SUMMARY

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WEST VIRGINIA HEALTH CARE AUTHORITY

DIABETES CARE- EXPERT PANEL CONFERENCE CALL

SEPTEMBER 16, 2002 10:00 am

Participants: Peggy Adams, RN, Cathy Chadwell, RN, Chris Clark, Mary Emmett, PhD, Sandra Joseph, M.D., Lisa Lewis, RN, Gretchen Oley, M.D., Kathy Parsons, RN, Annette Riehle, RN, Linda Sovine, Scott Spradlin, M.D., Cathy Taylor, Marilyn White, RN.

Unable to Participate: Barbara Bodner, RN, John Brehm, M.D., Richard Crespo, PhD, Stephen Grubb, M.D., Cecil Pollard, Ph.D,

Call Summary:

The call was convened by Cathy Chadwell of the West Virginia Health Care Authority, who welcomed participants and provided a brief overview of the project to date. Initiated at the panel meeting in January 2002, the project focus has been to define a Diabetes-related screening and monitoring guideline for use by clinicians in West Virginia. Following the review of published guidelines from the American Diabetes Association and several others, a composite of recommendations was presented for panel review in May 2002. At this meeting, definitions were selected for screening and most of the monitoring areas. Remaining recommendations were obtained in a follow-up mailing.

The agenda for the call included three action items: 1) review of suggested guideline changes submitted by panel members following the May meeting; 2) establishing targets/parameters for specified values; and 3) discussion of guideline maintenance and dissemination.

The proposed guideline changes were discussed and the decisions are highlighted in the table below.

Guideline Heading	Proposed Change	Recommendation
Population	Change age to 45 from 30	Keep age at 30 due to the special needs of the population in WV
Risk Factors	Change obesity definition to weight> 22 and BMI > 25	Keep weight > 20 and BMI > 25
Risk Factors		Add impaired glucose tolerance test (IGT) to impaired fasting glucose (IFG)
Risk Factors	Add HDL and triglyceride levels	Add HDL < 35 mg/dL or triglyceride > 250 mg/dL or total cholesterol > 200mg/dL
Risk Factors	Delete or refine “Habitual physical inactivity”	Change wording to “Marked Sedentary Lifestyle” to better reflect serious levels of inactivity versus lack of exercise

The decision was made to include targets/parameters for the following items; blood pressure, HbA1C and lipids. They are included in the column titled Definitions/Specifications of the attached guideline.

Finally, discussion of the maintenance question resulted in several suggestions. It was proposed that the guideline should be reviewed at least every 2 years or sooner if updates become available. It was suggested that the Comprehensive Diabetes Control Program, Bureau for Public Health might undertake this activity. Peggy Adams offered to investigate this option. A similar initiative in Kentucky has been conducted by a group identified as The Kentucky Network for Diabetes. Dr. Spradlin has contact information and will provide this to Ms. Adams for her research into this area. Other organizations identified as potential dissemination partners include the West Virginia Diabetes Association, West Virginia Academy of Family Practice and the West Virginia State Medical Association. Finally, the issue of including a disclaimer was raised. All members agreed this would be a good idea. Wording from a published state guideline was reviewed and it was decided to draft similar language for this guideline.

In closing, Cathy Chadwell reviewed the next steps and thanked all the participants for their time. The call concluded at 11:30am.

Next Steps:
      Complete the guideline changes and distribute to panel members for a final review.
      Develop a disclaimer and obtain legal review.
      Contact the West Virginia chapter of the ADA