The Texas Diabetes Council (TDC) is an advisory body created by the Texas state legislature in 1983 to coordinate state efforts to promote diabetes awareness and prevention. The TDC was the first state-based, interagency body of its kind in the United States to address a chronic, degenerative disease like diabetes and its multiple long-term complications, such as kidney failure, blindness, and nerve damage.
Legislative action began in 1981 with bipartisan support of the appointment of the Special Committee on Diabetes Services in Texas to examine the problem statewide. Senator Carl A. Parker from Port Arthur chaired the committee, which submitted its report to the Sixty-eighth Texas Legislature in January 1983. Based on research, public testimony, and the support of professional and volunteer associations like the Texas Medical Association and the American Diabetes Association, the committee found three major problems. These findings served as the impetus for the new council.
First, Texas had no coherent plan to manage the disease. In the early 1980s existing diabetes programs focused on treating the costly, life-threatening complications but did not address how to prevent the disease or its complications. While many different state boards and commissions dealt with diabetes, state services lacked centralization. This situation created gaps in the delivery of care, which Senator Parker aptly described:
If you’re a diabetic and you show up at the Rehabilitation Commission or the Commission for the Blind or one of the other agencies and say, “Here I am. I have diabetes,” they say, “Are you blind?” No. “Do you need to be on a kidney machine?” No. “Do you need a limb amputated?” No. “Are you going into a coma?” No. “Well come back when you get worse; we have a program for you.” That doesn’t make sense, but that’s where we are.
Second, state expenditures for diabetes were high and continued to increase. State agency budgets did not itemize all the costs for diabetes, but those that were itemized exceeded $34 million in 1979. Another study estimated that more than $36 million in state funds went toward diabetes-related treatment in Medicaid patients alone for the same year. The committee recommended greater investment in awareness and prevention to reduce costs and to decrease the number of new cases and the severity of complications.
The third major problem was a lack of diabetes education available to Texans. Nationwide, standards for diabetes self-management training did not exist. In Texas, educational services were not reimbursable under current insurance plans. Patients and their families required easily accessible, multi-lingual resources to combat a steep learning curve and a constant stream of new information. Health care providers needed continuing education to diagnose and manage the disease.
Diabetes education, cost-containment, and the coordination of diabetes services all became priorities in Texas’s first diabetes control plan. On May 24, 1983, the state legislature passed Senate Bill 215, which established the TDC and charged it to develop a state plan for the control and the prevention of diabetes. Subsequently, every two years, the council publishes current epidemiological data and makes recommendations to the state legislature regarding education and health care services to Texans with diabetes.
The makeup of the council offers an innovative way to coordinate diabetes services in Texas. The eleven voting members (originally six) are citizens appointed by the governor to serve staggered six-year terms either for their professional expertise, such as physicians, nurses, and educators, or for their personal commitment to diabetes issues. The five non-voting members represent state agencies whose activities, policies, or regulations affect people with diabetes in Texas: the Texas Department of Health (presently the Texas Department of State Health Services), the Texas Education Agency, the Texas Department of Aging and Disability Services, and the Texas Department of Assistive and Rehabilitative Services (into which the Texas Commission for the Blind and the Texas Rehabilitation Commission were merged).
Since its creation, the council’s mission has remained “to effectively reduce the health and economic burdens of diabetes in Texas.” Early efforts focused on working with the public and private sectors to raise awareness through professional conferences and public health campaigns. The council has worked with state boards and commissions to improve guidelines for drivers’ licenses for persons with diabetes, to adopt new school textbooks to include information on diabetes, to address the need for diabetic diets in state correctional facilities, and to provide insurance coverage for diabetes medications, equipment, supplies, and self-management training. Through the council’s activities, Texas has become a recognized leader in community health initiatives for “at risk” populations, including children, the elderly, women, and groups based on race and ethnicity, as it continues the fight against diabetes.