Magnitude of the problem: Diabetes mellitus is the most common metabolic complication of pregnancy, affecting 7 to 20% of all pregnant women - approximately 200,000 nationwide each year. This is a staggering 2 million women affected over a ten year period. Approximately 50% of the women with gestational diabetes will develop type 2 diabetes within 5 to 10 years. Many ethnic groups including Hispanic, African American and Native American populations have an even greater incidence of GDM and type 2 diabetes.
These mothers and their infants are at increased risk for many complications including:
•Increased special care nursery days for infant
•Increased hospitalization stays
•Type 2 diabetes later in life for women with a history of GDM
•Childhood obesity and type 2 diabetes for offspring
Often third-party reimbursement (private or public) isn’t available for education services during pregnancy causing patients to seek help late in pregnancy leading to poor outcomes.
The California Diabetes and Pregnancy Program developed and implemented a highly successful, cost-effective, outpatient based education program called Sweet Success. Over 200 California hospitals, clinics and/or doctors offices now have active Sweet Success Programs. Because of the program’s flexibility, it has been successful for all size facilities because it is able to deliver selected services tailored to utilize the available resources.
Cost-effectiveness: Sweet Success has been shown to be cost-effective and cost-beneficial. Two California studies have shown that $3 to $5 is saved for every $1 spent on diabetes and pregnancy prenatal care. By providing care consistent with the Sweet Success Guidelines, millions of dollars a year can be saved during pregnancy alone. (References for studies are available upon request.)
Improved Outcomes: The California Sweet Success data show improved outcomes for the following variables:
•Decrease in special care nursery admissions
•Decrease in maternal admission for diabetes control
•Decrease in macrosomia to almost the same level as the general pregnant population
•Dramatic decrease in birth defects and congenital anomalies
•Almost eliminated chance for unexplained stillbirth
•Decrease in women with GDM initiated on insulin therapy (exercise and nutrition therapy only)
•Increase in funding from both private and public third-party payers (In California, public funding through MediCal [Medicaid]
available for Sweet Success Services)
Long-term Implications: Diabetes is at epidemic proportions costing billions of dollars each year. It is projected that the incidence of diabetes will dramatically increase over the next 10 to 15 years and the financial implications in terms of payment for services are absolutely staggering. A healthy lifestyle can prevent or delay the onset of type 2 diabetes. Obesity and lack of exercise are two of the major contributing factors to developing diabetes. The incidence of obesity is also on the rise.
Until recently, women with pre-existing diabetes were told they could never have a child, women with GDM were reassured that it would “go away” after pregnancy and long-term consequences of diabetes were ignored. The sad part is that this is still happening in many parts of the nation.
Golden Opportunity: Today, with appropriate management, women with diabetes can have healthy pregnancies with optimal outcomes, and prevent or delay the onset of type 2 diabetes later in life. The Sweet Success model focuses on pre-pregnancy planning, education and long-term lifestyle modifications. This model focuses on practical approaches to meal planning, weight management and exercise strategies to help prevent or delay type 2 diabetes. If the incidence of developing type 2 diabetes in GDMs can be decreased by 30%, it would prevent approximately 500,000 women from developing the disease in the next 10 years, saving millions of dollars in health care costs. This is the power of preventative education.
Working Collaboratively: SSEP collaborates with state and national organizations, Indian Health Services and other quality diabetes and pregnancy education programs, to promote diverse avenues for providing continuing education products and services that will improve care in out-lying facilities. One of SSEP’s goals is to make current diabetes and pregnancy standards of care available and accessible to all programs in every state.
Today there are about 200 Sweet Success Affiliate Programs in California, 18 programs trained as SSEP Sweet Success Associates in other states and approximately 200 individual and organizational members representing 38 states providing services to these high-risk women. SSEP currently receives over 500 inquiries for information annually. The goal of SSEP is to make current diabetes and reproductive health practice recommendation information available and accessible to every program in the nation.
SSEP: Mission Statement
The goal of SSEP is to improve pregnancy outcomes and long-term quality of life for women with diabetes and their offspring, which extend beyond birth for both mother and child.
SSEP: A Nonprofit Corporation
We work with provider groups to increase their knowledge and delivery of care by:
1) Developing and/or endorsing events and activities that increase their knowledge.
2) Supporting multidisciplinary health care teams as they take a proactive approach, focused on healthy lifestyles.
3) Encouraging providers to involve the entire health care system, community and patient at all levels in supporting lifestyle changes that foster improved long-term health and quality of life.