Assessing the evidence base for local health department practices in diabetes prevention and control

Objective: To describe evidence-based practices in diabetes prevention and control in North Carolina local health departments (LHDs). Methods: We conducted a cross-sectional mailed survey of all 85 LHDs in North Carolina in 2005. The survey was designed to measure capacity and performance and was based on federal performance standards instruments. Specific questions assessed whether LHDs programs or services were consistent with recommendations of the American Diabetes Association (ADA) or the Community Guide (CG). We also asked about awareness and implementation of the recommendations of the CG. Results: The response rate was 100%. Overall personnel capacity in diabetes was low (median of 0.9 FTEs). The proportions of LHDs providing recommended services were: screening for diabetes (74%); screening for pre-diabetes (48%); case management (35%); disease management (31%); and health education for persons with diabetes (58%). Thirty-four percent screen for diabetes in community settings, which is discouraged by the ADA. Among LHDs conducting diabetes screening, 36% use ADA criteria, 59% screen whomever requests, and 74% screen at the provider's discretion. Only 24% were aware of CG recommendations, and only 11% were implementing or disseminating CG recommendations. Conclusions: As more evidence-based recommendations for public health practice emerge, it is useful to begin to examine adherence. We found varying levels of evidence-based diabetes prevention and control practices in NC LHDs. Where capacity exists to provide any programs or services in diabetes, work is needed to understand how to better align practice with evidence-based recommendations.