Kentucky has a state bird, the cardinal; a state flower, goldenrod; and a state tree, the tulip poplar. And now, thanks to the latest data from the Centers for Disease Control and Prevention, we have a state disease, diabetes, with 90 to 95 percent of the cases classified as Type 2, formerly called “adult onset diabetes.”
In our population of about 4.4 million, some 600,000 of us (almost one in seven) in Kentucky have diabetes, and about 1.1 million (one in four) of us have pre-diabetes. Sadly, 30 percent of those with diabetes don’t know they have it, while an estimated 90 percent with pre-diabetes are unaware of having it.
However, the saddest thing about both of these numbers is that we actually know how to prevent half of those with pre-diabetes from progressing to diabetes, and how to prevent or delay the serious complications in those who already have diabetes. We just don’t apply very well the knowledge we have to help our fellow Kentuckians deal with our state disease.
It’s time we faced up to the problem and took action.
To begin with, we need to accept the fact that the national—and Kentucky—prevalence of diabetes has tripled since 1994 when the head of the CDC Diabetes Translation Unit, Dr. Frank Vinicor, declared it to be both an epidemic and a public health problem. It is not just a personal health problem, but a non-contagious epidemic and major societal concern. Vinicor’s successors at CDC have said “these problems are beyond the capacity of individual health care delivery systems.”
The health and economic costs of diabetes are staggering! It is a major cause of heart disease and stroke, and is responsible nationally and in Kentucky for at least half of the new cases each year of blindness, leg amputation and kidney failure, often followed by dialysis and/or kidney transplantation.
In 2015 some 800 new cases of end-stage renal disease in Kentucky are predicted, followed in many of them by dialysis at a cost of $80,000 per case per year or a total of some $64 million. The prediction is for 1,000 leg amputations this year—three per day!—at an average of $50,000 per case for just the hospital charge, for a total of $50 Million. An estimated 72,000 people will have a significant degree of impaired vision, including blindness, this year.
Overall, the cost of diabetes in Kentucky in 2015 is estimated to be $5.7 billion! Medicaid alone will spend $1 billion for diabetes this year!
So, what can we do about it?
First, we can finally take the advice we were given by Vinicor in 1994, acknowledge that we have a diabetes epidemic, and deal with it as a public health problem. There has to be behavioral change at the personal level, but defeating this epidemic calls for strong community as well as individual action. Blaming the victim has not solved the problem.
Second, our communities must take responsibility for diabetes and pre-diabetes in their populations. It is an equal-opportunity disease, although it is more common among the underserved and minorities, and all elements of the community need to be involved.
One way to start would be to form broad-based Community Diabetes Control and Prevention Councils representing all segments of the population in every county. The local health department should initiate this activity and appoint a Council Chair. The Council should have clear responsibilities, resources and enough staff outside of the health department to carry out the decisions of the Council.
Third, the community and the Kentucky Department for Public Health need more precise information about the magnitude and extent of the epidemic. We therefore advocate universal screening of all residents over the age of 45 in doctors’ offices and in community screening locations. This has recently been advocated for those who are overweight in this age group in the program—Stop Diabetes-Stat!—jointly sponsored by the American Diabetes Association and the American Medical Association.
A state population-based diabetes registry, managed by the Kentucky Department for Public Health, will be needed to collect screening data and incident reports from practitioners’ offices just like the Kentucky Cancer Registry does now for all newly diagnosed cancer cases. It will preserve patient confidentiality, as the KCR does, but will provide important information to those fighting the epidemic.
Fourth, in order to prevent as many people with pre-diabetes as possible from developing diabetes, there should be numerous, available, affordable organized prevention programs in accessible community sites, e.g., the Diabetes Prevention Program promoted by CDC at YMCA branches, health departments, hospitals and other community locations.
There is a “saving” of $10,000 per patient per year in avoidable health insurance claims for “graduates” of the DPP and others whom we help avoid developing diabetes.
Obviously we have both health and financial incentives to keep as many people with pre-diabetes from developing diabetes. Now we need to do it!
These are some of the positive steps we Kentuckians can take together to defeat the Great Diabetes Epidemic. The time for action is now!
Gilbert H. Friedell, MD, and J. Isaac Joyner, MPH, are the authors of The Great Diabetes Epidemic: A Manifesto for Control and Prevention, Butler Books, 2014.