In Tennessee, the prevalence of diabetes was highest among African American females (13.2 percent followed by Caucasian males (9.0 percent), Caucasian females (8.8 percent), and African American males (8.4 percent).4 African Americans represent more than half of Shelby County’s population with African American females outnumbering African American males. In Memphis and Shelby County, the burden of diabetes falls disproportionately on African-American residents compared to other races and ethnicities. Diabetes and pre-diabetes contributed to the majority of premature deaths in Tennessee, according to a study from the University of Tennessee Health Science Center. The same study also reported that diabetes increased medical costs for employers and employees and created a substantial loss of productivity and a decrease in quality of life for persons diagnosed with diabetes Type 2.5
DFL hoped to show that emergency department visits, medical costs and death from diabetes complications could be reduced by providing education, coaching and support for patients, as well as training providers and their staff on best practices, improved communication processes and tracking meaningful quality data.
Effective primary care delivered early can prevent emergency department visits later by patients with diabetes. In other words, many diabetes patients’ visits to hospital emergency department are “sensitive” to the availability of, and access to, effective primary care. In 2012, Shelby County primary care sensitive ED visits cost insurance companies and other third-party payers nearly $130 million.6 Primary care providers have become the principal sources of care for an estimated 90 percent of patients with diabetes and are challenged to meet the needs of this large patient base due to inadequate infrastructure, time constraints, and obstacles to providing care and counseling.7 African American patients with diabetes Type 2 are challenged to manage their own care due to limited access to primary care services, and lack of resources and information related to chronic disease self-management.8 Health outcomes of this underserved population can be improved with greater flexibility for health care professionals to deliver care using evidence-based interventions that address specific needs of their communities.9
A Brief History of Diabetes for Life
Memphis Healthy Churches (MHC), funded by Baptist Memorial Health Care, is a network of African American churches that has long been involved in health promotion for their congregants. In 2008, a MHC certified diabetes educator approached a MHC program manager with a funding opportunity announcement from the Merck Company Foundation through its Alliance to Reduce Disparities in Diabetes Initiative. The opportunity announced funding for projects aimed at reducing health disparities, and the announcement described much of MHC’s earlier work done with congregants living with diabetes Type 2 and other chronic diseases. MHC submitted a letter of interest, was invited to submit a grant proposal and later received approval for funding. The approval of the grant request was exciting, but the requirements exceeded MHC’s capacity to manage it adequately. MHC contacted Common Table Health Alliance (CTHA), formerly Healthy Memphis Common Table, for assistance. CTHA, the regional health improvement collaborative dedicated to improving the health of people in the Greater Memphis area, agreed to serve as the grantee and fiduciary agent for the project. In February of 2009, CTHA received five-year grant funding of $1.9 million to launch the program. The leadership team was formed under the direction of CTHA, and one of its first tasks was to name the initiative. The certified diabetes educator found that many saw their diagnosis of diabetes Type 2 as a death sentence. In addition, both the MHC project manager and the certified diabetes educator had family members who died as a result of poor diabetes self-management. As a result, they were both passionate about helping others understand that diabetes is manageable. The team unanimously agreed the program name should elevate the word “Life,” so the name “Diabetes for Life” was adopted. 7