Thursday, November 09, 2006

November 14 is World Diabetes Day

Well, I did not exactly meet the deadline for the recent D-Blog Day, but I did post a number of blog posts more than usual during the past few weeks which I think qualifies me, and I have tried to comment on other's blogs since there were so many great posts. However, I did want to post a comment on World Diabetes Day, which is on November 14, 2006. World Diabetes Day is "celebrated" every year on November 14, chosen as it is the birthday of Frederick Banting who, along with Charles Best, first conceived the idea which led to the discovery of insulin in 1922.

My own thoughts are that Banting and Best's discovery of insulin was a mixed blessing. Sure, I am alive thanks to their discovery, but at the same time, the discovery also shifted the focus away from finding a cure by making diabetes a disease that we could live with because it was no longer seen as a deadly condition. Should we be celebrating this, or cursing it instead? That is a debate that many who live with this condition justifiably question. I will not resolve that debate here.

But we should use this occasion to focus on this year's theme of "Diabetes Care for Everyone". While these events are often focused on less developed countries in Africa and elsewhere, we should not forget that many patients with diabetes in the U.S. do not receive proper care. Approximately 46.6 million Americans were uninsured last year (or about 16% of the U.S. population) according to data from the U.S. Census Bureau. Given that around 6% of people in the USA have diabetes, of the approximately 46.6 million people with no healthcare cover, we can estimate that around 3 million people with diabetes in the U.S. have either insufficient cover for reasonable healthcare, or receive no care at all. Even more troubling is the fact that one the fastest-growing segments of the newly uninsured are people with jobs. According to the Kaiser Family Foundation, only 60% of U.S. employers offered health coverage during 2005, which is down from 63% in 2004 and 69% in 2000.

A few weeks ago, The New York Times ran an article on how some hospitals were finding it cheaper to provide patients with chronic conditions like diabetes free basic care than it is to see them in for emergency care later. There was a relevant chart showing just how widespread the uninsured are across the U.S. in that article which I have posted below. (If you'd like to read the complete article, you may do so here).

Interestingly, New York City recently implemented an involuntary diabetes registry which takes patients' hemoglobin A1C test results without disclosure. (Naturally, I am leading the charge to challenge this. I have established a website at with more information). NYC Health officials claim the plan will reduce uncontrolled diabetes by 20% during the next few years, but I think they are living in Neverland. The question health officials should be asking is why people do not properly care for their condition? We all know that caring for diabetes costs money, but the uninsured pay more for medicines than insurance companies pay for the same medicines, and low-income neighborhoods being targeted have a higher level of uninsured (this was established in a report published back in 2000 called "Five Boroughs, Common Problems: The Uninsured in New York City," by David Sandman and Elisabeth Simantov with The Commonwealth Fund.) Based on IMS Health data, excluding the effect of rebates, the typical cash customer paid nearly 15% more for the same medicines than did customers with third-party coverage. For a quarter of the most common drugs, the price difference between cash and third parties was even higher -- over 20%. I believe that the NYC diabetes registry will not deliver the health department's projected improvements because it overlooks the uninsured (many of whom do not even have A1C's done). I was recently interviewed by CBC television on this very topic as it related to the NYC Diabetes registry. You can view my television interview here!

The data supports my claims. Uninsured adults with diabetes are less likely than those insured to receive the professionally recommended standard of care for monitoring blood glucose levels and other complications. Uncontrolled blood glucose levels puts persons with diabetes at increased risk of hospitalization and additional complications (e.g., heart and kidney disease) and disability (e.g., amputations and blindness). It is hard to imagine, but on average, 25% of persons with diabetes go without a checkup for two years if they have been without health insurance for a year or more compared to just 5% of diabetes patients with insurance. Of course, the longer diabetes patients go without health insurance, the greater the chance they will experience uncontrolled blood-sugar levels. In addition, uninsured people with diabetes are also significantly less likely to receive regular foot and eye exams, which as we know can help prevent blindness and amputations. (see the full report here)

In honor of World Diabetes Day, we should reflect upon the issues impacting people with diabetes not only in the far reaches of the world, but right here in the U.S. In fact, a report recently published by the International Diabetes Federation in March 2006 (Volume 51, Issue 1) of Diabetes Voice, their quarterly magazine entitled "Health insurance for all: the key to improved diabetes management" highlighted the issue of U.S. healthcare coverage and its impact on diabetes care. The U.S. has some serious health problems to deal with, and many Americans with diabetes are suffering as a result of our peculiar healthcare delivery system. My hope is that now that a new Congress lead by a party which has traditionally been more involved in domestic issues has been elected, perhaps we'll finally start to address some of these issues.


George said...

Scott, I really like the thought that the discovery of insulin is bitter sweet. I have never thought of that but it is so true.

Kassie said...

good stuff, Scott. I absolutely agree that the focus of World Diabetes Day - the disadvantaged and vulnerable of the world - include folks here in the US.

Re the registry, I can't believe that the opt-out is for *contact* ony, not for opting out of reporting. Unreal!

Sarah said...

Not having insurance would certainly change the face of my diabetes care. My insurance covers 15 test strips per DAY! Out of pocket expenses are astronomical for diabetes care.