Impact of uncontrolled diabetes Impace of managed care Questions for health care professionals   Obstacles and Opportunities for Reducing Diabetes-Related Health Care Costs Darian Schaubert LRD, MS Project Coordinator North Dakota Diabetes Control Project North Dakota Department of Health Impact of Uncontrolled Diabetes Did You Know? The crude mortality rate for diabetes increased 46% over the past decade in North Dakota to its highest reported rate since the discovery of insulin 50 years ago. In 1994, 945 people with diabetes died in North Dakota; 17% of all people in North Dakota have diabetes at the time of death. In 1993, diabetes contributed to 48% of all newly diagnosed renal disease in North Dakota, nearly double the percent (25%)of total cases reported in 1981. North Dakota had the sixth highest rate of diabetes-related renal disease in the US. in 1989, a four-fold increase in the number of new cases since 1981. One out of every seven people in North Dakota develops diabetes. That's one person every three hours developing the disease, yet nationally only 60% are diagnosed. The direct cost of reported North Dakota diabetes-related hospitalizations increased from $25 million in 1990 to $44 million in 1994. Sources: 1994 North Dakota Diabetes Surveillance Report. Centers for Disease Control. Diabetes Surveillance, 1993. Atlanta GA, US. Department of Health and Human Services, Public Health Service, 1993 Diabetes In America, 1995; National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; NIH Publication No. 95-1468 Return to top of page Impact of Managed Care Did You Know? Formal diabetes education classes reduce the risk of diabetes-related hospitalizations by 33-73%. In North Dakota: Nearly half (43%) of insulin dependent and three-quarters (74%) of non-insulin dependent diabetics have not attended any form of diabetes education class. Overall, less than 16% of diabetics have attended the two and/or five day formal education class. Less than 25% of physicians are aware that reimbursement is available to cover the costs of diabetes education programs. Blood sugar control (average BS. level 155 mg/dl) reduces the risk of diabetes-related complications by up to 76%. In North Dakota: Less than 13% of diabetics screened had normal blood sugar levels. 49% of insulin dependent and 39% of non-insulin dependent diabetics had average blood sugar levels over 235 mg/dl (dangerously high levels). Highest rates of uncontrolled diabetes were found in the youngest age groups. People who self monitor blood sugar levels four times a day have the best level of control. In North Dakota: 13% of insulin dependent diabetics test their blood sugar levels 3-4 times per day; the same percent (13%) of people screened had normal blood sugar levels. 48% of insulin dependent diabetics test their blood sugar levels once per day or less; nearly the same percent (49%) of people screened had uncontrolled blood sugar levels. 68% of diabetics on oral medication and 75% of diabetics treated with diet alone test less than once per day. 21% of physicians do not monitor long-term blood sugar levels (only fasting blood sugar levels) which limits their ability to detect treatment problems. Through early diagnosis and treatment up to 85% of diabetes-related complications could be prevented. In North Dakota: 45% of diabetics report they have never had their feet examined by their attending physician (diabetes is the leading cause of amputations). 28% of diabetics report they do not receive an annual dilated eye exam (diabetes is the leading cause of blindness). 33-55% of physicians do not test for microproteinuria (diabetes is the leading cause of kidney disease). 62% of diabetics have blood pressure levels exceeding recommended levels. Sources: Diabetes Out of Control: A North Dakota Preventive Care Study, 1995 NDDH Economic Aspects of Diabetes Services and Education, CDC, 1992 Return to top of page Questions For Health Care Professionals How can we encourage your members with diabetes to attend the 16-hour self care education programs? How can we encourage your providers to guide their patients to these self care education programs? How can we make it easier for both patients and providers to utilize reimbursement for these preventive care services? Does your case management include talking to providers about recommended courses of treatment and available reimbursement. How can we work together to improve knowledge of providers and diabetics about the importance of these preventive care services? Return to top of page THE INVISIBLE EPIDEMIC | LEARN MORE ABOUT DIABETES | THE IMPACT OF DIABETES | ORGANIZATIONS THAT CAN HELP | BACK TO HEALTHWORKS MAINPAGE © 1998 Prairie Public Broadcasting, Inc.