Pacing alongside the nation's steadily increasing diabetes rates, last year Ohio had one of the highest prevalence rates for diabetes in the country, with residents over age 65 topping the state's charts. As a result, five health plans covering retired public employees in the state launched a diabetes education program that has improved screening and diabetes diagnosis rates among their members.

Ohio has five benefits systems with approximately 220,000 retired state employees — including teachers, police officers and firefighters — as members. Each plan is self-insured and contracts with Hartford, Conn.-based Aetna to provide a variety of group medical plans. The insurance company monitors members' claims to report on trends to the retiree groups and structure benefits accordingly.

In the 1990s, those annual reports began to show an increase in members who were diagnosed with diabetes, a chronic disease in which blood glucose levels are above normal. Left untreated or poorly managed, the disease can lead to heart disease, blindness, kidney failure and damage to nerve endings. In an effort to improve the health of diabetes patients and prevent it for those at risk, the retiree benefit groups contracted with the insurance company to create educational information for members.

Launched in 2001, the Health Quality Diabetic Initiative consisted of a series of six brochures that were mailed over three years to more than 75,000 people. The materials described ways to prevent the onset of diabetes, such as maintaining a healthy weight and blood pressure, and exercising regularly. They also described tests that determine whether individuals have diabetes, how often the tests should be taken, and stressed early prevention and the importance of family health.

Information for the brochures came from leading health information sources, including The National Institutes of Health, the U.S. Department of Health and Human Services, and the National Institute of Diabetes and Digestive and Kidney Disorders. Because the retiree groups have a large number of members that retire in their mid-40s, the appearance and tone of the brochures were designed to appeal to several age groups.

In addition to the brochures, health plan members received two newsletters each year that included information about conditions that often accompany diabetes, such as hypertension and depression. The newsletters featured articles about diabetic care practice guidelines and announcements about benefits for nutritional education, as well as medical and surgical treatment options for obesity. Physicians in the network also received updates about diabetes screenings and recommended to their patients ways to manage the disease.

After two years, there was a 6 percent increase in diabetes diagnoses rates among plan members, a 174 percent increase in dilated retinal examinations in diabetics and a 28 percent increase in cholesterol screenings to detect heart disease risk. Those results garnered a 2005 Meritorious Pinnacle Award from the Columbus, Ohio-based Ohio Association of Health Plans.

As the education campaign has continued, screening rates have increased. Cholesterol screening rates jumped from 45 percent in 2003 to 58 percent in 2004, and the dilated retinal examination rate improved from 63 percent in 2003 to 82 percent in 2004. Ohio retiree benefits managers expect claims for diabetes complications to decrease in the future as a result of improved disease awareness and education.