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The Dose - JK Wall

Welcome to The Dose, which tackles the finances behind local health care and life sciences and points to the most interesting national analysis. Your host is J.K. Wall.

Health Care & Life Sciences / Life Science & Biotech

The price we pay for diabetes

May 15, 2015

A new study, which I'll describe shortly, calculates that people with diabetes generate more than three times as much in health care every year as those without the disease.

That sounds about right to me. I saw the steep cost of diabetes up close when I was just a kid.

In 1991, my grandfather died while sleeping in his bed in my family’s dining room. I was 12 years old
 
It was cancer that technically killed him, but it was obesity and diabetes that turned a vigorous young man into an incapacitated old man.
 
My first painful memory was watching him inject himself with insulin.
 
Then he lost the ability to walk and had to use a wheelchair.
 
Then he developed a massive boil on one of his legs and had the lower half of that leg amputated.
 
Once he had to go to the hospital—an ambulance made a special trip to our house from the nearest hospital, which was 20 minutes away.
 
My grandfather’s diabetes was the result of poor kid who grew up to be fairly financially successful, and then enjoyed it a bit too much.
 
He went to a one-room school in the coal-mining town of Jasonville, Indiana, in the 1930s. He was in great shape as a young man. There is a black-and-white photograph of him in my parents’ house that shows him as a buff lifeguard in his late teens or early 20s. He was on the Indiana University football team during his brief stint in college.
 
He achieved affluence as an insurance salesman and sales manager. So he drove a Cadillac . He ditched the cigarettes of his youth, but replaced them with cigars and pipes. He loved rich food—the only time I ate at the King Cole restaurant growing up was when my grandfather was buying.
 
When my grandfather died, only one out of every 17 Hoosier adults had diabetes. But today, that rate has nearly doubled to one out of nine.
 
If you want that in percentage terms, the rate of adult diabetes rose from 5.8 percent of Hoosiers in 1990 to 11.0 percent in 2013, according to surveys conducted by the Indiana State Department of Health.
 
What’s the cost impact of that increase? A new study from the Health Care Cost Institute shows that for employer-sponsored insurance plans spend nearly $10,700 more every year on medical care for a person with diabetes than for one without diabetes.
 
That’s $14,999 for diabetics and just $4,305 for non-diabetics.
 
Across Indiana, there are 548,613 adults with diabetes. That’s 259,344 more Hoosiers with diabetes than there would be if the rate of diabetes was the same as when my grandfathered died.
 
That means as a state, we’re spending $2.6 billion more on diabetes care than we would be if we just had kept diabetes at the same levels they were in 1990.
 
That’s nearly $400 per person every year. And that’s not even counting the rising costs of childhood obesity. The Health care Cost Institute study includes the costs of adolescent diabetics, which are no cheaper than working-age adults.
 
It’s not like the situation was good in 1990. Indiana’s rate of adult diabetes, even then, was 60 percent higher than the national average.
 
But if Indiana had maintained its diabetes rate from 1990, it would today be 35 percent BELOW the national average.
 
So this isn’t just a problem of fatso Hoosiers pigging out while states full of “vegetarian runners” (in the memorable phrase of one of my readers) are doing fine. This is a nationwide problem. In fact, it’s a global problem.
 
Obesity and diabetes have been rising worldwide for the past 30 years, as Dr. Ram Yeleti, president of Community Physician Network in Indianapolis, pointed out at an IBJ Power Breakfast in 2012. And that suggests there are social and systematic aspects to it, not just changes in individual behavior.
 
“Just in the past 30 years we’ve had an obesity epidemic and so the past 2 million years we haven’t. So to say that the patient’s personality and behavior suddenly changed so they want to be fatter is obviously absurd,” Yeleti said. “Obesity itself is a system, is a cultural issue, it’s not an individual freewill issue by itself.”
 
Some think genetic modification of our food has messed with our bodies. Some point to the fact that, with far more homes filled with two working parents, it’s far harder for families to cook and eat healthy meals. Some think it's purely a function, at least in the United States, of people overconsuming food because it is cheaper now than at any time in history. Yeleti thinks it's partly a failing of the health care system, which has not typically provided incentives to doctors and patients to help to counter the broader cultural forces.
 
My grandfather’s style of diabetes came on because of the drop in metabolism and increase in insulin-resistance that occur in most people after age 45—combined with the fact that folks at that age are typically earning some of the highest wages of their life and yet they are less physically active.
 
But today we tend to skip the skimpy eating of the Depression, as well as the lifeguard and football playing phases, and jump right into the success-enjoying phase.
 
From an early age now, most of us adopt a diet of soda, lots of white breads and lots of low-fat foods filled with sugar to make up for the lack of fat (we tried to take saturated fat out of foods under the increasingly dubious belief that doing so would reduce the risk of heart disease, missing that sugar and carbs contribute even more to heart problems).
 
We then try to keep up this regimen for decades with only sporadic exercise and too little sleep, both of which can also contribute to diabetes.
 
The rate of diabetes is also rising because we are older, overall, than we were 25 years ago. And, thanks to advances in medical science, we have more tools to detect and fight diabetes than we did before.
 
But as diabetes becomes so common, it’s important not to forget it’s a devastating disease. It’s devastating to employer and health insurers’ finances—and by extension the premiums we pay for health insurance and the taxes we pay to support Medicare and Medicaid.
 
And, as my grandpa’s last years show, it’s devastating to everyone who suffers from it—and those who suffer alongside them.

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