DIABETES CONTROL: A GOOD INVESTMENT

Intensified blood pressure control can cut health care costs by $900 (2000 US dollars) over the lifetime of a person with type 2 diabetes. It can also extend life by 6 months.

In just 5 years, a foot care program can save $900 (2000 U.S. dollars) in health care costs for a person with diabetes who has had foot ulcers. Such care prevents amputations.

Outpatient training to help people self-manage their diabetes prevents hospitalizations. Every $1 invested in such training can cut health care costs by up to $8.76.

Preconception care for women with diabetes leads to healthier mothers and babies. Every $1 invested in such care can reduce health costs by up to $5.19 by preventing costly complications.

Regular eye exams and timely treatment could prevent up to 90% of diabetes-related blindness.

Foot care programs that include regular examinations and patient education could prevent up to 85% of diabetes-related amputations.

Treatment to better control blood pressure can reduce heart disease and stroke by 33%–50% and diabetes-related kidney failure by 33%.

EFFECTIVE STRATEGIES

Early detection, improved delivery of care, and better self-management are key for preventing diabetes complications. Here are several examples of these strategies in action:

Small Steps. Big Rewards. Prevent Type 2 Diabetes is a national campaign that targets people hardest hit by diabetes, including African Americans, American Indians and Alaska Natives, Asians and Pacific Islanders, Hispanics, and older adults. The National Diabetes Education Program (NDEP) launched the campaign to encourage people with pre-diabetes to make modest lifestyle changes that could delay and possibly prevent the onset of the disease. By losing 5%–7% of their body weight and getting just 2 1/2 hours of physical activity a week, people with pre-diabetes can cut their risk for developing type 2 diabetes by more than half.

The National Diabetes Collaborative (also known as the Diabetes Prevention Prototype) is helping federally funded health centers improve diabetes care for their patients and prevent pre-diabetes from progressing to diabetes. Three major partners are involved: CDC, the Bureau of Primary Health Care, and the Institute for Healthcare Improvement. Supported by a network of 48 CDC-funded Diabetes Prevention and Control Programs, the collaborative aims to improve care delivery systems for people with diabetes, increase people’s access to diabetes care, and help medically underserved people at the participating centers. Preliminary results are promising. A greater percentage of diabetes patients are having the highly effective A1C blood test, and the centers have identified 1,660 people who are at risk for pre-diabetes. All of these individuals have had an oral glucose tolerance test, and over 850 of them have been diagnosed with either pre-diabetes or diabetes. In addition, the collaborative is pilot-testing to identify strategies for reaching people at high risk for diabetes.

HOPE FOR THE FUTURE

Congress has given CDC the funds to expand Diabetes Prevention and Control Programs in all states, U.S. territories, and the District of Columbia. CDC currently provides 22 states with limited funding (capacity-building) and 28 states with more substantial support (basic implementation). The 28 states receiving basic implementation funds have improved preventive care practices for people with diabetes and worked with partners to improve people's access to high-quality diabetes care. Thus, CDC will continue to expand the number of state programs receiving basic implementation funds and will work with them to launch primary prevention pilot programs. Such activities generate innovations that enable states to continue preventing diabetes and improve the lives of millions of people.

GLYCEMIC CONTROL: A CRITICAL GOAL

For more information, Click Here to go to the CDC Fact Sheet

The key component of any company’s diabetes intervention should be the promotion of glycemic (blood sugar) control among its employees. Why is glycemic control critical? Keeping glycemic levels near normal will be a major factor in improving your employees’ quality of life and reducing your company’s human and economic costs from diabetes and its complications.

Two studies have looked specifically at the effect of glycemic control and diabetes interventions for employees. A 12-week double-blind study (Testa et al., 1998) of 569 individuals who had type 2 diabetes found that those who improved their glycemic (blood sugar) control

Another study (Burton et al., 1998), performed at the First Chicago NBD Corporation, found that after 3 months of attending a worksite diabetes education program, employees with diabetes had:

Although the values in this study were still higher than the ideal blood sugar range, any improvement in glycemic control has been shown to reduce the risk for diabetes-related complications.

A third recent study, conducted by Health Partners, a nonprofit HMO, looked at the inpatient and outpatient cost of its members who had diabetes*. The researchers found that those with higher hemoglobin A1c values had higher medical costs over a 3-year period. Expenses were significantly higher for each percentage point increase above a hemoglobin A1c of 7%. For example, the medical costs of a person with a hemoglobin A1c of 9% might average $2,000 more than those for a person with a hemoglobin A1c of 8%. Costs were found to be even higher if the person also had heart disease and high blood pressure.

*Testa MA, Simonsen DC. Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus: a randomized, controlled clinical trial. JAMA 1998;280(17):1490–6.

Burton WN, Connerty CM. Evaluation of a worksite-based patient education intervention targeted at employees with diabetes mellitus. J Occup Environ Med 1998;40(8):702–6.

Gilmer TP, O’Connor P, Manning WG, Rush WA. The cost to health plans of poor glycemic control. Diabetes Care 1997;20(12):1847–53.

Please note that the Health Partners study did not demonstrate that lowering glucose levels by the amounts in the study would reduce costs. The program costs to lower glucose levels are also not taken into account. Rather, it showed an association between baseline glycemic control and subsequent health care costs.