diabetes have been established; and

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     WHEREAS, People with undiagnosed diabetes have medical expenditures that are about

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two and three tenths percent (2.3%) times higher than medical expenditures for people without

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diabetes; and

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     WHEREAS, Diabetes is preventable and controllable; and

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     WHEREAS, For people with pre-diabetes, lifestyle changes, including a five through

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seven percent (5-7%) weight loss and at least one hundred and fifty (150) minutes of physical

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activity per week, can reduce the rate of onset of type 2 diabetes by fifty-eight percent (58%); and

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     WHEREAS, Disability and premature death are not inevitable consequences of diabetes.

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By working with their support network and health care providers, people with diabetes can

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prevent premature death and disability by controlling their blood glucose, blood pressure, and

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blood lipids and by receiving other preventative care in a timely manner; and

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     WHEREAS, Twenty-three million, six hundred thousand people in the United States

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(seven and eight tenths percent (7.8%) of the total population) have diabetes. Of these, five

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million, seven hundred thousand (5,700,000) have undiagnosed diabetes; and

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     WHEREAS, From 1999 though 2000, seven percent (7%) of United States adolescents

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aged twelve through nineteen (12-19) years had impaired fasting glucose (pre-diabetes), putting

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them at increased risk of developing type 2 diabetes, heart disease, and stroke; and

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     WHEREAS, In 2007, approximately one million, six hundred thousand (1,600,000) new

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cases of diabetes were diagnosed in people aged twenty (20) years or older; and

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     WHEREAS, Diabetes is the leading cause of new cases of blindness, kidney failure, and

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non-traumatic lower extremity amputations among adults; and

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     WHEREAS, Diabetes was the sixth (6th) leading cause of death on United States death

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certificates in 2006. Overall, the risk of death among people with diabetes is about twice that of

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people without diabetes of similar age; and

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     WHEREAS, There is a need for diabetes screening for low-income, underinsured, or

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uninsured adults and the United States Center for Disease Control and Prevention has guidelines

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for diabetes screening, disease risk factor screening, lifestyle intervention, and referral services in

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an effort to prevent diabetes and its serious complications such as cardiovascular disease and to

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promote healthy lifestyles; and

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     WHEREAS, Standard preventative services, including diabetic screening, blood pressure

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and cholesterol testing and, lifestyle programs targeting poor nutrition, physical inactivity, and

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smoking; and

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     WHEREAS, Rhode Island is currently not participating in diabetic screening programs

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due to lack of federal funding; and

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     WHEREAS, The best chance for this state to reduce mortality rates due to diabetic

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disease is through education and prevention.

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     SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

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amended by adding thereto the following chapter:

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     CHAPTER 86.1

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DIABETES SCREENING AND RISK REDUCTION PILOT PROGRAM

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     23-86.1-1. Diabetes screening and risk reduction pilot program. – (a) The department

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of health (hereinafter, "the department") shall develop a diabetes disease screening and lifestyle

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intervention pilot program at one site in one of Rhode Island's six (6) core cities for low-income,

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underinsured and uninsured, namely Pawtucket, Providence, Woonsocket, Newport, West

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Warwick or Central Falls.

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     (b) The department shall develop the program based on the federal Center for Disease

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Control and Prevention's guidelines. The pilot program shall employ specified measures to gauge

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the impact and outcome of the program. These measures may include the number of people

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served, the number who receive lifestyle interventions, the number of follow-up visits, an

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evaluation of the use of progress markers to reduce risk factors, and a research and evaluation

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component.

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     (c) The department shall prepare an annual report and submit it to the legislature by

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January 31st of each year summarizing the scope and reach of the pilot program. The final report

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shall include a fiscal analysis and a recommendation outlining the benefits and costs of expanding

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the pilot program throughout the state after the program has been in existence for three (3) years.

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The pilot program shall expire on July 1, 2015.

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     (d) Implementation of the diabetes screening and risk reduction pilot program shall be

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subject to appropriation.

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     SECTION 2. This act shall take effect upon passage.

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LC00608

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HEALTH AND SAFETY - DIABETES SCREENING AND RISK

REDUCTION PILOT PROGRAM

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     This act would establish a diabetes screening and risk reduction program.

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     This act would take effect upon passage.

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LC00608

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