Keeping a Leash on Diabetes

Keeping a Leash on Diabetes: Diagnostics Play Critical Role

More than 18 million Americans suffer from diabetes, and that number is expected to rise by 70 percent by the year 2030 as our population ages and obesity becomes more common. People with diabetes either cannot produce insulin (Type one) or their bodies cannot use insulin efficiently (Type two).

Aside from the physical cost on the individual, America spends more than 130 billion dollars each year treating this disease—one of every 10 healthcare dollars. But people who manage their diabetes properly can avoid the potential by-products of their disease: kidney disease, blindness, lower limb amputation, heart disease and stroke.

The Monitoring Revolution

Tightly controlling insulin levels is the key to living a relatively healthy life. Since about 1980, people with diabetes have had access to one of the most important breakthroughs in the war against their disease: the hemoglobin A1c (HbA1c) test. Taken every three months, this test gauges an integrated curve of blood glucose levels over the previous three months. The American Association of Clinical Endocrinologists recommends an HbA1c target level of 6.5% as evidence of good control.

Prior to the A1c test, physicians could look at finger-stick blood tests or monitor blood sugar levels intravenously or through urine tests. But these measures were inadequate—the blood tests only monitored the amount of sugar at that moment in time, and the sugar in urine does not increase until the level in blood rises extraordinarily high.

“The HbA1c revolutionized the way we treat diabetes. It provided a new tool to estimate the average level of blood sugar,” said Helena Rodbard, MD, Past-President of the American Association of Clinical Endocrinologists. “Several large studies correlated high levels of HbA1c with the risk of complications from diabetes. The HbA1c is an important indicator that helped establish that tight control of diabetes may prevent complications. It's a number that patients need to know, like their cholesterol.”

A Patient Keeps Track

Caroline Hurley has had diabetes since 1982 when she was 16 years old. Through her late teens, college years, young adulthood and now mid-life, she's been a prisoner of her insulin level. At first through diet and later through constant monitoring, she has followed doctor's orders to maintain those levels. She remembers the first time she fully understood how the A1c numbers really affected her:

“I had returned from a two-week trip to Eastern Europe in the mid 1990s and I was sick the whole time. The doctor compared my A1c to past numbers. It was a 13.5 vs. my normal level, below (7). This was the first articulation of numbers in a way that made sense to me. But in the life of an insulin-dependent diabetic, this is just one indicator. It lets me measure where I am in history, and it explains why my kidneys are good, and my eyes are good.”

A Case for Control

Today, monitoring with the A1c test represents one critical element of the standard of care in treating diabetes in America . The National Committee for Quality Assurance (NCQA), in its 2004 report, The State of Health Care Quality: Industry Trends and Analysis, showed that each one percent drop in HbA1c level correlated to a 40 percent reduction in the risk of eye disorders, renal disease and lower extremity amputation. NCQA also said that if HbA1c levels were maintained in the 90 th percentile, Americans could avert five million sick days each year.

Not every diabetes patient is like Caroline Hurley. NCQA showed that poor management of the disease leads to 14 thousand heart attacks, strokes, or amputations, as many as 9,600 avoidable deaths, and more than $570 million in avoidable costs.

“Diabetes can be like an annoying monkey on your shoulder. It's with you every minute of every day and you can cope or not,” Hurley said. “Over the years, I have felt good and I have felt bad. Now, I do what I need to do to feel good; it's a lot of effort and a lot of work, but well worth it to know that I am a healthy person with a chronic disease.”

Fortunately, advancements in diagnostics are making it easier for people living with diabetes to remain in that fight. The HbA1c is bolstered by home glucose monitors that are smaller, simpler to use, less painful, and more precise than ever before. People with diabetes who use these devices regularly find the end payoff in healthy eyes, limbs and kidneys.

Ensuring Patient Access

It took an act of Congress, The Medicare Modernization Act of 2003, to make the government-run health care plan cover diabetes screening tests, physical exams, and self-management training for seniors at-risk for diabetes. This historic law also called for integrating disease-management programs into Medicare.

Now, Congress must monitor the progress of the Centers of Medicare and Medicaid Services implementing these provisions. In addition, lawmakers and health officials must recognize the important roles these technologies play in diagnosing and managing diabetes and modernize Medicare to ensure patients have access to the latest diagnostic tools to control diabetes. This will ultimately save and improve countless lives and health care dollars.