A good use of health care dollars

According to recent statistics from the American Diabetic Association, 25.8 million Americans have diabetes mellitus, a condition where the body does not process glucose, or sugar, efficiently.  Instead of glucose making it's way into cells, it stays in the blood stream, causing a slew of medical problems over time, including but not limited to blindness, kidney failure, heart disease and vascular disease, which increases risk of amputation.

The cost of diabetes in America is staggering.  In 2007, the cost of providing care for this disease was $218 billion dollars.  That is not a typo.  To put this in perspective, heart disease in 2009 cost us $316 billion (and is a complication of diabetes), and cancer care in the U.S. is expected to reach ~$160 billion by 2020.

The incidence of diabetes in America is increasing, so the above statistic is just the beginning.  Americans are more and more sedentary (both at home and at work), and our diets are high in starchy foods, such as pizza, pasta, rice, potatoes and breads.  We have trended away from preparing our own meals, instead opting for fast food.  Our intake of fruits and vegetables isn't enough, and when we do eat them, it's usually with a caramel dipping sauce or ranch dressing.  It's not good.

Once someone becomes diabetic, I aggressively educate them on behavior modification.  Exercise more, even if it's going for a long brisk walk.  Cut back on those starchy food, and replace them with more proteins or veggies.  Drink more water.  Really count your calories for a few days, just to see how much you are eating (people are usually amazed they are eating as much as they are).  Information is power, and once you show the patient the data, it really can change their behaviors.

Part of that data is blood glucose testing.  Each physician is different, but I tell my patients to check their fasting morning sugars, before breakfast, and the to check 2 hours after meals, to see how high their numbers go.  If their sugars are really high, they can correlate that high number with what and how much they ate.  It's pretty easy.

Data is king in this disease, and it brings me to the crux of this post.  The cost of testing.

I am simply amazed at how much diabetic testing supplies cost.  For some of my patients, the cost of testing is significantly more than the cost of their medicines.  I have patients tell me regularly that they don't test their sugars as much as they would like because of the cost.  This simply is unacceptable.

Data is a funny thing.  It's just information.  It lacks emotion.   That changes when the data comes from a drop of someone's blood.  It's a snapshot of how someone "is".  When patients see their how abnormal their blood sugars are, they respond emotionally.  They feel bad about it, ashamed, angry.  They take it personally.  This emotional reaction becomes a powerful tool for change, specifically, behavioral change.   Once patients improve their behaviors, their blood sugars also improve, and it feels good to see that objective change in their data.  It's positive emotional reinforcement.

I challenge the system to provide testing supplies to all diabetics.  For free.  No strings attached.  If you remove the financial disincentive to testing, patients will be more apt to do it.  In order to make a dent in the end cost of this disease, we need to improve the access of diabetics to their own blood sugar data.  I would expect the cost savings to be significant.  Improved glycemic control means fewer heart attacks, amputations, dialysis and blindness.  It's not rocket science.

There isn't a reason why this simple plan couldn't be put into place immediately.  Big Medicine - are you listening?