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Virgin Islands Diabetes Center of Excellence Testimony 36th Legislature of the Virgin Islands June 1, 2026 1 Introduction Good morning, Senators, members of the 36th Legislature of the Virgin Islands and the viewing and listening audience. My name is Dr. Donna M. Christensen, Board Chair of the Virgin Islands Diabetes Center of Excellence (VIDCOE), former Congressional Representative for the United States Virgin Islands, physician, and lifelong advocate for health equity and chronic disease prevention. I would like to begin by acknowledging and thanking Governor Albert Bryan Jr, Senator Ray Fonseca, Chair of the Health, Hospital and Human Services Committee, Senator Novelle Francis Jr, Chair of the Budget, Appropriation and Finance Committee and the members of this body for supporting our request to allocate $1 Million from the Community Facilities Trust Fund to implement a Residency Program in partnership with Howard University, the Department of Health, our local Federally Qualified Health Centers and Hospitals Territory- wide. These funds will also assist us in expanding VIDCOE’s Chronic Care Management Program and enhance the services we offer on St. Thomas and St. John. Thank you for the opportunity to confirm VIDCOE’s commitment to reducing diabetes complications and improving the quality of life for people living with diabetes. I appear before you today on behalf of the Board of Directors, our staff, healthcare providers, patients, and the thousands of Virgin Islanders whose lives have been impacted by diabetes and related chronic diseases. I thank you for the opportunity to provide testimony on the critical work being carried out by VIDCOE and to share our vision for strengthening diabetes prevention, treatment, and chronic disease management throughout our Territory. Diabetes remains one of the most serious public health challenges facing the Virgin Islands. It contributes significantly to heart disease, stroke, kidney failure, blindness, amputations, disability, and premature death. Beyond the human toll, diabetes places a substantial burden on our healthcare system, our economy, our workforce, and our families. The Virgin Islands Diabetes Center of Excellence was established to address this crisis through a comprehensive, coordinated, and patient-centered model of care. Our mission is to prevent diabetes whenever possible, improve outcomes for those living with diabetes, and reduce the devastating complications that too often result when individuals lack access to timely and specialized care. Today, VIDCOE serves as the Territory's leading diabetes prevention and management center. Through clinical services, education, outreach, telehealth, specialty care, and community partnerships, we are improving health outcomes and expanding access to care for residents across the Virgin Islands. CURRENT IMPACT OF VIDCOE During 2025 alone, VIDCOE served 3,121 patients and provided diabetes education and interventions to more than 1,661 individuals. Through our multidisciplinary model of care, Virgin Islands Diabetes Center of Excellence Testimony 36th Legislature of the Virgin Islands June 1, 2026 2 patients have access to primary care, diabetes management, endocrinology, podiatry, nutrition counseling, laboratory services, retinal screenings, diabetes education, telehealth services, support groups, and chronic disease prevention programs. One of VIDCOE's greatest strengths is its ability to bring services directly into communities. Through annual diabetes health fairs, mobile health initiatives, and participation in more than fifty community outreach events each year, we are reaching residents who otherwise may not receive preventive care or diabetes screening. Our annual health fairs alone have provided services to over 500 hundred residents living in rural and underserved communities. Participants receive A1C testing, blood pressure screenings, nutrition counseling, medication education, and consultations with healthcare professionals, including endocrinologists, internists, podiatrists, ophthalmologists, cardiologists, nurse practitioners, and physician assistants. The results of these efforts are encouraging. Among individuals screened during 2025, approximately 30 percent were identified as having previously undiagnosed prediabetes, allowing us to intervene before the disease progresses. Eighty percent of patients served experienced reductions in their A1C levels, and forty percent of patients with dangerously elevated A1C levels above 9 percent achieved measurable improvement. Eighty percent of patients received annual urinary albumin testing to monitor kidney health, while forty percent received annual diabetic foot examinations. These outcomes demonstrate that when specialized diabetes care is available, patients respond positively and their health improves. As part of its commitment to preventing diabetes before it begins, VIDCOE launched a Childhood Diabetes Prevention Program in partnership with the Department of Education. This initiative brings health screenings, education, and early intervention services directly into our schools. While this program is still in its early stages, the preliminary findings underscore both the need and the opportunity to improve the health of our Territory's children. While 96 percent of students screened had normal A1C levels, indicating that most children had not yet developed prediabetes, 4 percent already demonstrated A1C levels within the prediabetes range. These findings reinforce the importance of early identification and intervention before diabetes develops. The screenings also revealed significant concerns regarding childhood weight status and cardiovascular health. Nearly one in five students screened were classified as obese, while additional students were identified as overweight. Even more alarming, nearly half of the students screened had blood pressure readings within the hypertension range, with additional students exhibiting elevated blood pressure levels. These findings are particularly important because childhood obesity and elevated blood pressure are among the strongest predictors of future diabetes, heart disease, stroke, and other chronic health conditions. Without intervention, many of these children face an increased risk of developing preventable chronic diseases later in life. VIDCOE is responding by offering a Future Fit Summer Camp for children ages 10-12, expanding school-based screenings, nutrition education, physical activity promotion, family engagement, and referrals for follow-up care when risk factors are identified. Virgin Islands Diabetes Center of Excellence Testimony 36th Legislature of the Virgin Islands June 1, 2026 3 As a CDC-recognized Prevention Center, VIDCOE offers a yearlong Prevent T2 Diabetes Program for individuals with prediabetes to help prevent or delay the onset of type 2 diabetes. We also offer cooking classes that teach healthy, culturally appropriate meal preparation for diabetes management. We recently launched a weekly radio show, entitled “Living Well with Diabetes,” to provide practical information, expert advice, and real conversations about preventing and managing diabetes here in the Virgin Islands. I am happy to report that in July 2026, VIDCOE will officially launch its Diabetes Support Group “Stronger Together: Diabetes Support”, Managing Diabetes. Living Fully. I would like to thank Mary Howe and Stephen Proster for leading this effort. SPECIALTY CARE AND TELEHEALTH ACCESS VIDCOE has developed important partnerships that help overcome the challenges associated with delivering specialty care in a small island jurisdiction. Through our collaboration with Howard University, nationally recognized endocrinologist Dr. Gail Nunlee-Bland provides in-person endocrinology services in the Virgin Islands every three months and tele- endocrinology consultations on a weekly basis. This partnership allows patients to access specialized diabetes care without the financial burden and inconvenience of traveling off island. VIDCOE also provides podiatry services, nutritional counseling, retinal screenings in partnership with Plessen Ophthalmology, and telemedicine visits that help bridge geographic barriers and improve continuity of care. Telehealth has become particularly important in serving residents living in rural communities and on islands where specialty services may not always be readily available. Through telehealth, patients can receive follow-up care, medication adjustments, nutrition counseling, and specialty consultations while remaining connected to their local support systems. Despite these successes, significant gaps remain. Current resources limit our ability to provide comprehensive services throughout the Territory. Clinical services on St. Thomas have been reduced from three days per week to twice a week. However, we recently established an MOU with Island Health & Wellness Center on St. John to provide tele- endocrinology services beginning in July 2026. EXPANDING SERVICES TO MEET GROWING NEEDS To address these challenges, VIDCOE has developed a comprehensive expansion strategy designed to increase access, improve outcomes, and strengthen long-term sustainability. In addition to expanding direct patient care services, VIDCOE is proud to be working with Howard University to strengthen the healthcare workforce throughout the U.S. Virgin Islands through the development of a comprehensive medical residency training program. Virgin Islands Diabetes Center of Excellence Testimony 36th Legislature of the Virgin Islands June 1, 2026 4 VIDCOE has expanded its partnership with Howard University to support the development and implementation of a residency training program that will provide physicians with opportunities to train within the Virgin Islands while serving the healthcare needs of our residents. This initiative will be implemented collaboratively with the Virgin Islands Department of Health, the Territory's federally qualified health centers, Schneider Regional Medical Center, Juan F. Luis Hospital and Medical Center, and other healthcare partners throughout the Territory. Through this partnership, residents will gain experience in primary care, chronic disease management, endocrinology, community health, preventive medicine, telehealth, and population health while working directly with patients across St. Croix, St. Thomas, and St. John. The program will place special emphasis on addressing the high burden of diabetes, hypertension, cardiovascular disease, obesity, and other chronic conditions that disproportionately impact Virgin Islanders. The residency program will create a pipeline of highly trained physicians who are familiar with the unique healthcare challenges, cultural strengths, and healthcare delivery systems of the Virgin Islands. It will also strengthen collaboration among healthcare institutions, enhance clinical capacity, support recruitment and retention efforts, and improve access to quality care for residents throughout the Territory. For VIDCOE, this partnership represents more than a workforce initiative. It is a critical investment in the future of healthcare in the Virgin Islands. By training physicians locally and exposing them to the needs of our communities, we are creating opportunities to develop the next generation of healthcare leaders while improving care for patients today. "Additionally, through our expanding partnership with Howard University, the Virgin Islands Department of Health, federally qualified health centers, and our territorial hospitals, VIDCOE is helping to build the healthcare workforce of the future by establishing residency training opportunities that will strengthen physician recruitment, retention, and access to care throughout the Virgin Islands for generations to come." EXPANDING CHRONIC CARE MANAGEMENT TO IMPROVE OUTCOMES AND REDUCE HEALTHCARE COSTS A critical component of VIDCOE's expansion strategy is also the enhancement of its Chronic Care Management (CCM) Program, which is designed to provide continuous, coordinated care for individuals living with diabetes and other chronic conditions. Many Virgin Islanders with diabetes also struggle with hypertension, cardiovascular disease, kidney disease, obesity, and other complex health conditions that require ongoing monitoring and support between office visits. Through its expanded CCM program, VIDCOE will provide comprehensive care coordination services that extend beyond traditional clinical encounters. Patients enrolled in the program will receive individualized care plans, medication management support, regular follow-up contacts, appointment coordination, health coaching, and assistance navigating healthcare and community resources. The program will also ensure that patients have access Virgin Islands Diabetes Center of Excellence Testimony 36th Legislature of the Virgin Islands June 1, 2026 5 to healthcare professionals who can address concerns before they become medical emergencies. VIDCOE plans to utilize dedicated care managers, nurse practitioners, medical assistants, pharmacists, registered dietitians, and primary care providers working together as an interdisciplinary team to proactively manage patient health. Through regular communication and monitoring, the CCM program will help identify gaps in care, improve medication adherence, increase patient engagement, and reduce preventable complications associated with chronic diseases. The expanded CCM program will be closely integrated with VIDCOE's Remote Patient Monitoring initiative, allowing healthcare providers to monitor blood glucose levels, blood pressure readings, and other health indicators in real time. This proactive approach will enable earlier intervention when patients experience worsening health conditions and will reduce unnecessary emergency room visits and hospitalizations. For patients, Chronic Care Management means having a healthcare team actively supporting them throughout the year—not just during scheduled appointments. For the healthcare system, it means improved care coordination, better clinical outcomes, lower healthcare costs, and more efficient use of healthcare resources. Importantly, Chronic Care Management is also a key component of VIDCOE's long-term sustainability strategy. By leveraging Medicare and other insurer reimbursement opportunities for care coordination services, the program generates recurring revenue that supports expanded patient services while improving quality of care. The Chronic Care Management Program will serve as a cornerstone of a comprehensive, integrated care model that strengthens both patient outcomes and organizational sustainability. Through this expansion, VIDCOE expects to significantly increase the number of patients receiving coordinated chronic disease management services, improve adherence to treatment plans, reduce preventable complications, and enhance the overall quality of life for Virgin Islanders living with diabetes and other chronic conditions. Through the expansion of our Chronic Care Management Program, VIDCOE is transforming diabetes care from episodic treatment into continuous, coordinated support—helping patients stay healthier, avoid costly complications, and remain connected to the care they need every day of the ye LEGISLATIVE SUPPORT AND PARTNERSHIP Members of the Legislature, the fight against diabetes cannot be won by healthcare providers alone. It requires collaboration among government, healthcare institutions, community organizations, schools, employers, and policymakers. The support that VIDCOE has received from the Government of the Virgin Islands and this Legislature has helped establish an organization that is now improving lives throughout our Territory. Virgin Islands Diabetes Center of Excellence Testimony 36th Legislature of the Virgin Islands June 1, 2026 6 Today, we ask for your continued partnership as we work to expand access to care, improve health outcomes, reduce healthcare costs, and build a healthier future for our residents. Investing in diabetes prevention and management is not simply a healthcare expenditure. It is an investment in our workforce, our families, our economy, and our future. Every prevented amputation, every avoided hospitalization, every patient who gains control of their diabetes represents both a human success story and a financial savings for our healthcare system. CONCLUSION On behalf of the Board of Directors, staff, healthcare providers, community partners, and the thousands of Virgin Islanders we serve, I thank you for your continued support of the Virgin Islands Diabetes Center of Excellence. VIDCOE has demonstrated that comprehensive, coordinated diabetes care can improve outcomes and change lives. With continued legislative support and strategic investment, we can expand these successes, reach more residents, and establish the Virgin Islands as a national model for diabetes prevention and chronic disease management. Thank you for your time, your leadership, and your commitment to improving the health of the people of the Virgin Islands. I am available to answer any questions the Committee may have.