As part of the DLI, four state demonstration projects worked to detect and address the complications associated with diabetes. These projects provided invaluable insights on how early health system interventions can help people with diabetes who are at risk for complications, and provided them with appropriate strategies to help them manage their risk. Each state project focused on two complications: diabetic kidney disease (DKD) and an additional complication based on needs of the individuals served by participating health systems.

For more information about the activities in each state, hover your cursor over one of the four states in the map below.


The Michigan project worked with Henry Ford Health System in Detroit, MI, a major health system, and the Center for Family Health in Jackson, MI, a federally qualified healthcare center, which both offered diabetes self-management education (DSME) programs. The primary intervention strategy focused on integrating an assessment for DKD and retinopathy in the DSME one-on-one assessment conducted by a diabetes educator. Additionally, for patients with stage 3 or 4 DKD, staff provided educational materials and communicated with the primary healthcare provider about referrals to nephrologists and medical nutrition therapy, as needed. Finally, staff performed phone follow-up to measure patient knowledge and behavior change as a result of these efforts.

The project worked with 24 health care providers and reached over 3,100 people living with diabetes.

Contact Richard Wimberley, MPA, the Michigan DLI Program Director, for more information.

New York

The New York project worked with Hudson River HealthCare (HRHC), a community health center network, in Spring Valley and Yonkers to develop and implement a curriculum focused on diabetes complications, including diabetic kidney disease (DKD) and the importance of foot examinations. Project strategies included training community health workers to deliver the curriculum to educate people with diabetes, conducting diabetes community education days and holding webinars for educating healthcare providers.

In addition, information generated by an electronic database was used to identify and contact people with stage 3 or stage 4 DKD and encourage them to attend a diabetes self-management education (DSME) program. Global alerts in the health center's electronic health record were used to increase the healthcare team's awareness of services that may be needed as a result of a patient's DKD or neuropathy. The system also tracked the percentage of patients with diabetes who received an annual foot exam.

The project worked with 12 health care providers and reached over 1,100 people living with diabetes.

Contact Laura Shea, RN, MA, the New York DLI Program Director, for more information.

North Carolina

The North Carolina project worked with three community health centers (New Hanover Community Health Center, Blue Ridge Community Health Services and Gateway Community Health Center) and two free clinics (New Hope Free Clinic and Cape Fear Free Clinic) to increase diabetes patient participation in medical nutrition therapy and diabetes self-management education (DSME) programs. The project focused on updating the DSME curriculum to adequately address diabetes complications, including DKD and high blood pressure, and the community health centers tracked quality of care and health outcomes for people with diabetes. Additionally, the program aimed to improve access to community resources and increase the number of referrals from physicians to educational programs. Primary care physicians were encouraged to refer patients to nephrologists as needed.

The project worked with 37 health care providers and reached over 1,700 people living with diabetes.

Contact April Reese, MPH, CPH, the North Carolina DLI Program Director, for more information.


The Wisconsin project worked with three clinics within the Wisconsin Research and Education Network to improve quality of clinical care related to DKD and cardiovascular disease. They used tools to increase awareness and education of DKD and high blood pressure in order to improve self-management strategies among people with diabetes. The program aimed to support healthcare providers in helping their patients understand test results and to increase engagement to slow the progression of diabetes complications.

The project worked with six health care providers and reached over 500 people living with diabetes.

Contact Liz Grinnell, the Wisconsin DLI Program Director, for more information.

As part of the Diabetes Leadership Initiative, the National Association of Chronic Disease Directors developed the following materials for professionals working to serve people with diabetes:

White Papers

Additional Resources and Fact Sheets