The Kentucky Diabetes Control Program and the Feasibility of the Pyramidal Model for Public Health Intervention in Diabetes Mellitus

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Abstract
The Kentucky Diabetes Control Program was the first statewide program to use an indirect, "pyramidal" model to achieve desired changes in health care delivery for diabetes. This model leverages the expertise of sub- specialists through regional sub specialty teams (RDTs) of allied health professionals to primary health professionals for use with their patients. It has the advantage of yielding geometric increases in the numbers of patients affected while utilizing the existing primary care system. The model was implemented throughout Kentucky over four years and now includes an admin istrative core, two subspecialty resource centers, and 18 RDTs, with a registered nurse and dietitian in each. During its first five years of operation, the program providedformal, continuing education in diabetes to 16, 035 health professionals. They, in turn, provided formal patient education to 20, 866 patients and family members. These results suggest the feasi bility of the indirect, pyramidal model as afunctional public health intervention in diabetes.