PUBLIC HEALTH
THE DIABETES Tsunami
Tom James , MD
Nearly every morning , Pittsburgh TV station , KDKA * presents a five-minute infomercial produced by the Center for Disease Control ( CDC ) featuring former Good Morning America anchor Joan Lunden talking about diabetes and more recently , pre-diabetes . It struck me that as clinicians we have a hard enough time with getting compliance from people with frank type-2 diabetes ; how can we expect people who are at risk but don ’ t have diabetes to change their ways ? After all isn ’ t that akin to trying to persuade people at risk for other conditions to actually engage in prevention programs ? We have all had problems getting the salt shaker out of the hands of our patients with hypertension , let alone convincing the 30-something who has a strong family history of early heart disease to put down the pizza and pick up the running shoes . After all , I have moved to Pittsburgh , the land of pierogis , beer and self-driving Ubers . Healthy diets , reduced alcohol , and walking are just not a part of the lexicon of the region .
So , I greeted the CDC pronouncements through its spokesperson , Joan Lunden , with more than a pinch of skepticism . However , curiosity did get to me . In 2014 , the most recent year for the evaluation , the Center for Disease Control ( 1 .) estimated that there are 29 million people in the US with diabetes . The CDC started the Diabetes Prevention Project after it estimated that there are 86 million people in the United States with pre-diabetes . So , if pre-diabetes is the pipeline to frank diabetes , then this pre-diabetes population represents a tsunami of people likely to increase the number of diabetics in the country at a time that resources are being strained . Looking at it in a different angle , nearly nine percent of the US population has type-2 diabetes . Add in the pre-diabetic population and we are talking about 35 percent of the population ( scary ). Worse still , if the pre-adolescent population is excluded , then four out of six people have diabetes or pre-diabetes . This country is far from fit .
While the CDC has made clear distinctions between diabetes and pre-diabetes to make it easier for the public , the American Heart Association , the American Association of Clinical Endocrinologists , the American College of Preventive Medicine and other specialty societies see this as a spectrum disease . Even for people with pre-diabetes , there is a recognized increase in cardiovascular and renal disease at a level much higher than the general population — even if they never progress to frank diabetes .
The numbers are so startling and the potential implications for taxing the health care system ( and the financing vehicles ) have attracted a lot of attention . The American Medical Association has praised efforts to develop formalized diabetes prevention programs
( 2 .) noting that the cost of diabetes in the United States will exceed 2 trillion dollars over the next 10 years . The American College of Physicians , representing internal medicine doctors , has developed a series of well-developed informational pieces for patients on pre-diabetes ( 3 .) Seems that everyone has gotten on-board with preventing diabetes . The YMCA has taken a lead with developing programs that meet the CDC recommendations . Academic medical centers and community hospitals have developed CDC certified programs . In Kentucky , Baptist Health has certified programs in Louisville and Lexington . Owensboro Health - inBalance Diabetes Education Program and the Diabetes Resource Center in Hopkinsville round out the certified centers in the Commonwealth beyond those at the YMCAs .
Since the concept of the continuum of disease and the real concern of potential increase in health care costs , pre-diabetes has now become a condition being addressed by the professional societies and now by Medicare . Effective January 1 , 2018 , Medicare will begin coverage of certified Diabetes Prevention Programs for Medicare beneficiaries who meet eligibility requirements ( see Table on page 15 ). The Centers for Medicare and Medicaid Services ( CMS ) is so concerned about the impending huge wave of new patients with diabetic / pre-diabetic complications that it has determined that a new benefit would more than pay for itself . This is now a Medicare version of the CDC program and is aimed at reducing the impact of diabetes-related morbidity more than the cost of administering a program . Since this new benefit is being rolled out without direct physician input , it is even more important that doctors who deal with diabetes and its complications are aware of it . While this program is being rolled out for traditional Medicare beneficiaries , it must apply to the Medicare Advantage carriers such as Humana , Anthem , United and Baptist Health Plan .
The program provides 12 months of an intervention program with at least 16 weekly one-hour motivational and educational sessions over months 1-6 of the program and at least six monthly maintenance sessions over the next six months . ( 4 .) Those individuals who lose at least five percent of their body weight are eligible for continued maintenance at three month intervals to reinforce their positive efforts . There are no copayments for eligible patients . However this is a one-time benefit with a one year maintenance reinforcement plan as currently proposed . Some commercial health plans are likely going to emulate that and may allow more repeat sessions since the longevity of a commercial member will exceed that of a Medicare beneficiary on average .
Medicare beneficiaries are covered only at CDC diabetes Prevention Recognition Program ( DPRP ) programs . The list is likely
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