diabetes, a metabolic disease in which the. body has difficulty converting food into fuel. “People with diabetes have a shortage of. insulin or a decreased …
Institute for Alternative Futures
FORESIGHT SEMINARS ON HEALTH INNOVATION
Supported by an Educational Grant from Novo Nordisk, Inc
The Looming Diabetes Crisis: Can it be Prevented?
Meeting Summary
Foresight Seminar Meeting, June 23, 2006 Room B-338, Rayburn House Office Building
The Foresight Seminar panel included:
Tom Boyer, Executive Director of Diabetes Care Coalition Dr Francine Kaufman, one of the nations foremost pediatric endocrinologists and
professor of pediatrics at the Keck School of Medicine of the University of Southern California and Childrens Hospital Los Angeles
R Stewart Perry, Vice Chair of National Board of Directors of the American Diabetes
Association
Dr William Rowley, Senior Futurist and Chief Operating Officer for the Institute for
Alternative Futures
Preventing the Worst Case for Diabetes Requires Action Now
Can the US prevent a rise from todays 21 million cases of diabetes to 50 million in 2025? This startling rise in diabetes will come from trends in childhood obesity, an increasingly obesogenic environment and an aging population The Institute for Alternative Futures held its 116th Foresight Seminar June 23 in the Rayburn House Office
Building to offer the nations policy makers options for preventing the worst of this crisis The likely 2025 scenario if we continue along our current path, according to Futurist Rowley, will be 622,000 deaths related to diabetes One in three of todays children will have diabetes that year and 50 will be obese Life expectancy in America may actually decline as children and young adults with diabetes die, on average 11 to 16 years earlier than normally expected Dr Kaufman, who has been treating children with diabetes for 25 years as a pediatric endocrinologist, noted that she saw virtually no type 2 diabetes in children before the 1990s But now, 25 of her new patients are children with type 2 diabetes, a disease once called adult-onset diabetes Diabetes is increasing rapidly in children This trend creates a real possibility that our grandchildren may have shorter and live less healthy lives than we do
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Paying for Treatment But not Prevention
Current diabetes treatment puts effort and money in the wrong places Treating diabetes and its complications amputations, kidney failure, blindness, and heart conditions is very expensive Diabetes care often starts late when the costs are much
greater Medicare does not pay for education and coaching It does not pay for pre-disease This presents health care providers with the most perverse incentives imaginable But it is how we finance our entitlement programs, Rowley said Perry of the ADA agreed Our reimbursements for diabetes treatment do not reward prevention or good care It does reward doctors and hospitals if they amputate your leg or put you on kidney dialysis Prevention is the least costly approach Major surgeries damage the health and finances of both the patient and the healthcare system Perry and Rowley both called for fixing the payment system so that it rewards healthy living and early diagnosis of diabetes and its complications in order to achieve timely, effective treatment
Diabetes More Prevalent than the Priority it Receives
Spending for diabetes is not only misdirected, it receives far too few resources given the prevalence of the disease Diabetes care advocate Boyer compared the governments approach to preventing diabetes to its aggressive focus on other diseases such as HIV/AIDS Approximately 11 million people live with HIV/AIDS in America There are 43,000 diagnosed and 16,000 deaths annually The
Federal Government almost unilaterally finances this initiative, and about 560,000 Americans receive care through a federally financed system at a cost of about 22 billion annually CDC funds prevention and education programs for HIV/AIDS with an annual budget of well over 650 million For breast and cervical cancer there are about 100,000 cases diagnosed each year Care is generally covered, with presumptive Medicaid eligibility available CDC funds prevention and education programs with an annual budget of at least 270 million Government programs have played an important role in reducing the reach of these diseases Then Boyer turned to diabetes Today, 208 million people live with diabetes, and there are about 15 million new patients each year The per capita total costs of diabetes are over 13,000 per year Over 40 million live with pre-diabetes Government provides little to no safety net and greatly restricts available assistance for most with or at risk for diabetes CDC oversees prevention and control programs for diabetes that receive only about 60 million annually Such a comparison clearly shows how government programs on diabetes lack resources to have an impact
Number of People
with Disease Diagnoses Annual Funding for Funding for Prevention
BREAST CERVICAL CANCER HIV / AIDS DIABETES
100,000 11 million 43,000 16,000 208 million 15 million 213,062 over 40 million with pre-diabetes
Generally covered by presumptive safety net/ 270 billion medicaid 22 billion Federal 650 million CDC little or no safety nets 60 million CDC Diabetes: over 13,000 per capita costs
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Policy Actions that Can Help Avert the Crisis
Rowley identified ten factors that could stem the twin epidemics of diabetes and obesity: prevention, screening, behavior modification, management of chronic disease, empowered self care, appropriate technology advances, personalized medicine, access to care, altering the obesogenic environment, and addressing the social determinants of health Kaufman reinforced the need to focus on schools Neighborhoods and communities need to focus on better nutrition and foster physical activity Boyer called on law makers to increase government support for the prevention and management of diabetes Perry noted that even though diabetes is one of the most important health challenges facing the United States, currently there is no national plan to deal with diabetes
or obesity Federal healthrelated agencies and some states have plans but these are not consistent or coordinated An effective national plan is needed A national dialogue is needed on strategies to prevent the looming crisis of type 2 diabetes and to improve the health systems management of both type I and 2 diabetes Preventing the growth of type 2 diabetes is a monumental challenge that will require not only action on the national level, but at the state and local level as well Combating the twin epidemics of obesity and diabetes will require us to change how we structure our lives and communities, and how we care for those with the disease A national plan with state and local actions will require dialogues in families and communities A national plan should include support to change policies for funding, health care and our own behavior modification
Additional Resources Reports Diabetes Forecasts to 2025 and Beyond: The Looming Crisis Demands Change
Dr William Rowley and Dr Clement Bezold 2005
THE DIABETES EPIDEMIC: The Case for Changing Diabetes
The Institute for Alternative Futures and Yale University Schools of Public Health and Medicine 2005
Diabetes Obesity 2025: Four
Future Scenarios for the Twin Health Epidemics
The Institute for Alternative Futures 2006 http://wwwaltfuturescom/foresight/Diabetes_Scenarios_June_1stpdf
Books Diabesity
Kaufman, MD, Francine R New York: Bantam Books, 2005
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Source:leg.state.mn.us
