CDAPP Sweet SuccessGuidelinesfor CareChapter 1Overview2015

CDAPP SWEET SUCCESS GUIDELINES FOR CARE 2015OVERVIEWCalifornia Diabetes and Pregnancy Program Sweet SuccessGuidelines for CareLeona Shields, PHN, MN, NP andGuey-Shiang Tsay, RN, MSN (Editors)California Department of Public Health; Maternal, Child andAdolescent Health Division.Suggested CitationShields, L and Tsay, GS. Editors, California Diabetes and Pregnancy ProgramSweet Success Guidelines for Care. Developed with California Departmentof Public Health; Maternal Child and Adolescent Health Division; revisededition, Chapter 1 updated September 2015.Funding for the development of this toolkit was provided by:Federal Title V Block Grant Funding through the California Departmentof Public Health (CDPH), Center for Family Health (CFH), Maternal,Child and Adolescent Health (MCAH) Division and was used by theRegional California Diabetes and Pregnancy Program, CDAPP SweetSuccess to develop the toolkit.The California Diabetes and Pregnancy Program (CDAPP) Toolkit“CDAPP Sweet Success Guidelines for Care” was reviewed by theCalifornia Department of Public Health; Maternal, Child and AdolescentHealth Division. The toolkit is considered a resource, but does not definethe standard of care in California. Readers are advised to adapt theguidelines and resources based on their local facility’s level of care andpatient populations served and are also advised to not rely solely onthe guidelines presented here.Copyright Information 2015 California Department of Public Health. Originally publishedin July 2012, revised and updated September 2015 to reflect additionalresource review. The material in this toolkit may be reproduced anddisseminated in any media in its original format, without modification,for informational, educational and non- commercial purposes only. Anominal sum to cover costs of reproduction and distribution can beassessed. Any modification or use of the materials in any derivativework is prohibited without prior permission of the CaliforniaDepartment of Public Health.CALIFORNIA DIABETES & PREGNANCY PROGRAM

CDAPP SWEET SUCCESS GUIDELINES FOR CARE 2015ACKNOWLEDGEMENTSOVERVIEWCalifornia Department of Public Health; Center for Family Health, Maternal,Child and Adolescent Health Division would like to thank the authors for theirinitial drafts and revisions.Regional California Diabetes and Pregnancy Program (CDAPP) StaffCharlene Canger, LCSW, MFTMaribeth Inturrisi, RN, MS, CNS, CDELeona Dang-Kilduff, RN, MSN, CDEMelissa Ortiz, MA, RD, CDECathy Fagen, MA, RDSuzanne Sparks, RN, BSN, CDEKristi Gabel, RNC, MSN, CNSCDPH CFH MCAH would like to gratefully acknowledge the contribution andreview from the people listed below:Additional CDAPP members:D. Lisa Bollman, RNC, MSNSharmila Chatterjee, MSc, MS, RDJenny Ching, RN, BSNSara Corder, LCSWGeetha DeSai, MS, RD, CDEKay Goldstein, MFTGeorge Knapp, RN, MSKatina Krajniak, RNSylvia Lane, PhD, LCSWElaine Lee, MPH, RD, CDETracy Lewis, MSWNancy McKee, LCSW, MSWEmmy Mignano, RD, MS, CDEJacqueline Masullo, MSW, LCSWLily Nichols, RDDeidre Paulson, MS, RDSibylle Reinsch, PhD, MFCCSadie Sacks, RN, MSNMelissa Shin, RN, BSN, PHNTrudy Theiss, RD, MS, CDESusan Yoshimura, RD, CDECDPH CFH MCAH Division Staff, Sacramento, California:Flojaune Griffin, PhD, MPHSangi Rajbhandari, MPHSuzanne Haydu, RD, MPHKaren Ramstrom, DO, MSPHJanet Hill, MS, RD, IBCLCLeona Shields, PHN, MN, NPMaria Jocson, MD, MPH, FAAPGuey-Shiang Tsay, RN, MSNConnie Mitchell, MD, MPHCheryl Terpak, MS, RDHSusan Wallace, RN, (MPH student, UC Davis)Medical experts:Kathleen Berkowitz, MDBarry Block, MDRoger Chene DHS(c), MPH, RDConrad Chao, MDMaurice Druzin, MDElizabeth Harleman, MDLois Jovanovic, MDJohn Kitzmiller, MDSiri Kjos, MDSherrie McElvy, MDThomas Moore, MDDavid Sacks, MDKimberlee Sorem, MDProgram support:Post production resource review for the revised and updated 2015 edition completedby California Diabetes and Pregnancy Program (CDAPP) Sweet Success Resource& Training Center: Tracy Esquivel, BA; Kevin Van Otterloo, MPA; D. LisaBollman, RNC, MSN, CPHQ. Original formatting for the 2012 edition by CynthiaPena MPH, MSW.CALIFORNIA DIABETES & PREGNANCY PROGRAM

CDAPP SWEET SUCCESS GUIDELINES FOR CARE 2015OVERVIEW1 OverviewTable of ContentsHistory of California Diabetes and Pregnancy Program (CDAPP)Sweet Success . 1Mission of CDAPP Sweet Success . 1Purpose of CDAPP Sweet Success . 1Goals of CDAPP Sweet Success . 2Funding . 2CDAPP Sweet Success – Role of the Team . 3AADE7 Self-Care Behaviors Framework . 4For More Information .4References .5TableTable 1 AADE7 Self-Care Behaviors . 4CALIFORNIA DIABETES & PREGNANCY PROGRAMi

CDAPP SWEET SUCCESS GUIDELINES FOR CARE 2015OVERVIEW1 OverviewH I S T O R Y OFCALIFORNIAD I A B E T E S ANDPREGNANCYPROGRAM (CDAPP)SWEET S U C C E S SCDAPP Sweet Success began as a pilot project in San Francisco in1982, originally funded by the March of Dimes. Based on the successof that pilot project, the inland counties in southern California becamethe first CDAPP regional program funded by the federal Title V BlockGrant through the California Department of Public Health (CDPH),Maternal, Child and Adolescent Health (MCAH) Division.From 1984 through 2006, the number of CDAPP Sweet Success regionalprograms gradually expanded to ten. Regional CDAPP staff recruited,trained, supported and retained local CDAPP Sweet Success Affiliateswho provided health care services to pregnant women with preexistingor gestational diabetes. Prior to CDAPP Sweet Success, pregnantwomen with diabetes received minimal intervention. Today, CDAPPSweet Success Affiliates are widely available across the state, providingcare for thousands of pregnant women each year.CDAPP Sweet Success regional programs were originally establishedbased on the regional perinatal health systems model. The regionalprogram consisted of a multidisciplinary team that ideally included adiabetes nurse educator, a registered dietitian, and a behavior medicinespecialist who worked in conjunction with a regional medical director.Due to budget shortfall, funding for ten regional CDAPP SweetSuccess programs ended in June 2012. A new statewide CDAPPSweet Success Resource and Training Center was establishedstarting July 1, 2012 to support and train our CDAPP SweetSuccess Affiliates.M I S S I O N OF CDAPPSWEET S U C C E S SThe mission of CDAPP Sweet Success is to promote best practices ofcare for pregnant women who have preexisting or gestational diabetes.CDAPP Sweet Success strives to optimize maternal and neonatal birthoutcomes, slow or prevent ongoing diabetes among women withgestational diabetes, and reduce complications of diabetes amongwomen with preexisting diabetes.P U R P O S E OF CDAPPSWEET S U C C E S SThe purpose of CDAPP Sweet Success is to improve maternal andneonatal birth outcomes through health education and promotion, anddisease prevention. The CDAPP Sweet Success Resource and TrainingCenter staff recruit, support, retain and provide resources for the trainingof Sweet Success Affiliates who provide health care services to pregnantwomen who have preexisting or gestational diabetes using the CDAPPSweet Success Guidelines for Care. The Resource and Training Centerstaff assess education and training needs and coordinate efforts to assistlocal Sweet Success Affiliates to plan, develop and deliver care forpregnant women with diabetes.CALIFORNIA DIABETES & PREGNANCY PROGRAM1

CDAPP SWEET SUCCESS GUIDELINES FOR CARE 2015THE GOALS OFCDAPP SWEETSUCCESSOVERVIEWThe goals of CDAPP Sweet Success are to:1.Promote quality medical management, psychosocial and nutritioninterventions for women with diabetes or for women who developdiabetes during pregnancy so their pregnancy outcomes matchthose of women in the general population with respect to: Intrauterine growth patterns Birth defects Morbidity and mortality of both mother and infant2.Promote healthy lifestyle changes in order to prevent recurrentgestational diabetes or development of diabetes after pregnancyand to prevent the complications of diabetes among women whohave overt diabetes.The overall CDAPP Sweet Success goals are accomplished by: The CDAPP Sweet Success Resource and Training Center whichdevelops and maintains web-based training and disseminatesdiabetes resources. The Center provides web-based informationto affiliated health care professionals and clinics who provideservices to pregnant women with preexisting diabetes or womenwho develop diabetes while pregnant. CDAPP Sweet Success Affiliates who promote optimalmanagement of diabetes, before, during, and after pregnancy.Affiliates are encouraged to:o Use the CDAPP Sweet Success Guidelines for Care.o Utilize interdisciplinary health care teams to providepreventive and health promoting strategies that areculturally appropriate and research-based.o Collect and analyze clinical data for validation ofservices to patients and for quality improvement (QI)activities.FUNDINGCDAPP Sweet Success Resource and Training Center is a project ofCDPH/MCAH. MCAH State Program Consultants for CDAPP SweetSuccess, provide direction and oversight in communicating the Title Vgoals and objectives to the CDAPP Sweet Success Resource andTraining Center.The CDPH/MCAH Division allocates Title V Block Grant Funds tosupport the work of CDAPP Sweet Success Resource and TrainingCenter in order to accomplish the Program’s mission and goals.CALIFORNIA DIABETES & PREGNANCY PROGRAM2

CDAPP SWEET SUCCESS GUIDELINES FOR CARE 2015CDAPP SWEET SUCCESS- ROLE OF THE TEAMOVERVIEWThe CDAPP Sweet Success Affiliates care for pregnant women with diabetesusing a multidisciplinary team. The team is comprised of various health careprofessionals, depending on the health care setting, and can include physicians,nurse educators, nurse practitioners, certified nurse midwives, health educators,physician assistants, behavioral medicine specialists (social workers,marriage/family therapists, and clinical psychologists), registered dietitians, andmedical assistants. The roles of these team members may overlap in some cases,but all team members work closely with the woman throughout her pregnancy.Team members need understanding of the physiology and management ofpregnancies complicated by diabetes as well as experience in educating womenabout diabetes-related issues.MCAH provides: Title V federal funding for CDAPP Sweet Success Resource andTraining Center. Program Consultants who deliver direction and oversight incommunicating the MCAH Title V goals and objectives to theCDAPP Sweet Success Resource and Training Center.CDAPP Sweet Success Resource and Training Center provides: The CDAPP Sweet Success Guidelines for Care. The CDAPP Sweet Success Resource and Training Center Website. The CDAPP Sweet Success materials and brochures to affiliates andproviders in electronic formats. Monthly web-based educational trainings for existing and newCDAPP Sweet Success Affiliates. Assistance to affiliates in order to maintain their Memorandum ofUnderstanding (MOU) and inclusion in the online CDAPP SweetSuccess Affiliate Directory. Collection of CDAPP Sweet Success Affiliate On-line AnnualSurveys including number of clients served. Annual Certificates of Affiliate Status that can be displayed verifyingthe site has met requirements. An Annual Report to the MCAH Division.CDAPP Sweet Success Affiliates provide: A health care team knowledgeable about the CDAPP SweetSuccess Guidelines for Care which utilizes these guidelines intheir current practice. Patient management based upon participation in CDAPP SweetSuccess training programs. Comprehensive clinical preconception and pregnancy care forwomen with diabetes. Clinical competency by ongoing participation in monthlyeducational programs. Data collection about the care they provide to clients in orderto self-monitor and evaluate their clinical practices. Feedback and sharing of their goals and plans with the CDAPPSweet Success Resource and Training Center staff through anannual on-line site survey.CALIFORNIA DIABETES & PREGNANCY PROGRAM3

CDAPP SWEET SUCCESS GUIDELINES FOR CARE 2015OVERVIEW Promotion of diabetes awareness in the community andparticipation in diabetes educational programs.CDAPP Sweet Success affiliates can be located iliateLocator.aspxAADE7 SELF-CAREBEHAVIORS FRAMEWORKThe American Association of Diabetes Educators (AADE) created aframework known as the AADE7 Self-Care Behaviors Model.1This AADE7 Self-Care Behaviors Framework will be utilizedthroughout the CDAPP Sweet Success Guidelines for Care. It alsois listed in the table below:Table 1 The AADE7 SELF-CARE BEHAVIORS 11. Healthy Eating – Understanding the best times of the day to havemeals, controlling portion size and choosing nutritious food for dailysnacks and meals2. Being Active – Important for overall fitness and reduces risk for DM23. Monitoring – Including SMBG, blood pressure, urine ketones andweight4. Taking Medication – Use of medications from oral to injections5. Problem Solving – Ability to recognize signs and symptomsand make informed decisions6. Reducing Risks – Keeping up with preventative care such asroutine dental, foot and eye exams as well as discontinuingunhealthy habits such as smoking7. Healthy coping – Psychological and social elements can hinder ormotivate a diabetic individual. A diabetes educator should allow apatient the opportunity to express patient fears or anxieties andoffer coping mechanisms for things out of their control.FOR MOREINFORMATIONThe CDAPP Sweet Success Guidelines for Care are intended to assistmembers of the health care team to provide optimal health educationand care during preconception for women with preexisting diabetes andduring pregnancy for women with preexisting diabetes or gestationaldiabetes mellitus (GDM). They were developed from a careful reviewof current literature and in collaboration with recognized experts in thefield. The authors and editors hope the reader will find these guidelinesprovide accurate and useful basic-level information about the healthcare of pregnant women with diabetes. The toolkit is considered aresource, but does not define the standard of care in California. Readersare advised to adapt the guidelines and resources based on their localfacility’s level of care and patient populations served and are alsoadvised to not rely solely on the guidelines presented here.CALIFORNIA DIABETES & PREGNANCY PROGRAM4

CDAPP SWEET SUCCESS GUIDELINES FOR CARE 2015OVERVIEWREFERENCES1.American Association of Diabetes Educators. AADE7 Self-Care Behaviors . American Association ofDiabetes Educators Web site. /aade7-self-carebehaviors. September 10, 2015.CALIFORNIA DIABETES & PREGNANCY PROGRAM5

CDAPP SWEET SUCCESS GUIDELINES FOR CARE 2015For more i n f o r m a t i o n :OVERVIEWCalifornia Department of Public Health, Center for Family Health,Maternal Child and Adolescent Health Division,California Diabetes and Pregnancy Program (CDAPP) Sweet Success(916) ifornia Diabetes and Pregnancy Program (CDAPP) Sweet SuccessResource and Training CenterTracy Esquivel, BA(714) 921-9755http://www.CDAPPSweetSuccess.orgCALIFORNIA DIABETES & PREGNANCY PROGRAM6

Charlene Canger, LCSW, MFT Maribeth Inturrisi, RN, MS, CNS, CDE Leona Dang-Kilduff, RN, MSN, CDE Melissa Ortiz, MA, RD, CDE Cathy Fagen, MA, RD Suzanne Sparks, RN, BSN, CDE Kristi Gabel, RNC, MSN, CNS CDPH CFH MCAH would like to gratefully acknowledge the contribution and review from the people listed below: Additional CDAPP members: