BILL ANALYSIS Ó
AB 2696
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Date of Hearing: April 12, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2696
(Beth Gaines) - As Amended March 18, 2016
SUBJECT: Diabetes prevention and management
SUMMARY: Requires the Department of Public Health (DPH) to
submit a report to the Legislature on or before January 1, 2018,
that includes a summary and compilation of recommendations on
diabetes prevention and management. Specifically, this bill:
1)Requires the report to include a summary and compilation of
recommendations on diabetes prevention and management, if any,
from all of the following sources:
a) The University of California;
b) The federal Centers for Disease Control and Prevention
(CDC);
c) The California Wellness Plan;
d) Other statewide diabetes stakeholder groups; and,
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e) Other entities identified by DPH as having relevant
findings and recommendations.
2)Requires DPH to include in the report any recommendations from
the institutions listed in 1) above on all of the following
items:
a) Evidence-based strategies to prevent or manage diabetes;
b) An analysis of the financial impact diabetes and its
complications have on the state; and,
c) Policy recommendations for the prevention and management
of diabetes.
3)Requires DPH to include in the report a description of the
existing level of coordination between state departments with
regard to programmatic activities and the provision of
information to the public regarding managing and preventing
diabetes and its complications.
4)Requires DPH, commencing July 1, 2017, to annually post all of
the following information on its Internet Website:
a) A summary of the amount and source of any funding
directed to DPH for programs and activities aimed at
preventing or managing diabetes; and,
b) A summary of the expenditures by DPH on programs and
activities aimed at preventing or managing diabetes.
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5)Sunsets the reporting requirement on January 1, 2024.
6)Makes various findings and declarations regarding diabetes,
including that there is no cure for any type of diabetes;
however, there is evidence that diabetes can be prevented or
delayed in onset through lifestyle changes and medical
intervention.
EXISTING LAW establishes DPH to protect and improve the health
of communities through education, promotion of healthy
lifestyles, and research for disease and injury prevention.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, diabetes has
reached epidemic levels in California. The author states as
of 2012, about one in seven adult Californians have diabetes
and many more will be diagnosed in the near future and within
10 years, it will be one in three adults. The author contends
that, today, the State of California has no action plan in
place to mitigate the escalating fiscal impact of diabetes and
this bill would require DPH to create and submit to the State
of California a "diabetes action plan." The author concludes
the goal of the plan is to provide policy guidance addressing
the escalating fiscal impact of diabetes treatment and care.
2)BACKGROUND.
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a) Diabetes. Diabetes is a chronic medical condition
marked by high levels of blood glucose (a form of sugar)
resulting from defects in insulin production, insulin
action, or both. Type 1 diabetes, previously known as
juvenile diabetes, is an autoimmune disease in which the
body does not produce the hormone insulin. There is no
known way to prevent type 1 diabetes. Type 2 diabetes
(previously called non-insulin-dependent diabetes or
adult-onset diabetes), accounts for about 90% to 95% of all
diagnosed cases of diabetes. It usually begins as insulin
resistance, a disorder in which the cells do not use
insulin properly. As the need for insulin rises, the
pancreas gradually loses its ability to produce it.
Gestational diabetes occurs in pregnant women who have
never had diabetes before, but have higher than normal
blood glucose levels during pregnancy. Immediately after
pregnancy, about 5% to 10% of women with gestational
diabetes are found to have diabetes, usually type 2. Women
who have had gestational diabetes have a 35% to 60% chance
of developing diabetes in the next 10 to 20 years.
Prediabetes is a condition in which individuals have blood
glucose levels higher than normal but not high enough to be
classified as diabetes. People with prediabetes have an
increased risk of developing type 2 diabetes, heart
disease, and stroke. Without intervention, about one out
of four people with prediabetes will develop diabetes
within three to five years. Ethnic minorities and those
who are poor or disadvantaged have especially high rates of
diabetes. In 2010, one in seven African American (14.3%),
one in nine American Indian/Alaskan Natives/Native
Hawaiian/Other Pacific Islander (11.6 %), one in 10 Latino
(10.9%), one in 11 Asian American (7.7%), and one in 14
white (7.0%) adults had diagnosed diabetes.
According to DPH, diabetes costs in California exceed $24
billion each year. Total health care and related costs for
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the treatment of diabetes in California are about $24.5
billion. Direct medical costs (e.g., hospitalizations,
medical care, treatment, supplies) account for about $18.7
billion, the other $5.8 billion include indirect costs such
as disability payments, time lost from work, and premature
death. The average annual treatment cost per case for
diagnosed diabetes in the U.S. was nearly $10,000 in 2007.
Increased risk of heart disease, stroke, and kidney damage
(and the need for dialysis as a result) are the most deadly
effects of diabetes. Uncontrolled high blood sugars may
also affect the eyes and cause blindness. Diabetes
frequently affects circulation, and a simple cut on the
foot can lead to an amputation due to infection. Diabetics
tend to experience longer hospitalizations and mortality
rates. California has an estimated 3.9 million adults with
diabetes (2010), and the numbers are rising rapidly.
b) California Heart Disease, Stroke, and Diabetes
Prevention. In July of 2013, DPH received a five-year
grant from the CDC, referenced in California as Prevention
First, in the amount of $2.4 million per year. In 2014,
DPH applied for and was awarded supplemental funding for
Prevention First to conduct activities aimed at increasing
diabetes self-management programs and increasing the use of
lifestyle intervention programs. The amount of the
supplemental grant is $1.35 million per year, with 75% ($1
million) awarded to four local health departments -
Alameda, Madera, Monterey, and Sacramento. The Prevention
First grant (including supplemental) ends in 2018. It is
not known if CDC will continue this funding past 2018.
In September 2014, DPH was awarded a four-year grant from
the CDC, entitled State and Local Public Health Actions to
Prevent Obesity, Diabetes, Heart Disease, and Stroke. The
total funding amount per year is $3.52 million with $3
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million being allocated to six local health departments -
Fresno, Merced, San Joaquin, Shasta, Solano, and Tulare --
who conduct activities related to implementation of the
National Diabetes Prevention Program. It is not known if
CDC will continue this funding past 2018.
c) The California Wellness Plan. In February 2014, DPH's
Chronic Disease Prevention Branch published the California
Wellness Plan (Plan), the result of a statewide process led
by DPH to develop a roadmap for DPH and partners to promote
health and eliminate preventable chronic disease in
California. The plan aligns with the Let's Get Healthy
California Taskforce priorities and includes 26 priorities
and performance measures developed in 2012 that are based
upon evidence-based strategies to prevent chronic disease
and promote equity. The Plan contains short, intermediate,
and long-term objectives with measurable effects on a
variety of chronic diseases, of which diabetes is a major
focus. The plan contains 15 objectives specific to
diabetes, including objectives to increase utilization of
diabetes prevention and self-management programs, as well
as broad objectives to reduce the prevalence of obesity and
diabetes among children and adults. DPH's chronic disease
programs plan to collaborate with local and state partners,
including the Office of Health Equity, engaged in diabetes
prevention to implement the objectives. DPH intends to
monitor the progress of Plan objectives and publish regular
reports on outcomes.
d) Progress updates and Plan revisions. According to DPH,
the Chronic Disease Control Branch Chief ensures that, at a
minimum, the Plan is reviewed in conjunction with partners
every five years to assess the need for a new version. As
funding permits and partners agree, a process to create a
new version of the Plan will be developed and implemented,
overseen by the Director of Coordination. The process will
capture observations and recommendations based on lessons
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learned from Plan implementation efforts and from which
updated priorities and evidence-based strategies can be
determined. The process will identify specific revisions,
assign them to responsible parties and establish targets
dates for completion. This review process will be
consistent with the CDC and Evaluation Program guidelines.
Triggers for reviewing the Plan sooner than the five year
cycle include, but are not limited to: a) major changes to
DPH authority; or, b) major changes in federal and/or state
funding, guidance, or requirements. Any future versions of
the Plan developed in conjunction with partners will also
be available to the public on the DPH Website.
DPH further states that a one-day statewide conference will
be held on May 18, 2017, for partners and programs to
report on progress or short term outcomes of goals of the
plan. The meeting, entitled P21 2.0, will showcase the
progress report on the Plan Objectives and Focus Areas
shared at a February 2014 meeting that brought together
experts and partners from multiple organizations and
sector; discuss how chronic disease prevention efforts
align and have contributed to Let's Get Healthy goals; and,
highlight success and best practices.
e) Diabetes Burden Report. In September 2014, DPH
published the "Burden of Diabetes in California," a report
funded by a grant from the CDC. The brief report seeks to
describe the current burden of diabetes among adults in the
state, and to describe some of the current diabetes
prevention and control activities being implemented by DPH.
The report also discusses a number of ongoing activities
by DPH that support the primary prevention of diabetes
through the promotion of healthy eating, increased physical
activity, tobacco cessation, and the prevention and control
of overweight and obesity. Secondary prevention activities
focus on evidence-based strategies to prevent or delay the
onset of complications among Californians diagnosed with
type 2 diabetes. DPH is establishing a statewide network
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of evidence-based lifestyle change programs that are
designed to prevent the development of type 2 diabetes
among people at highest risk and prevent or delay the onset
of complications among people diagnosed with type 2
diabetes.
This report addresses some of the required components of
this bill including diabetes burden, cost of diabetes in
the state and some comparison with other chronic diseases,
such as obesity and high blood pressure. The report
required by this bill could serve as a complement to this
existing report.
3)PREVIOUS LEGISLATION.
a) AB 572 (Beth Gaines) of 2015, would have required DPH to
update the 2014 Plan to include specified items, and
required DPH to report to the Legislature on or before
January 1, 2018, and as specified, on the progress of the
update. AB 572 died Senate Appropriations Committee.
b) AB 270 (Nazarian) of 2015 would have required DPH to
apply to the State Department of Motor Vehicles to sponsor
a diabetes awareness, education, and research specialized
license plate program. Would have established the Diabetes
Awareness Fund, with revenues to be used by DPH to fund
programs related to diabetes awareness and prevention. AB
270 died in the Senate Appropriations Committee.
c) AB 1592 (Beth Gaines) of 2014 would have required DPH to
complete and submit to the Legislature a Diabetes Burden
Report by December 31, 2015 including, among other things,
actionable items for consideration by the Legislature that
will aid in attaining the goals set forth by DPH in the
Plan for 2014. Would have required DPH to include in the
report guidelines that will reduce the fiscal burden of
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diabetes to the state. AB 1592 was vetoed by the Governor,
stating that DPH had already submitted its Diabetes Burden
Report to the CDC, as required, and is unable to withdraw
the report to include additional information prescribed by
the bill.
d) SB 1316 (Cannella) of 2014 would have required the
Department of Health Care Services, DPH, and the Board of
Administration of the Public Employees' Retirement System
to submit a report to the Legislature regarding their
diabetes-related programs, and stated it was the intent of
the Legislature to coordinate a response that assesses the
quality of care and manages the costs paid for by
state-financed health programs relating to diabetes. SB
1316 died in the Senate Rules Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
None on file.
Opposition
None on file.
Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097
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