Paying for diabetes: Disease, complications cost U.S. more than $170 billion

Monday, January 16, 2012
John McMullin, owner of John's Pharmacy in Cape Girardeau, demonstrates blood sugar testin (Kristin Eberts)

More than 25 million people in the U.S. have diabetes, according to the latest numbers from the American Diabetes Association. More than triple that number -- 79 million people -- have pre-diabetes. And the doctors' bills for all those people add up. In 2007, the total cost of diagnosed diabetes in the U.S. was $174 billion.

"Diabetes affects every part of the body," says Dr. Darren Allcock, endocrinologist with Southeast Endocrinology.

The disease leads to complications with the nervous system, vision, kidney function, the vascular system and blood pressure; it can also lead to heart disease and stroke.

Treating those complications is often where the medical expenses add up for diabetics.

"The more likely you are to develop complications, the more the cost to the system," says Dr. Phenu Zachariah, endocrinologist with Cape Diabetes and Endocrinology. "Renal failure leads to dialysis. With eye problems, you may need laser treatment. Blindness brings many other costs for daily living. If (diabetes) leads to amputation, it limits activity; if you have a physical job you may not be able to do it." And the list goes on. "The cost to the system itself is tremendous when people don't take care of diabetes."

And the complications can compound on each other. Nerve problems, for example, often start in the feet. "It starts with the longest nerves, the tips of the toes, and the hands as well, and proceeds up," Allcock says. "People lose sensation or get pain in the toes, progresses to the feet, then the ankle toward the knees. Then you add blood vessel problems with low circulation and you're set up for a problem."

With nerve damage in the foot, a diabetic may injure his foot without knowing it, which then leads to infection, which could result in amputation.

There are ways for diabetics to manage the disease and minimize costs, however.

John's Pharmacy in Cape Girardeau offers diabetic shoes and socks and support stockings to help minimize injuries to the feet. "Calluses and blisters can be very dangerous," says pharmacist Nicole Lee, who is board-certified in advanced diabetes management. "We have Carol Jenson, who is a certified pedothorist. She has taken extra classes, certification and exams to custom fit diabetic shoes for patients."

It is also important for diabetics to manage their disease with diet and exercise to maintain optimum health. "Diabetes is primarily a disease of self-management," Zachariah says. "Doctors see people once every three months. So that's 89 days [between appointments] a physician has no say-so. The patient determines diabetes management of what to eat, how much to exercise. The more information you have about your diabetes and how it is affected by what you do, the better you'll be able to get sugar under control. ... It is important for individuals to know themselves and what works for them."

Blood meters and test strips are tools diabetics can use to monitor their sugar -- they also add to the cost of treating the disease. But assistance is often available for those who need it. "We offer free meters and low-cost test strips," says Lee of John's Pharmacy. "We troubleshoot a lot of meters." She says they also work with people who have questions about getting test strips paid for by insurance.

Allcock stresses the importance regular checkups: "They'll do screenings on a regular basis to show average blood sugar, kidney function." He says having feet checked by a podiatrist once a year and an annual dilated eye exam are standard things to help manage the disease and avoid or delay complications.

The best way to curtail the cost of diabetes is to prevent it. "Pre-diabetes is the time to catch up," Allcock says. "The upfront cost of preventing it is minimal compared to the cost of treating it once problems occur."

Again, diet and exercise are the way to ward off diabetes.

"It's important to realize that it's a lot cheaper to eat garbage," Zachariah says. "Processed foods with lot of calories are cheaper. It costs a lot in the short term to eat healthy, which is unfortunate. (But it is) less costly to never get on medications."

Allcock suggests focusing on reducing total calorie consumption rather than following a specific diet.

As for exercise, Zachariah says the ADA recommends 150 minutes of activity a week, noting a prediabetic should aim to facilitate 8 percent weight loss.

Zachariah says he was struck by something a fellow physician recently told him. "He says to think of diabetes in terms of patriotism," Zachariah says. "He was saying 'How is it that we plan on being a country that can be industrious and make strides in industry and the amount of product we can offer the rest of the world when everyone is so deathly ill?'"

Diabetes by the numbers

* 25.8 million children and adults in the U.S. have diabetes. That's 8.3 percent of the population.

* 1.9 million new cases of diabetes were diagnosed in people 20 and older in 2010

* Adults with diabetes have heart disease death rate about 2 to 4 times higher than adults without diabetes

* The risk for stroke is 2 to 4 times higher among people with diabetes

* In 2005-2008, 4.2 million people 40 and older with diabetes had diabetic retinopathy

* In 2008, 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant

* 60 percent to 70 percent of people with diabetes have mild to severe forms of nervous system damage

* More than 60 percent of nontraumatic lower-limb amputation occur in people with diabetes.

Source: American Diabetes Association 2011 National Diabetes Fact Sheet

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