diabetes can lead to multiple, severe conse- quences such as heart attack, stroke, kidney People with diabetes cannot break down glu- cose and use it for …
Focus on Patients
Tests to Diagnosis Diabetes
Doctors use one of three blood tests to find out if a person has diabetes: the fasting plasma blood glucose test FPGT; the oral glucose tolerance test OGTT; or the random plasma glucose test Patients cannot eat for at least 8 hours usually overnight before taking the FPGT or the OGTT A random plasma glucose test can be taken without fasting A person may have diabetes if his or her blood glucose is: 1 126 mg/dL or higher on the FPGT; 2 200 mg/dL or higher on the OGTT; or 3 200 mg/dL or higher on the random test, plus symptoms of diabetes A person may have pre-diabetes if his or her blood glucose is: 1 between 100 and 125 mg/dL on the FPGT or 2 between 140 and 199 mg/dL on the OGTT The random test is not used to test for pre-diabetes Doctors will confirm whether or not an individual has diabetes by conducting a second FPGT or OGTT on another day1
Diabetes: Cost, Treatment, and Health Outcomes
This issue of PhRMAs Focus on Patients provides background information on diabetes and emphasizes the importance of adequate and early treatment for people with diabetes Appropriate treatment can prevent life-debilitating complications, improve
quality of life, and reduce health care costs While overall lifestyle changes are extremely important in controlling this chronic disease, medicines play an important role in managing it There are three types of diabetes: 1 Type 1 diabetes develops when the body can no longer make the hormone insulin Insulin regulates blood glucose or blood sugar People with type 1 diabetes must take insulin to survive 2 Type 2 diabetes develops when the cells in the body no longer use insulin properly 3 Gestational diabetes develops in some women while they are pregnant Pre-diabetes, a condition that raises the risk
Effect of Medication Treatment Among of developing type 2 diabetes and other diseases, occurs when individuals have blood Patients with Diabetes
As legislators and businesses focus on ways to reduce health care costs, spending for prescription medicines has come under increased scrutiny, particularly by the media However, prescription medicines, which account for only 11 percent of overall health care costs,2 play a positive role in preventing serious complications that can result from untreated conditions such as diabetes If left untreated, diabetes can lead to multiple, severe
consequences such as heart attack, stroke, kidney failure, blindness, amputations, nerve damage, foot and skin complications, and even death The good news is that medications and significant lifestyle changes can decrease the number of complications and unnecessary hospitalizations that can result from not treating diabetes As a result, the quality of the patients life will improve and the cost of treating the condition may be dramatically reduced glucose levels that are higher than normal, but not high enough to be classified as type 2 diabetes Ninety to 95 percent of people with diabetes have type 2 diabetes, which typically develops in older, overweight adults However, clinicbased reports and studies indicate that type 2 diabetes is becoming more common among children and adolescents3 Type 2 diabetes affects people of all ages and races However, it is more common among African-Americans, Latinos, Native Americans, Asian-Americans/ Pacific Islanders, and senior populations4
Cost of Diabetes
Diabetes is a growing epidemic and major cost burden to the health care system An estimated 208 million people in the United States or 7 percent of the population have diabetes, although 62
million or nearly one-third are unaware that they have the disease Diabetes was the sixth leading cause of death in the United States in 2002 However, it is likely to be underreported as the cause of death About 65 percent of deaths among people with diabetes are attributed to heart disease and stroke5 Proper treatment of diabetes can prevent cardiovascular complications In 2002, diabetes cost the United States 132 billion Direct medical costs for diabetes care, including hospitalizations,
Overview of Diabetes
Diabetes is a serious metabolic disorder People with diabetes cannot break down glucose and use it for growth and energy This results in symptoms like frequent urination, excessive thirst, extreme hunger, unusual weight loss, increased fatigue, irritability, and/or blurry vision
Tests to Monitor Blood Glucose Levels in Patients with Diabetes
If you have diabetes, it is important to test and track your blood glucose level This will help you and your doctor find out if your treatment plan is working To see how you are doing at any given point in time, you can check your blood glucose level at home For people with diabetes there is another test that shows how well controlled
blood glucose has been during the past few months This test is called the A1C test also known as glycated hemoglobin or H6A1c The normal A1C range for people without diabetes is about 5 percent If you have diabetes, your 
goal is to have an A1C of less than 7 percent11 According to the American Diabetes Association ADA, the doctor should check your A1C level at least twice each year at a minimum because controlling your blood glucose level helps avoid complications12 In addition, there are times when A1C levels need to be tested quarterly, according to the ADA In general, for every percentage point reduction in A1C, the risk of developing microvascular diabetic complications such as eye, kidney, or nerve disease is reduced by up to 40 percent13
medical care, and treatment supplies, were responsible for 92 billion Indirect costs, including disability payments, time lost from work, and premature death, cost the United States 40 billion6 While patients with diabetes compose 7 percent of our population, they consume 11 percent of our countrys health care dollars Much of this is attributed to the cost of treating complications of the disease, not to the day-to-day treatment of the
disease itself7 However, when placed in perspective, the undertreated patient with diabetes will incur greater costs when life-threatening complications occur, with hospital stays and necessary medical treatments resulting in lost wages and income A loss of nearly 88 million disability days in 2002 was attributed to diabetes and 176,000 cases of permanent disability were caused by diabetes, costing 75 billion8
New medicines provide powerful tools to prevent complications down the road and can help save the health care system money in the long run — Richard Dolinar, MD,
member of the Legislative and Regulatory Committee, American Association of Clinical Endocrinologists, and practicing physician
that there was significant underuse of prescription medications in seven of the nine conditions, including diabetes9 This study is compelling when you consider the incredible costs that occur when patients do not receive the necessary treatment
I almost died when I accidentally gave myself too much insulin before going to bed, causing hypoglycemic shock Today, I use a new form of insulin that gives me just the right dose I have the peace of mind that the effects of a stressful day on my
blood sugar wont throw me into an emergency room — Pat Martinez
Fortunately, advances in a number of prescription medicines offer new treatment solutions for people with diabetes These medicines can help people effectively control their diabetes, preventing severe complications As of September 2006, there are 21 new diabetes medicines in development for type 1 and 2 diabetes10 Providers, patient advocates, public health officials, and others must teach patients how to prevent and treat diabetes Undertreatment can have tremendous implications for the patients future health status, and managing complications that result from untreated diabetes can generate extremely high costs
1 National Diabetes Information Clearinghouse, http://diabetesniddknihgov/dm/pubs/diagnosis/2B 2 Centers for Medicare and Medicaid Services, National Health Expenditures, wwwcmshhsgov/ NationalHealthExpendData/downloads/highlightspdf 3 American Diabetes Association, National Diabetes Fact Sheet, 2005, wwwdiabetesorg/uedocuments/ NationalDiabetesFactSheetRevpdf 4 American Diabetes Association, wwwdiabetesorg/ type-2-diabetesjsp 5 American Diabetes Association, wwwdiabetesorg/
diabetes-statistics/complicationsjsp 6 American Diabetes Association, National Diabetes Fact Sheet, op cit 7 American Diabetes Association, wwwdiabetesorg/ diabetes-statistics/cost-of-diabetes-in-usjsp 8 Id 9 E McGlynn et al, The Quality of Health Care Delivered to Adults in the United States, New England Journal of Medicine 348, no 26 26 June 2003: 2635-2645 10 ADIS RD Insight database, Adis International accessed September 2006 11 American Diabetes Association, wwwdiabetesorg/ type-1-diabetes/a1c-testjsp 12 Id 13 American Diabetes Association, wwwdiabetesorg/ diabetes-statistics/complicationsjsp
Treatment for Type 2 Diabetes
Treatment for patients with type 2 diabetes varies according to the severity of the disease Some people with type 2 diabetes can control their blood glucose levels by changing their diet and by exercising However, the majority of patients need prescription medicines such as oral drugs or insulin injections, either alone or in combination The goal of these medicines is to bring blood glucose levels within a normal range, which in turn reduces the risk of long-term complications such as kidney failure and lower extremity amputation Reducing these longterm
risks can improve quality of life, lengthen life expectancy, and reduce the overall cost of the disease A recent study, conducted by RAND Health, analyzed nine different health conditions identified by the Agency for Healthcare Research and Quality as high priority conditions that required treatment with prescription medications RAND determined
Updated fall 2006
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