Saturday, June 09, 2007

Diabetes Is An Expensive Disease

"Take a walk or take an [expensive] pill."

The day you're diagnosed with diabetes is the day you'll want to begin making deposits into your own personal diabetes fund. It's also a good day to review your medical coverage. A plan that's comprehensive (includes dental and vision), with low deductibles (those were the days) and no donut hole is a good choice. Make arrangements for that plan to be with you for a long time too, because diabetes isn't something that goes away.

I've worked in this field for years. I'm humbled when I see the costs patients endure ... the costs to their health, to their sense of wellbeing, to their productivity, to their time, and to their wallet - the cost I've chosen to discuss here. I can't think of an organ system that diabetes doesn't affect. That widely distributed, long-term, insideous chipping-away at someone's vigor is difficult to watch. I can only imagine how difficult it is to experience.

The day you're diagnosed with diabetes is the day you'll begin to look back with fondness at once- or twice-a-year visits to a doctor. The schedule of healthcare visits recommended for a person with diabetes is breathtaking:
  • Physician (Minimum every 6 months, more frequently if on insulin: HbA1c, glucose, lipids, urinary protein, blood pressure, BMI, immunizations)
  • Gynecologist/Women (Yearly: breast exam, mammo, pap test, polycystic ovary, sexual dysfunction)
  • Urologist/Men (Yearly: PSA, rectal exam, sexual dysfunction)
  • Specialists: Endocrinologist, Cardiologist, Gastroenterologist, Dermatologist, etc. (As needed: stress test, micro/macrovascular disease, gastroparesis, colorectal exam, acanthosis nigricans)
  • Dentist (Every 6 months: periodontal disease, thrush, infections)
  • Eye Doctor (Yearly: retinopathy)
  • Podiatrist (Yearly: neuropathy, vascular disease, infections, ulcers)
  • Dietitian (Several visits up front then as needed: macronutrient intake, weight management)
  • Mental Health Professional (Psychosocial screening (eating disorders, mood disorders, therapy compliance, etc.) should be be conducted by your physician with follow-up by specialist as needed. The rates of dysthymia and depression with diabetes are high and may be linked to the disease.)
  • Diabetes Educator (Several visits up front then as needed: disease self-management, lifestyle)
Office visits are only part of the expense pie. There are also:
  • Pharmaceuticals (oral, injectible)
  • Medical Supplies (testing meters, lancets, strips, batteries, syringes, insulin pumps)
  • Specialty Items (glucose tablets, skincare products, software, socks, logbooks)
Most of the above are just basics. They can help people successfully manage blood glucose and other aspects of their disease (foot care1, skin care, wound care, eye care2, sick days, etc.) and stave off diabetic complications. Once a complication sets in, say neuropathy, kidney disease, or heart disease, your schedule for office visits, lab tests, and procedures gets even more crowded. Diabetes provides a non-stop revolving door to the healthcare arena.

All those visits and supplies cost.

Two studies I came across recently that attempted to document those costs:

1. Health Care Expenditures For People With Diabetes, 1992, in the Journal of Clinical Endocrinology and Metabolism:
"Per capita expenditures for confirmed diabetics ($11,157) were more than four times greater than for non-diabetics ($2,604)."
2. Economic Costs Of Diabetes In The US In 2002, in the journal Diabetes Care:
"Per capita medical expenditures totaled $13,243 for people with diabetes and $2,560 for people without diabetes."
That last figure is useful as a stand-alone amount but a little misleading in a comparison since people in their study who had diabetes tended to be older than people who didn't. Still, after adjusting for age, sex, and race/ethnicity they found people with diabetes were spending about 2.4 times as much as those without the disease.

The Bureau of Labor Statistics has an Inflation Calculator:

It can convert that $13,243 (2002 dollars) to 2007 dollars. It's based on the Consumer Price Index though, and healthcare costs have risen faster than the cost of consumer goods (and wages) in the last 5 years.

When it comes to diabetes, the saying "Take a walk or take a pill." could be more aptly worded, "Take a walk or take an expensive pill."
1 Diabetes is the leading cause of lower-limb amputations in this country.
2 Diabetes is the leading cause of blindness in this country.

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