The Diabetes Care Crisis

Diabetes is a very serious disease that can lead to very serious complications (e.g., heart disease, stroke, blindness, kidney disease, amputations) and can result in premature death. In 2000, Diabetes either caused or contributed to the death of 213,062 people in the United States.

In 2002, the combined cost of Diabetes in the United States was roughly $132 billion; $92 billion for direct health care and another $40 billion for indirect costs such as disability, work loss, and premature death.

STANDARDS NOT MET

There is a substantial amount of knowledge and research on effective treatment strategies to prevent and/or delay diabetes and its complications. In spite of this knowledge, there exists a tremendous disparity between proven treatment regimens and the widespread use of these strategies. The American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) have provided medical guidelines for the intensive management of type 2 diabetes. Even with these guidelines, data from the Centers for Disease Control and Prevention suggest that less than 5% of patients with diabetes receive care that conforms to current guidelines.

People of color are disproportionately affected by diabetes and its complications. When compared to Caucasians the death rate from diabetes is 2 times greater in African Americans. There are 3 million African Americans in the United States with diabetes; 730,000 do not know they have the disease. Diabetes affects African American men at a rate that is nearly 50% greater than that for Caucasians, and for African American women the rate is 100% greater. Diabetes affects Latinos 1.9 times more often than non-Hispanic whites and Native Americans are 2.8 times more likely to have the disease than non-Hispanic whites.

LIMITED ACCESS TO DIABETES CARE

The majority of patients with diabetes receive their care from primary care physicians/providers (PCP) rather than from a diabetes specialist. There have been a number of studies designed to improve the delivery of diabetes care at the level of the primary care provider. Thus far, these studies have shown the level of diabetes care currently provided at the primary physician level to be sub-par.

BARRIERS TO EFFECTIVE DIABETES CARE

Health care providers are confronted with numerous challenges in their efforts to effectively deliver high quality diabetes care. Barriers may be patient-oriented, provider-oriented, or systems-oriented.

Diabetes outcomes have been improved by incorporating features within the health care delivery system that reduce the barriers to care. Examples of these include diabetes flow sheets, non-physician providers and diabetes self-management education.

Over the last 10 years the prevalence of diabetes has increased, while the availability of comprehensive diabetes education programs has diminished. This is due to a number of factors including: lack of qualified educators, financial resources, poor patient attendance, and inability to link diabetes education to improved clinical outcomes.

Evaluation of existing diabetes education programs highlight the need to enhance enrollment and completion of Diabetes Self-Management Training Programs along with creating innovative approaches to reach diverse populations in their native languages.

GROSSLY INADEQUATE RESOURCES

Currently there are only 750 American Diabetes Association certified programs nationwide to service the nearly 20,000,000 Americans now living with diabetes.