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New report calls for action on diabetes and its complications

A new report is, once again, sounding the alarm about the state of diabetes care in this country. And this time, the sheer magnitude of the costs and complications associated with diabetes has stunned even specialists who spend every day caring for patients with the disease.

Among other staggering statistics, The State of Diabetes Complications in America points out that the country spent nearly $23 billion in 2006 just on the costs associated with treating the complications of the disease. Further, the healthcare costs of people with complications from type 2 diabetes are three times higher than that of the average American who has not been diagnosed with the disease.

Unveiled in April at the annual meeting of the American Association of Clinical Endocrinologists (AACE) in Seattle, the report is an urgent warning to providers and patients that they are not doing enough to get the disease under proper control. Further, it marks the beginning of a campaign that AACE and partnering organizations hope to use to bring more attention to the problem.

Ample room for improvement

“The earlier you intervene, and the more aggressively you intervene, the lower the risk is of developing complications,” noted Daniel Einhorn, MD, FACP, FACE, the secretary of the board of directors at AACE, speaking at the organization’s annual meeting. “What is remarkable about this report is that, despite knowing this, and despite having the tools to control blood glucose, we are still getting this high burden of complications.”

To that point, not only is diabetes the leading cause of new blindness in people ages 20 to 74, but nearly half of all people diagnosed with diabetes have eye damage. In addition, diabetes is the most common cause of kidney failure, accounting for 44% of new cases in 2002. And the disease is responsible for more than 60% of noninjury- related foot amputations, even though comprehensive foot care can prevent a large percentage of amputations. “We have a new report that clearly tells us we are not getting the job done well enough,” Einhorn said.

In breaking down the costs and prevalence statistics associated with all the major complications from diabetes, the report uses data from the National Health and Nutrition Examination Survey conducted by the National Center for Health Statistics at the Centers for Disease Control and Prevention, and the Medical Expenditure Panel Survey, a collection effort of the Agency for Healthcare Research and Quality, which is cosponsored by the National Center for Health Statistics.

Diabetics have more complications

Highlighting some of the report’s findings, Willard Manning, PhD, a professor in the department of health studies at the University of Chicago, noted that 57.9% of diabetics have one or more complications from the disease. (See Figure 4 above.) “These numbers are just incredible in terms of their implications for quality of life, mortality, and healthcare costs,” Manning said.

But those numbers aren’t even the worst of it. The cost estimates associated with the disease and its complications are actually quite conservative, he said. “They don’t include all of the other economic costs and human costs that are associated with the disease and its complications. What’s missing from this [report] are the things that are related to reduced employment, drops in productivity, increases in disability, and of course, the very substantial costs associated with premature mortality.”

The report breaks down the complications associated with diabetes into two categories—microvascular and macrovascular. In terms of numbers, the microvascular complications, including kidney disease, retinal disease, and foot problems, are particularly striking, Manning said. (See Figure 5 below.)

For example, the report suggests that nearly a third (27.8%) of all diabetics will develop kidney disease as opposed to only 6.1% of people who do not have diabetes. And foot problems occur in more than twice as many diabetics (22.8%) as nondiabetics (10%). “I had always known that type 2 diabetics have more complications than the general population, but I never quite appreciated until the report came out how big the disparity is between diabetics and nondiabetics,” he said. “In some cases, we are talking about factors of two, three, and four. That is an enormous difference.”

Road maps guide treatment

With funding support from GlaxoSmithKline, a Diabetes Complications Consortium is now in place to promote awareness of the results of AACE’s report, and to help people with type 2 diabetes reduce their risk of complications. Members of the consortium include the Amputee Coalition of America, the National Kidney Foundation, the National Federation of the Blind, and Mended Hearts, Inc. (a support group for heart-disease patients and their families).

In addition, through its Web site, AACE is distributing diabetes road maps to guide clinicians toward evidence-based treatment of the disease. “It is really an approach to help the medical community achieve good glucose control, and what it suggests are what medications can be used at what point and at what combination,” Einhorn said.

As it stands now, clinicians are using the tools available to treat diabetes too late, and the evidence shows that what is needed is earlier and more aggressive intervention, he noted. In fact, AACE is mounting a separate effort aimed at intervening with people before they have even developed the disease.

“We hope to move the discussion to an earlier [stage] of the illness where it is much more treatable and much more manageable . . . You can’t choose to not deal with this. The only question is whether you deal with the diabetes up-front or, rather, you deal with it later on, as complications. And that is a message that I think has not been heard clearly enough,” Einhorn said.

Editor’s note: For more information about the report and the Diabetes Complications Consortium, visit the group’s Web site at www.stateofdiabetes.com.