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Virgin Islands Diabetes Center of Excellence Testimony 36th Legislature of the Virgin Islands 1 Introduction Good morning, Senators, members of the 36th Legislature of the Virgin Islands and the viewing and listening audience. I am Dr. Julia Sheen, Executive Director of the Virgin Islands Diabetes Center of Excellence (VIDCOE). I would like to begin by acknowledging Senator Novelle E. Francis Jr., Chair of the Budget Appropriation and Finance Committee and Senator Ray Fonseca, Chair of the Health, Hospital and Human Services Committee, as well as other distinguished members of this legislature. Thank you for the opportunity to discuss VIDCOE’s operations and accomplishments. I am joined today by our dedicated team --- Dr. Donna Christensen, Vice Chair of our Board, Jaielean Jagrup, Program Manager; Dr. Ava Roberts, Podiatrist; and virtually, Dr. Anthony Oliva, Medical Director: Dr. Gail Nunlee-Bland, Endocrinologist; Dr. Tin Yan Alvin Liu, Ophthalmologist, Sharmera Robinson, Registered Dietician, and Dr. Ebony Evans, Pharmacist. We are also honored to be joined by several of our patients and program participants. The Challenge Before Us Senators, as you may know, diabetes is a serious public health crisis in the U.S. Virgin Islands, affecting more than 14,000 residents and ranking as the 7th leading cause of death. The territory’s prevalence of diabetes for exceeds national averages, with high rates of hypertension, cholesterol and obesity compounding the issue. VIDCOE’s Mission and Approach VIDCOE, is a 501(c)(3) nonprofit organization, whose mission is to prevent diabetes and reduce its complications through education, treatment, health promotion, and research. Our goal is to reduce the burden of diabetes while improving the quality of life for individuals living with or those at risk for this disease. VIDCOE is located at 4040 La Grande Princesse in Christiansted, St. Croix and in the Roy Lester Schnieder Hospital on St. Thomas. We are open on: • Mondays through Fridays from 9am-5pm on St. Croix • Mondays, Wednesdays, and Fridays from 8am-5pm on St. Thomas. VIDCOE is relocating its St. Croix operations to the Sion Farm Shopping Center on April 25th and will plan an open house shortly thereafter. VIDCOE’s diabetes clinical services are offered in person and via telemedicine and includes consultations with the specialists I mentioned earlier. Our chronic care management services are where we follow our patients every three months and include them in interventions that help them control their condition. VIDCOE takes a patient-centered approach to providing healthcare services for our diabetic population. We combine clinical services with education, enlisting family and friends to support our patients and we connect our patients with community resources. We have been successful in building a multi-disciplinary team of providers to serve our patient population. We now have Dr. Nunlee-Bland, an Endocrinologist from Howard University who sees both children and adults with diabetes, an Ophthalmologist, Dr. Alvin Liu Virgin Islands Diabetes Center of Excellence Testimony 36th Legislature of the Virgin Islands 2 from Johns Hopkins University who screens our patients for diabetes retinopathy, a nurse practitioner, Mrs. Amanda Monteiro, and Dr. Anthony Oliva, Medical Director. We also have Dr. Ava Roberts, a podiatrist who recently joined our team. Accomplishments and Impact Since receiving ARPA funding, VIDCOE has made significant strides in expanding access to diabetes care and education. Over the past year, we have provided services to more than 2,301 diabetes patients through monthly outreach activities, diabetes Self-Management and Support classes, Nutrition and Medication Management programs. Seventy-seven (77%) percent of our patients have Type 2 diabetes, twenty-one (21%) percent have prediabetes, and two (2%) percent have type 1 diabetes. Sixty-eight (68%) percent of our patients have high blood pressure, and Forty-one (41%) percent have high cholesterol. Eighty (80%) percent of our patients are overweight, and Fifty (50%) percent are obese. Metric Percentage/Number Patients with Type 2 Diabetes 77% Patients with Prediabetes 21% Patients with Type 1 Diabetes 2% Patients with high blood pressure 68% Patients with high cholesterol 41% Patient who are overweight 80% Patient who are obese 50% Additionally, VIDCOE continues to raise awareness and reach underserved communities. VIDCOEs services include our mobile health initiative where we go into the community and conduct diabetes screenings to identify new cases of diabetes and people with uncontrolled diabetes. We recently purchased a mobile unit to increase access to these types of services and conducted a diabetes screening event at the Flamboyant Gardens Independent living community on April 11th. To further increase accessibility, we have purchased an ADA- compliant, 6-passenger van to transport patients to their appointments. For the first time in decades, our pediatric endocrinologist is seeing children with Type 1 diabetes, helping to address a longstanding gap in care and has seen over thirty (30) children ages 4-18. I am happy to report that VIDCOE is partnering with the Department of Education to launch its Childhood Diabetes Prevention Program. VIDCOE will conduct diabetes screenings for Children in the 4th and 5th grades on May 8th at the Eulalie R. Rivera K-8 School on St. Croix. Children identified with diabetes will participate in interactive education on preventing diabetes through healthy eating, physical activity, and lifestyle choices. Parents will be encouraged to schedule a visit with our pediatric endocrinologist for diagnosis and next steps. I would like to thank Mary Moorhead and the Commissioner of Education, Dionne Wells-Hedrington and her team for their support. We are partnering with Howard University and Freestyle Libre to provide continuous glucose monitors (CGM) at no cost to our patients and we will use those monitors to help manage the care of our patients over a 12-month period. This program will roll-out in the summer. In recognition of National Diabetes Awareness Month, we partnered with the University Center for Excellence in Developmental Disabilities to launch eight public service announcements (PSAs) to promote diabetes education and prevention. Our partnerships are expanding. VIDCOE receives referrals from the Department of Health, Federally Qualified Virgin Islands Diabetes Center of Excellence Testimony 36th Legislature of the Virgin Islands 3 Health Centers, the local hospitals, Cleveland Clinic, and local private providers. I would like to thank the 34th and 35th Legislature for including VIDCOE in the miscellaneous budget and for supporting our work. We are expanding our footprint in this community with outreach, education and awareness activities. Over the past 12 months we have conducted and/or participated in over 50 outreach events. Our efforts also include launching a CDC-approved Prevent T2 Diabetes Program, a year- long initiative designed to delay or prevent the onset of Type 2 diabetes. Most recently we conducted a cooking class in partnership with the UVI School of Agriculture Cooperative Extension Services Community Nutrition Program on St. Croix on April 3rd and on St. Thomas on April 10th. We have grocery store walk-throughs scheduled for April 17th on St. Thomas and April 24th on St. Croix. Our monthly Diabetes Medication Management and Nutrition classes are held virtually from 12pm to 1pm. The next Nutrition class is scheduled for April 24th. Among our recent innovations is the remote patient monitoring initiative, which has already yielded promising results. As of September 2024, 80% of patients with uncontrolled diabetes have seen improvements in their A1C levels. Notably, 21% of patients showed a marked reduction in their A1C, and those with A1C levels greater than seven experienced reductions ranging from 10% to 40%. At the August 2024 Diabetes health fair on St. Thomas, we had over one hundred people waiting for eye exams. Of the thirty-nine patients screened, sixteen patients required further evaluation by an ophthalmologist. Of the sixteen patients who required further evaluation, eight had referable diabetic retinopathy. Of the eight patients with referable diabetic retinopathy, five had vision threatening diabetic retinopathy. These results underscore the value of these types of initiatives. Patient Success Stories Our patients are the heart of our mission. With their permission I would like to share some improvements our patients have made in reducing their A1cs. By way of background, diabetes is diagnosed through a Hemoglobin A1c test, Fasting Plasma Glucose test and/or an oral glucose tolerance test. A normal A1c is less than 5.7%, you are within the prediabetic range if you have an A1c of 5.7%-6.4% and you have diabetes when your A1c is greater than 6.5%. St. Croix District • Ms. Andrea Dubois reduced her A1c from 6.2% to 6.0% and lost over 20 pounds. • Mrs. Paschaline Jacob lowered her A1c from 10.2% to 7.7%. • Mr. Gregory Douglas improved his A1c from 8.5% to 5.8%. St. Thomas District • Mr. Arvin Joseph reduced his A1c from 12.6% to 6.9%. • Mrs. Sheila Welsh lowed her A1c from 6.4% to 5.7%. • Mr. Michael Daniel improved his A1c from 7.6% to 6.4%. These are just a few examples of the real-life impact our programs have had. Improved health outcomes for our patients will lead to reduced hospitalization costs, decreased long- Virgin Islands Diabetes Center of Excellence Testimony 36th Legislature of the Virgin Islands 4 term medical costs, reduced disability and increased workforce productivity and prevention savings from early intervention. Innovations and Expansions ✓ Over 580 people participated in diabetes related educational programming ✓ Obtained CDC Prevention Center Recognition ✓ Partnered with Howard University to provide Endocrinology Services ✓ Recruited an Ophthalmologist from Johns Hopkins University to screen VIDCOE’s patients for diabetes retinopathy ✓ Partnered with United Health Care on Health & Wellness Initiatives ✓ Partnered with the Division of Personnel on Health Promotion activities for all GVI employees ✓ Conducted a very successful Diabetes Health Fair on August 24th at the UVI 13D Innovation Center on St. Thomas where over 200 people received Rapid A1cs, had visits with diabetes specialists, got their feet and eyes examined and participated in nutrition classes ✓ Purchased two retinal imaging cameras one for each district. ✓ Invested in telemedicine infrastructure and upgraded our electronic health records to participate in the Territory’s Health Information Exchange. ✓ Collaborated with Amazon Web Services to enhance our data infrastructure. Funding Request In line with our sustainability goals, VIDCOE has made significant strides in securing funding through billing for services and obtaining four new grants. To continue this lifesaving work, we are respectfully requesting 1.5 million in funding to sustain our current operations and expand critical services such as pediatric endocrinology care, podiatry, and community outreach programs in the St. Thomas/St. John districts. Fifty (50%) of these funds will be allocated for direct patient care, forty-three (43%) will cover preventive programs, and seven (7%) percent will support administrative and operational costs. Ongoing support is critical, particularly as sixty-three (63%) percent of our patients are Uninsured, Underinsured, Medicaid and Medicare recipients. VIDCOE’s preventive work helps reduce government healthcare spending and increase access to diabetes related services for vulnerable populations. When you consider the patient cost of managing diabetes at $10k-$15 per year verses $80-$100 per month for dialysis treatments, VIDCOE’s services is a worthy investment. VIDCOE is already demonstrating a return on investment. With this funding we can expand our diabetes mobile health services, reach more people with diabetes, continue to target children and adolescents with early interventions and improve the quality of life for people living with diabetes. Without this continued support, we risk losing momentum on the tremendous progress made in prevention, treatment, and education. Access to essential diabetes care for thousands of Virgin Islanders, especially seniors, children and low-income families will be significantly compromised. Virgin Islands Diabetes Center of Excellence Testimony 36th Legislature of the Virgin Islands 5 VIDCOE represents hope and healing for thousands of Virgin Islanders battling diabetes. With your continued support, we can turn the tide on this epidemic and build a healthier, stronger territory. Vision for the Future Senators VIDCOE is on a path to becoming a regional leader in diabetes care. We are expanding our reach to the British Virgin Islands, where we are cohosting a Diabetes Health & Wellness Fair in November. This cross-border collaboration exemplifies the broader impact VIDCOE can have across the Caribbean. We are unique in our holistic, patient-centered model of care that combines medical treatment, education, behavior change, and community engagement --- aligning with the U.S. Department of Health and Human Services’ Healthy People 2030 objectives. Closing VIDCOE represents not just a clinic --- but a community solution to one of the most pressing public health challenges in the Virgin Islands. Together, we can make diabetes preventable, manageable, and no longer life-threatening in our Territory. We are ready to partner, expand, and deliver--- Thank you for your continued support.