Physician intervention critical as diabetes costs skyrocket

More than 100 million people in the U.S. live with diabetes or prediabetes, according to the latest news from the Centers for Disease Control and Prevention (CDC).

Furthermore, diabetes racks up a behemoth $245.5 billion in healthcare costs, and costs American employers $20.4 billion thanks to 57 million unplanned, missed workdays this year, according to the latest Gallup-Sharecare Well-Being Index, which utilizes well-being metrics.

Gallup asked respondents to self-report about their height and weight. Obesity has risen about 3 percentage points since the first year of the Well-Being Index, from 2008 to 2016. The rate was 25.5% in 2008 and is now 28.2%, according to Dan Witters, research director for the index. For every three units that obesity rises, diabetes rises about one unit, he says.

"When obesity rates rise, diabetes numbers climb with it," Witters tells Medical Economics.

The survey looked at working adults, aged mid-20s through mid-60s. "People who are obese in that age group are four times more likely to have been diagnosed with diabetes," he says. Rates are even higher within the African-American, Hispanic and middle-aged demographics.

It's easy to think that everyone who's overweight knows what to do: eat better and get more exercise, à la "calories in, calories out." One can also assume that people with diabetes know that they must be very vigilant about controlling their blood sugar. But it's not that easy.

"If you look at a newly-diagnosed diabetes patient, only about 6.8% of those individuals actually receive education in the first year of diagnosis," says Sheila Holcomb, RD, LD, CDE and vice president for health and wellness engagement platform provider Sharecare Diabetes Solution.

"It would follow that in their first year of diagnosis, a patient would learn how to eat healthy and how to take medications-how to be engaged in their diabetes management," she says.

Physicians can play a pivotal role in initiating and continuing meaningful conversations with patients, says Witters, therefore encouraging all-important patient compliance. Many people find it intimidating and even difficult to accept a chronic condition and to contemplate managing it for the long term.

Next: Having honest conversations

Make it clear

An untold number of Americans simply cannot afford to seek treatment for diabetes. Consider that the number of Americans who had high-deductible insurance plans in 2016 was 39.3% last year, according to the CDC's National Center for Health Statistics.

"Cost may prevent those with high-deductible plans from going to a diabetes education center that can help lower the risk of acute and chronic complications that occur with diabetes," says Holcomb. "Healthcare providers need to have honest conversations about long-term complications of diabetes if individuals with diabetes don’t adapt healthy lifestyles."

Conversations around A1C illustrate an excellent example, she says. "Patients may think they understand, but they may not realize that A1C is a three-month average of blood sugar. Saying, for example, that it's '9%' sometimes doesn't mean anything to the patient when their blood sugar is averaging around 212mg/dl. Sending a patient to a certified diabetes education center to talk to registered nurses and registered dietitians about blood sugar, weight loss and blood pressure, can be so helpful."

Additional support when patients leave the doctor's office is so important, Holcomb says. "Changing lifestyle behaviors for the better means blood sugar can come down and slow the progression of prediabetes to diabetes or simply slow the development of diabetes."

Employers have options

Holcomb says surprisingly, less than 50% of employers offer any type of on-site lifestyle behavior modification programs. And they seem to be paying a price.

Gallup's and Sharecare's research found that full-time workers with diabetes miss an average of 5.5 extra workdays per year, while part-time workers with diabetes miss an average of 4.3 extra workdays per year. That adds up to the 57 million unplanned work days among employees who have been diagnosed with diabetes compared to those who haven’t, after controlling for demographics and body mass index (BMI). Researchers applied a value of $354 day to get to $20.4 billion in losses for employers.

Physicians can encourage employers who are patients to consider the advantages of a diabetes education program. Local hospitals and health systems with diabetes centers will often come on site to conduct these programs, even over lunch, says Holcomb. It's an ideal time to discuss the merits of a healthy diet and its critical role in diabetes management.

Next: Treating the whole person

Treat the 'whole person' patient

Well-being is an all encompassing term. "We've examined and tracked many thousands of adults over time," Witters says. "We've also examined well-being as a predictor for disease states including diabetes, after controlling for age, race, ethnicity, education level, gender and BMI weight class. People who have a high level of holistic well-being have a substantially lower chance of onset of diabetes in the future."

In addition to physical well-being, which includes fitness, other critical components include:

• Social well-being: love and friendship in a person's life

• Financial well-being: living within means and managing wealth

• Community: how attached people are to community and how proud and safe they feel as well as how they give back

• Sense of purpose: forward momentum about what a person does, and how that pairs with natural abilities

Physicians who view a patient holistically from all perspectives can help impede disease burden overall, says Holcomb. 

Ongoing education

Holcomb encourages physicians to maintain comprehensive, state-of-the art knowledge around diabetes management for their patients. "New medications seem to be available almost monthly, so being up-to-date about them can really help, especially since many of them work well together," she says.

Physicians who follow standardized and evidence-based protocols for treatment of patients in an acute-care setting in the hospital and in ambulatory settings in medical practices have an advantage, she says. "We've had success with leveraging advanced nurse practitioners, board-certified in diabetes management, to help with the care and treatment of diabetes patients, especially when they coordinate with other specialists."