Definitions. As used in this article, unless otherwise indicated: (1) “Center for Diabetes Care and Control” means an interdisciplinary collaboration of health care professionals that includes, but is not limited to, physicians, surgeons, nurses, dietitian/nutritionists, community health educators, physical therapists, dentists, podiatrists, and psychologists. These professionals will have an expertise and special interest in diabetes mellitus. The center will be situated as a section within the Division of Public Health Services of the Department of Public Health and will provide for the diagnosis, treatment, control and prevention of diabetes in the CNMI. (2) “Diabetes mellitus” is: (a) A common, serious, chronic disease in which the body does not produce and use insulin properly, and is a disease that poses a major health problem to the indigenous populations of the CNMI. (b) A disease requiring continuing medical care and education to prevent acute morbid complications secondary to diabetes such as heart disease, high blood pressure, and cerebro-vascular accidents, and reduce long-term complications such as blindness, lower extremity amputations, dental disease, and kidney failure. (c) Type 1 diabetes or juvenile-onset diabetes, which is insulindependent; (d) Type 2 diabetes or adult-onset diabetes or non insulin-dependent, and prevalent in the CNMI; (e) Gestational diabetes which develops in 2% to 5% of all pregnancies and commonly disappears when a pregnancy ends. (3) “Diabetes Self-Management Training” means instruction in an outpatient or inpatient setting which helps diabetic patients to understand the diabetic management process and daily management tasks of successful diabetic therapy. This type of training is a method of preventing frequent hospitalizations and acute complications. Source: PL 11-31, § 3. Commission Comment: PL 11-31, “The Diabetes Control Act” took effect August 25, 1998. PL 11-31, §§ 1 and 2 stated its short title, and findings and purpose as follows: Section 1. Short Title. This Act shall be known as “The Diabetes Control Act”. Section 2. Findings and Purpose. The Legislature finds that the indigenous populations of the CNMI are experiencing a spiraling rise in diabetes, hypertension, obesity, and atherosclerotic vascular disease. Diabetes historically has ranked in the top ten as a primary cause of mortality among indigenous people in the CNMI. While in 1997 Chamorros and Carolinians comprised only 34% of the total CNMI population, a stagger-
ing 67% of persons in the CNMI with diabetes were either Chamorro or Carolinian. In 1995, indigenous deaths from diabetes equaled the number of indigenous deaths in the CNMI from motor vehicle accidents and lung cancer. In 1996, the latter two were surpassed by the number of indigenous deaths from diabetes. In addition to its mortality character, diabetes also is one of the leading causes of morbidity in the CNMI, lower extremity amputations, end-stage renal disease and blindness, for example. In addition, females make up the higher percentages of indigenous persons with diabetes, Carolinian women between 45-65 years old, and Chamorro women 65 years old and older. The male from the indigenous populations commonly dies before he reaches 65, often from causes related to diabetes. A comprehensive initiative is needed to stem the tide of diabetes morbidity and mortality in the CNMI and to reform the overall health system with respect to education about and diagnosis, treatment and prevention of diabetes. What is needed is to establish centralized, coordinated, integrated, and accessible administration of all presently desparate diabetes management activity. The purpose of this bill is to establish a CNMI disease management Center for Diabetes Care and Control (“Center”) that shall have three major focus: 1) Care, Treatment, and Research Program; 2) Self-Monitoring and Out-Reach Program; and 3) Prevention and Public Education Program. The Center shall be a new Section in the Division of Public Health Services of the Department of Public Health.