Implementation of the Diabetes State Plan: A collaborative academic and state partnership experience to improve diabetes care in South Dakota

Three-fourths of South Dakota (SD) counties are designated as health professional shortage areas. There is a corresponding demand for accessible diabetes management for the 50,000 residents with diabetes. Objectives: The University Partners in Health Promotion formed a multi-disciplinary team to address objectives in the state plan to improve diabetes care, specifically to: identify barriers and assess availability of care, assess diabetes curricula for the health professions schools, and establish a list of diabetes research and resources. Methods: Each team (faculty and students) developed surveys and data collection forms. Institutional Review Board approval was obtained. Clinics, key-informants, and people with diabetes agreed to participate in personal or phone interviews, or to complete self-reported questionnaires. Results: Participants were adults with diabetes type 2, mean age 63-68, primarily residents of rural areas, and 14% were American Indian. Participants' care was primarily affected by lack of diabetes education (38.4%) and nutritional instruction (28.3%), health costs (48%), lack of insurance (41.8%), poor physical health (58%), lack of diabetes knowledge (50%), and geographic distance (33.3%). Community health centers, private and Indian Health Service clinics provide diabetes care, but diabetes education, nutrition, eye, dental and foot care require referrals with travelling distance ranging from 0-70 miles. Areas for improvement in health professions diabetes curricula were identified and a central depository of diabetes research and resources was established. Conclusions and learning objectives: Sustained collaboration is needed to better understand diabetes care needs and to develop policies to assure access to quality diabetes management in SD.