Just this month UCLA researchers determined that 46% of California adults have pre-diabetes and most don’t know it. Another 9% are already diagnosed with diabetes. This means trouble, really big trouble.
In the LA Time’s piece covering the diabetic disaster, Dr. Francine Kaufman, the former head of the American Diabetes Association, sounds an alarm, “It’s not stopping.” Well, it’s not stopping because we do practically nothing to stop it. We mostly treat after the disease is diagnosed.
In 2012 economists estimated an appalling 41% increase in costs for treating diabetic patients over just five years. Researchers estimate costs at $1000 per year per capita–not just those diagnosed with disease. You would think that insurance companies would be all over reducing risk of disease, and you would be wrong.
MEDICARE AND PRIVATE INSURANCE BLOCKING GREATER ACCESS
Today I’m looking at two insurance claim statements for two different clients diagnosed with pre-diabetes, one from Medicare and the other from Anthem Blue Cross, a private insurer . Both agencies offer $0.00 to reimburse them for costs of medical nutrition therapy. Today most insurance companies don’t and won’t pay for nutrition education and medical nutrition therapy for pre-diabetes.
Prevention allows patients a better chance to dramatically reduce the risk of developing diabetes in the future because MNT steps in earlier in the curve, helping to calm inflammation and preserve beta cell function. Imagine the savings as we decrease, delay, even prevent costly complications down the road!
Americans spend 20% of our bloated health care budget to treat diabetic patients, with the vast majority of patients diagnosed with Type II diabetes— a condition decades in the making. Most costs ramp up when treating more severe illness and late stage complications, specifically medications, doctors visits and hospitalizations that treat long term conditions like heart disease, kidney failure, blindness, painful neuropathy, cancer, and Alzheimer’s disease. Anyone concerned by the increasingly high cost of health insurance should be screaming for reform.
WHAT IS PRE-DIABETES?
By the time a patient is diagnosed with pre-diabetes, blood glucose levels are on the rise. While not high enough for a diagnosis of type II diabetes (fasting blood sugar [FBS} above 126 mg/dl or a HgbA1c level above 5.7), pre-diabetes is diagnosed when FBS are measured somewhere in the vicinity of 100-126 mg/dl.
Rising blood sugar levels can mean many things, but increasing levels of sugar in the blood is code for distress. Your body can’t handle any one or a mix of lifestyle factors: your current diet, lack of exercise, current medications, level of stress, lack of sleep, a temporary infection or trauma.
Basically your pancreas is sending an SOS. It is likely spewing insulin to reduce glucose in the blood in an attempt to minimize damage to fragile capillaries and other tissues, but for whatever reason the cells in your body are not sensitive to the action of insulin. This is why we call the metabolic insult “insulin resistance”.
WHO’S AT RISK?
Some factors that increase risk of type II diabetes remain out of direct control. Family history plays a role, especially a history of diabetes, heart disease and weight issues–the kind of weight that contributes to an apple shape. Even relatively thin or “normal BMI” folks can develop the deep visceral fat stores linked to the metabolic mess of diabetes and other inflammatory disease states.
Kids born to a mom diagnosed with gestational diabetes during pregnancy are thought to be eight times more at risk for diabetes themselves. Higher risks occur for offspring of women diagnosed with Polycystic Ovarian Syndrome as well. PCOS is a sister state of insulin resistance, with symptoms more intense than that experienced by those with type II diabetes.
However, sometimes type II diabetes occurs with few clues why. Increasingly researchers look to environmental factors that influence everything from pollution and pesticide residues in food to the health of our gut microbiome. Many persistent organic pollutants (POPs) and other endocrine disruptors impact glucose tolerance (another way to describe how sensitive your body is to the action of insulin.)
Today every living organism carries a body burden of persistent organic pollutants. Researchers measure the burden in polar bear blubber living in the Artic north as the contaminates travel the globe and permeate our environment.
Communities with the greatest exposure to these engineered chemical agents experience the greatest concentration. Today farm workers and farming communities draw intense scrutiny as much higher rates of obesity, diabetes, asthma, allergy, and a whole host of other inflammatory diseases are seen in these vulnerable populations.
CAN WE REDUCE OUR BODY BURDEN OF ENDOCRINE DISRUPTORS?
Ninety five percent of POP body burden comes from the food we eat. POPs disperse into the air, the soil, and water. They are taken up into the food supply, and they bio-accumulate up the food chain.
While shifting to a vegetarian diet may seem like a good idea, most people with diabetes need to count their carbs. Carbohydrate rich foods, even the most fiber rich sources like beans and produce, need to be carefully balanced to avoid over taxing the already struggling pancreas. Eating adequate protein and fat tips the metabolic balance in a diabetic’s favor, and most of my clients find it’s easier when eating adequate nutrient dense meats, poultry, fish, and dairy products.
However, animals foods reside close to the top of the food chain and generally carry a higher burden of POPs. This presents a dilemma with an opportunity. Consumers minimize exposure when they purchase better food–food grown with fewer pesticides, fungicides, herbicides, hormones and antibiotics that are increasingly suspected of compromising health. Basically we need to step up and spend more money on better food, and less on health care.
HOW WE GROW FOOD MATTERS
My sense is that there is a reason organic food sales continue to rise in double digit percentages while sales of conventional food products stay flat at best. Consumers understand the link between better food and better health.
Grass fed beef now accounts for 8% of all beef sold, with sights on 20% by 2020 if sales continue to grow at the current rate. Consumers tap into resources such as Monterrey Bay’s SeaWatch, and the Environmental Working Group (EWG) and other organizations to guide more sustainable food choices.
However, while consumers attempt to take matters into their own hands, the alarming incidence of pre-diabetes tells me most could use some help.
MOST HEALTH CARE SYSTEMS COVER MORE FOR LESS WITH BETTER OUTCOMES
In “The Healing of America”, author Tim Reid compares and contrasts health care systems around the world with the current US medical market. Reid tells us customers in the US stay with a a health insurance plan for an average of 6 years. Armed with these statistics executives argue that the revolving door gives them little incentive to pay for prevention. Hogwash.
Consumers changing health plans every six years amounts to rearranging deck chairs on the Titanic. All insurance companies gain and lose the same customers, which means the total risk pool stays the same. Such short sighted thinking needs to change.
A CALL TO REIMBURSE MEDICAL NUTRITION THERAPY FOR PRE-DIABETES
Basically US citizens are saddled with a system that is far more about profit– profit for private insurance companies and anyone else with their well fed fingers in the proverbial cookie jar. Mr Reid argues that for profit insurance costs remain the primary reason Americans pay so much more for health care. And we pay more for less.
Americans pay more money for worse outcomes than any other industrialized nation. Prevention amounts to a series of screenings and tests with little more than lip service addressing diet and exercise. Even Mr Reid noted that when it comes to nutrition education and medical nutrition therapy, “Patients [in the US} have trouble securing $75 reimbursement for nutrition counseling”.
Big data allows increasingly more careful scrutiny to determine costs of treating diabetes, but I haven’t been able to find any accounting for the costs of medical nutrition therapy (MNT) and diabetes self management training (DSMT). I’m wondering why. Are the bean counters even looking? Are expenditures so low that they don’t even register?
MNT and DSMT remain the most effective yet underutilized resources to turn the tsunami of pre-diabetes and diabetes around. What are we going to do about it?