Treating prediabetes: An overlooked opportunity?

We are all aware of the staggering numbers of people diagnosed with diabetes in the United States. It is an established public health threat that costs the health care system billions of dollars each year.

More than 24 million people, or 8% of the U.S. population, are currently living with the effects of diabetes and struggling to prevent further complications. Diabetes educators help stem the tide by teaching people with diabetes critical self-care behaviors that result in healthier outcomes and reduced health care costs. Diabetes education is a key asset for combating the rising number of people with diabetes and the skyrocketing costs associated with treating the disease.

In addition to its grassroots efforts, the American Association of Diabetes Educators (AADE) and the greater diabetes community are working hard to obtain federal recognition under Medicare to acknowledge the important role of diabetes educators in providing diabetes self-management training and the need to increase access to care for the millions of Americans who need these services.

AADE is also working to increase federal support that will enable more diabetes self-management training programs to be available to meet patient needs and to ensure that diabetes educators are reimbursed appropriately for their services.

Deborah Fillman

Recently, the Medicare Diabetes Self-Management Training Act was introduced in the Senate as S. 3211 and in the House as H.R. 2425.

The key provisions from S. 3211/H.R. 2425 have already passed the House of Representatives as part of the health reform bill and were also included in one of the Senate’s main health proposals. The bills have been costed, or “scored,” by the main federal cost estimating office as having no effect on the federal budget, an important consideration in these times of rising concern over the federal budget deficit.

More access needed

Although we are making strides toward our goals in these areas, we know that there is another at-risk population that currently has limited or no access to diabetes education — individuals with prediabetes.

More than 57 million Americans have prediabetes. If left unchecked, most of these individuals will develop type 2 diabetes within a few years. Screening for diabetes and prediabetes is a covered Medicare benefit, but education and self-management training for individuals with prediabetes is not covered.

The most disturbing part of this gap is that it is possible to delay the onset of type 2 diabetes or slow its progression with lifestyle modifications and behavior changes, which is the primary objective of diabetes education. Diabetes educators specialize in helping individuals make changes in their eating and exercise habits, learn problem-solving skills and coping strategies, understand the need for monitoring blood glucose levels and reduce their risks for further complications. If taught to individuals with prediabetes, these same behaviors can, in many cases, prevent them from progressing to type 2 diabetes.

The results of a recent study commissioned by AADE and published in the September/October 2009 issue of The Diabetes Educator revealed that patients using diabetes education have lower average health care costs than patients who do not use diabetes education.

Additionally, the Diabetes Prevention Program study examined more than 3,200 overweight or obese adults with prediabetes and showed that lifestyle interventions, such as those taught in diabetes education programs, reduced the incidence of diabetes by 58% overall and by 71% for older adults.

Furthermore, a 2009 study commissioned by the National Changing Diabetes Program, published in Population Health Management, examined the financial effect of the prediabetic population on the American health care system and resources. The researchers estimated that people with prediabetes cost approximately $25 billion a year.

Expand Medicare coverage

If teaching healthy self-care behaviors to individuals with prediabetes can prevent the further progress of the disease and save the health care system billions of dollars, why are we not pursuing this issue more aggressively?

In a public policy brief, titled “Prediabetes: Using Diabetes Self-Management Education/Training (DSME/T) to Prevent Diabetes Onset,” AADE raised this question and viewed it as another key area for advocacy and policy initiatives. AADE recommended that “Congress take steps to include DSME/T as a Medicare benefit for those who are diagnosed with prediabetes, according to medically accepted screening guidelines adopted by the CDC.”

The incidence of diabetes is expected to double in the United States during the next 30 years, which will bring enormous strain to an already overburdened health care system. As more individuals are diagnosed with prediabetes, we have a critical opportunity to step in and teach them healthy self-care behaviors before they develop the disease.

To do this, DSME/T must be included as a covered Medicare benefit for those with prediabetes. AADE and the rest of the diabetes community will continue to work toward this goal, and we hope that one day we will have the opportunity to halt diabetes and prevent the onset of other related health complications.

Deborah Fillman, MS, RD, LD, CDE, is president of American Association of Diabetes Educators.

For more information:

• Zhang Y. Population Health Management. 2009;12:157-163.