N.C. diabetes ‘epidemic’ costs billions, Harvard finds; broad-based solutions urged

By Todd Cohen

RALEIGH, N.C. — Diabetes rates in North Carolina have nearly doubled in 20 years, reflecting a rapidly growing “epidemic” that costs billions of dollars in medical spending and a less efficient workforce, a new report from Harvard University says.

Diabetes is now the seventh-leading cause of death in the state, where the disease is far more prevalent than in the U.S. overall, the report says. And among African Americans and American Indians in the state, it is the fourth-leading and third-leading cause of death, respectively.

Economic impact

“This growing threat to the health of North Carolinians is also a threat to the state’s economy,” the report says.

At its current pace, it says, diabetes is on track to cost the state’s public and private sectors over $17 billion a year in medical expenses and lost productivity by 2025.

“With such high stakes, the state must take significant steps to address the disease from every angle,” the report says, including collaborative, coordinated efforts to attack known risk factors for diabetes for the population overall, and to improve the quality of care and access to it for all individuals living with the disease.

The report calls for “multipronged changes to the state’s healthcare, nutrition and physical activity landscapes,” including better access to healthy food and education programs; better access to medical and lifestyle interventions; improvements in the built environment; and new legislation and diabetes-related task forces.

1 in 10 Americans

In the U.S., diabetes affects nearly 26 million children and adults, or 1 in 10 Americans, and is the main cause of death for over 71,000 Americans a year, according to the American Diabetes Association. By 2050, if current trends continue, as many as one in three Americans will have diabetes, which now generates $245 billion a year in costs.

Type 2 diabetes, which accounts for nine in 10 diabetes cases, is a disorder of the body’s metabolic system that is characterized by high blood sugar, with obesity believed to be the main cause of the disease in people genetically predisposed to it. People who develop type 2 diabetes can lose up to 15 years of life, the report says.

Broad-based change

Funded through a grant from the Bristol-Myers Squibb Foundation and released last night in Raleigh, the report from the Center for Health Law and Policy Innovation at Harvard Law School is the result of research and over 90 interviews with policymakers, government agencies and nonprofits involved in North Carolina’s response to diabetes.

The report, “2014 New Carolina State Report: Providing Access to Healthy Solutions (PATHS) – The Diabetes Epidemic in North Carolina: Policies for Moving Forward” calls for a broad range of approaches to tackle diabetes. Among those recommendations:

* Promote “team-based, whole-person models” to deliver and finance diabetes care.

* Increase access to diabetes prevention and self-management programs.

* Expand telemedicine programs and access to durable medical equipment and insulin.

* Improve behavioral health services for people with diabetes.

* Increase economic and geographic access to healthy food.

* Increase opportunities for physical activities, and nutrition and cooking education.

* Expand programs for early childhood, school food, nutrition and wellness.

Focus on prevention

Allen Smart, vice president for programs at the Kate B. Reynolds Charitable Trust in Winston-Salem, says investment in efforts to reduce diabetes has focused on treatment of the disease, and on prevention of its complications, not on prevention of the disease itself.

The big challenge in fighting the disease, he says, will be to find ways to “engage communities, not just people in the health world, around some of the fundamental causes of diabetes that are really fueling this escalation.”

The Reynolds Trust, the state’s biggest private funder of diabetes programs, has invested roughly $10 million over the past five or six years to address the disease.

Just this week, the Reynolds Trust announced it is giving nearly $200,000 to the YMCA of  Western North Carolina to expand a diabetes program for McDowell County that has served 196 adults, helping them reduce their weight by 10.9 percent, on average.

Still, Smart says, “if I had $10 million to invest today in effective diabetes prevention programs in North Carolina, I wouldn’t have a place to put that money. There’s not enough evidence-based prevention work that’s been accepted that we feel confident works.”

Brad Wilson, president and CEO of Blue Cross and Blue Shield of North Carolina, the biggest health insurer in the state, says diabetes “is taking an increasingly heavy toll in our state on patients and families, citizens and taxpayers, and hospitals and other healthcare providers, and this has a direct impact on both the health of our customers and the cost of health insurance.”

The good news, he says, is that “common-sense, collaborative strategies can significantly reduce the impact of diabetes on the health and pocketbooks of North Carolinians, and on the costs to organizations that serve them.”

[Note: This article is a joint project of Philanthropy North Carolina and NCPressRelease.com, with financial support from Blue Cross Blue Shield North Carolina.]

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