by Matthew Freeby
Associate Director Diabetes Clinical Programs
Board member of the American Diabetes Association of Greater Los Angeles
November is American Diabetes Month. Nearly 30 million Americans are afflicted with diabetes mellitus –nearly 10% of our population. One in four of those with living diabetes are undiagnosed. The number of affected Americans is reaching epidemic levels and unfortunately is continuing to grow. There are an estimated 1.7 million new cases of diabetes diagnosed annually. It is well-documented that diabetes mellitus impacts health: it is a leading cause of blindness, kidney failure and amputation and a cardiovascular disease risk factor.
Yet there is hope.
When treatment goals are met, diabetes-related risks are quite low; but meeting these goals is a challenge. And it is even more difficult without the proper resources, education and expertise in place.
ACA Coverage Offers Hope
The ACA has impacted a large number of people: more than 16 million uninsured Americans gained health coverage since its passage. This offers an opportunity to reach and treat those not living with diabetes. In populations at high risk for diabetes, we are seeing an increase in coverage: in the African American community, the uninsured rate dropped by 6.8%, with 2.3 million people between the ages of 18 and 64 years gaining health insurance coverage under the ACA; in the Latino community, the uninsured rate decreased by 7.7%, with 4.2 million people between 18 and 64 years gaining insurance coverage. African Americans and Hispanics are almost as likely to have diabetes as non-Hispanic whites.
By increasing access to diagnoses, the rates of complications should be impacted in the long term. After diagnosis, coverage is critical for treatment – $322 billion dollars is spent on diabetes care alone in the U.S. This equates to 1 in 5 U.S. health care dollars. Individualized, the current average annual medical expenditure for a person with diabetes is $13,700. For those without insurance the cost of care is beyond reach.
Treatment and Education Are Critical To Health Outcomes
Proper treatment reduces rates of blindness, kidney failure and amputation substantially. This is an opportunity to avoid the worst-case outcomes of this debilitating disease. Increased access to coverage should also impact the availability of medical visits, medications and glucose monitoring supplies; each of which is critical but costly.
Of equal importance, resources should also focus on diabetes education, which has proven vital to the care of our patients. Experts suggest that education should involve a discussion of the diabetes disease process, nutrition, exercise, medications, glucose monitoring as well as treatment of acute and chronic complications. Time should also be devoted to addressing personal strategies to promote behavioral change. These discussion points can be addressed via one-on-one visits or group-based education. Studies suggest that group-based visits up to eight hours at a time are equally, if not more effective than individual visits. In communities where populations are treated, group based education is a more efficient delivery of care; a workshop can include up to 10 patients impacting a larger population. Significant others and family members are typically invited to attend too. Thus far, studies suggest formalized group-based education impacts glycemic control, weight loss and blood pressure reduction. These same studies suggest there is a lasting effect with an A1C improvement of 1% over a two year period.
In the end, the ACA has the potential to impact care and outcomes in those with a chronic disease such as diabetes. Reduction of complications is necessary with the goal to help people live longer and healthier lives. As a physician treating diabetes, I’m excited to see the potential opportunities and impact the ACA might make for our patients, providers and communities.