DIABETES: THE TSUNAMI IN HEALTH CARE Loretta Hothersall, PhD Family Nurse Practitioner Metabolic Leader
TSUNAMI • Defined as a very large sea wave or harbor wave caused by an earthquake under the sea. It can cause great destruction when it reaches land. The speed of a tsunami is 600m/hr and can travel a distance of over 2000 miles. • So WHY is diabetes compared to a tsunami?
TSUNAMI The answer is the rapid increase in people being diagnosed with this chronic disease and burden placed upon our resources: Impact on society and our future resources Impact on an already burdened health care system Impact on the economical system Impact on the cost of research .
Impact on Society 26 million Americans with DM 79 million with Pre-diabetes ~19 million new cases of diabetes
SOCIETY • Every 17 mins someone is diagnosed with DM • ½ of the population 65 years and older will be diagnosed with DM this year
SOCIETY • By the year 2050 1:3 adults will be diagnosed with DM • 1:3 Children born after the year 2000 will be diagnosed with DM
SOCIETY • 19,000 children will be diagnosed this year with DM (~16,000 with T1DM and ~3,000 with T2DM). They join the ranks of 24,000 children already diagnosed with DM
SOCIETY • GDM: Pregnancy rise 300,000 women per childbearing age • Increase in obesity in children: by 17.3% in ages 2-19 years. Highest in African-American boys, Hispanic Girls and White girls
Society Current Ethnic Percentages • White 7.1% • Hispanic 11.8% • African-American 12.6% • Native American 16.1% • Asian American 25.8% (Asian Indian 17.4% and Asian 8.4%)
Impact on Health Care • Management: 4000 practicing Endocrinologist 1:4700 patients with DM • Increased MD/NP role in management of DM at the primary care level
Health Care • 2010 cost of DM treatment $174 billion. • 2013 $245 billion (41% cost increase).
Health Care • 7th leading cause of death • CVD: 2-4 times higher (CVA) risk factor.
Health Care • CVD: 2-4 times higher death rate. • Hypertension:67% of patients have elevated BP >140/>90 • Retinopathy: 655,000 cases and leading cause of blindness • Neuropathy: 60-70%
Health Care • 44% new cases renal failure • >60% non traumatic LE amputations • 30million adults below basic general literacy level • 88% below the proficient health literacy level
Health Care Maine • Rate DM 8.7% (higher in populations w/o exercise regimens 11.0%) • Rate Pre-DM 3.5% ( 2.6 times higher in people with elevated LP levels and 5 times higher with people with elevated BP). Higher in females 7.0% and males 6.6%
Health Care Maine • Highest Counties: Aroostook and Penobscot 9.4-10.7%. Cumberland lowest 7.0-7.4% • CVD: 1:4 ( 25.6%)
Health Care Maine • LE Amputation: 2.8 per 1000 and lower than national rate 3.5 per 1000 • ESRD: 108.3 per 100,000 and down from 2007 184.6 per 100,000 • Dental: People >45 years of age are 3 times more likely to have severe gum disease • Death adjusted rates: 65.8 per 100,000 down from 71.2 per 100,000
Health Care Maine • Health Visits: Recent patient survey: Of those patients with diabetes, 90.4% reported 1 visit per year for their DM care • A1c: 2 in past 12 months 78% • Eye exam: (within the ADA recommended yearly exam)75.9% • Education: 60.7% patients with DM received education and training
Health Care Maine • Daily Foot Checks: 61.2% of patients with DM perform daily foot evaluations • Foot Exams: 60.3% have their feet checked at every office visit
Health Care Maine • So how is that being corrected? Quality control improvement (EMR) and insurance reimbursement.
Health Care Maine • 65+ age group: • diagnosed with DM 17.8% • diagnosed Pre DM 11.7% • Hospitalizations: DKA: 3.9/10,000
Health Care Maine Hospitalizations: • DKA: 3.9/10,000. • CVD: 40.8/10,000. • Infections: higher in males 2.8/10,000 • Clustered more in the northern and eastern areas of the state
Health Care Maine Male vs Female: • Males 14.5/10,000 likely to be hospitalized • Female 9.9/10,000 likely to be hospitalized
Health Care Maine Age Related Rates: • 34-64 years of age 2 times more likely • 65 + years of age 4 times more likely Loss in work days: • 1/3 of all work days (13.8 days/year), cost $ 3700-$8700
Research • $137.3 million for the Division of Diabetes Translation (access to DM self-management education and support health programs) • $20million for the National Diabetes Prevention Program ( community life style changes through weight loss programs, meal planning and physical activity through insurance reimbursement and employer sponsored health benefits: cost $400 per participant)
Research • Development of new treatment modalities: Medications: IncretinFactors (Glip-1 and DPP4). SGLT2 (Sodium-glucose co-transporter 2). Combination medication
Research Insulin: inhaled, oral. Analogs: current therapy vs past therapy U200, U300, U500 Pumps: 530G with Enlite, Sensors. Bionic Pancreas