To Change Health Care, Change Diabetes.

As we work to change health care in America, we must recognize the need to dramatically change diabetes.   Twenty-four million Americans have diabetes at a cost to our nation of an estimated $218 billion for diabetes and pre-diabetes, according to a series of studies recently published in Population Health Management.  Imagine the effects diabetes will have on our health and economy in the future if we don’t take action now. The prevalence and economic burden of undiagnosed and pre-diabetes make the case for the importance of policies that promote early diagnosis and prevention.  About 25 percent of Americans with diabetes aren’t even aware they have the disease.  And, those with undiagnosed diabetes result in $18 billion in health expenses, or $2,864 per person each year, according to one of the studies mentioned above.

The numbers associated with pre-diabetes, a precursor to type 2 diabetes, are equally as staggering.  Pre-diabetes affects an estimated 57 million Americans and costs our nation more than $25 billion a year in increased medical costs.  This translates to $443 for each adult suffering from pre-diabetes, according to another study in the series which looked at the costs of pre-diabetes.  The costs stem from the fact that people with the condition have higher rates of medical visits than those with normal blood-sugar levels.  They also seek medical attention more often for issues associated with diabetes, including high blood pressure and metabolic and renal complications. While the rates of undiagnosed diabetes and pre-diabetes are alarming, studies show that type 2 diabetes can be significantly prevented, or at least delayed, by losing weight through diet and regular exercise.  But, even with evidence supporting prevention, our nation isn’t allocating adequate resources.  In 2005, a study by the National Changing Diabetes® Program found that the federal government spent nearly $80 billion more on those with diabetes than those without the disease, and only $4 billion of that was spent on prevention and health promotion.   Early diagnosis and prevention are good places to start, but we must also take measures to improve diabetes care and management.  The first step to care improvement is to measure the quality of care being delivered in a consistent way.  A recent study (to be published) documents tremendous variability of how care quality is now being measured. Aggressive treatment is another key component of changing diabetes.  Studies show that intensive treatment to reduce blood sugar levels can delay or prevent debilitating and costly complications of diabetes, such as heart disease, stroke, blindness, kidney failure and amputation. Changing diabetes is not a simple task and requires coordination.  Strategies and activities among the 18 to 21 federal agencies that impact diabetes need to be aligned in order for us to succeed in the fight against this disease.  We must also look at our federal budget process and make adjustments to more accurately assess the long-term impact of prevention programs.  The current 10-year budget window doesn’t take into account that the value of prevention and improved treatment needs to be assessed over a longer period of time.           To truly reform health care in America, we must change diabetes.

Dana Haza is senior director of the National Changing Diabetes® Program, a diabetes leadership initiative established by Novo Nordisk to drive health systems change at the national and local levels.