Diabetes Self-Management Blog

As if we didn’t have enough reasons to keep our diabetes under control, here’s another: In case of a widespread medical disaster, such as pandemic flu, people with poorly controlled diabetes could be left to die.

No, I’m not joking. That’s the recommendation of “a task force whose members come from prestigious universities, medical groups, the military and government agencies…[including] the Department of Homeland Security, the Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services,” according to a recent Associated Press report. The idea, say task force members, “is to try to make sure that scarce resources—including ventilators, medicine and doctors and nurses—are used in a uniform, objective way.”

In addition to people with poorly controlled diabetes, the list includes the very elderly (defined as being over 85), seriously injured trauma victims, severely burned people, those with severe mental impairment (including Alzheimer disease), and those with a severe chronic disease, such as advanced heart failure and lung disease.

My friend Sara Smarty Pants once suggested that we should all tattoo the word “defective” on our foreheads. Perhaps it wasn’t as tongue-in-cheek as we thought it was at the time.

With today’s tools and knowledge, however, should any of us be “defective?” Well, most of us, anyway. Sadly, there are no guarantees.

While there’s nothing we can do about our age or many of the other “criteria” for death, most of us can do something about having poorly controlled diabetes. And, yes, I’m going to climb up on my diabetes self-management education soapbox. Again.

In “Will They Ever Learn?” (my blog entry from January 30, 2007), I wrote about one reason education isn’t more widespread: It isn’t valued. You can go read the whole megillah but, briefly, the system “rewards” complications while “punishing” diabetes education. In that post, I cited a 2005 study by the CDC showing that, for every $1 spent on diabetes education and training, $8.76 is saved on health-care costs.

A more recent study, published in the April 2008 issue of the journal Diabetes Care, says that having any type of diabetes self-management education was associated with fewer hospital stays and a reduction in hospital charges (duh!).

Specifically, any type of diabetes education resulted in 9.18 fewer hospital visits per 100 person-years and $11,571 less in per-person hospital charges. Each visit to a dietitian led to 4.7 fewer hospital visits per 100 person-years and a hospital cost reduction of $6,503 per person.

Sadly, however, it appears only 13.4% of the 18,404 subjects studied had any type of educational visit. Only 5.7% had a diabetes education visit, 9.1% had a dietitian visit, and 1.8% had a health education visit.

What’s wrong with those people? Did nobody refer them to an educator? Were they referred, but blew it off? If the latter, didn’t the referring person tell them how important diabetes education is for something they’re going to have to manage for the rest of their lives? Were there, perhaps, no educators in the area for them to be referred to? Do they know that diabetes educators exist? (I didn’t for the first nine years after my diagnosis.)

Lots of questions, and I have no answers.

It would be to our benefit, however, to seek education, even if we have to pay for it. I paid for mine, at $100 per hour.

Knowledge can lead to better diabetes management, which will make you feel better. Now we know it will save us money. And according to the grim task force report, it could save our lives.

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Comments
  1. Interestingly, the report making this suggestion did not indicate exactly how they recommend making the determination of whose diabetes is “poorly controlled” and whose is not — I would guess no one is going to be doing HbA1c’s in the wake of a natural disaster. The basic presumption will be that everyone with diabetes is poorly-controlled and are therefore expendable.

    The reference to diabetes education, while interesting, is a bit off-point; education may improve glycemic control, but there are many people who have been more than adequately educated who nevertheless have poor control, suggesting that education alone will not address the issue, it is sadly 1 piece of an arguably more complex issue that there are no quick-and-easy solutions for.

    Posted by Scott |
  2. To Jan I don’t know where you live but everybody does not have the luxury of great insurance or money to spare to get the education they need for their diabetes. I live in the south Lousiana and health care down here is not the greatest. I moved down here from Wisconsin two years ago and have gone thru hell and back to get some decennd care for my diabetes I have had diabetes for 44years now and have many problems that I need help with. I would love to find out where you can can help with your diabetes drugs, meaning insulin, syringes and testing strips once you hit your gap with medicare part D you have to pay 100% and I am flat out broke and can’t afford medicines or my diabetes stuff. aAny help would be nice to hear from a friends in deed God Bless Thanks

    Posted by Fran Nelson |
  3. I didn’t know the FDA officially approved of eugenics, Lord-of-the-Flies survivalist behavior. What happens to the Americans with Disabilities Act (where are the activists with disabilities on this one?), ageism, etc. Obviously expediency & the almighty dollar seem to want to rule on this one. Sheesh. Back to the stone age.

    Posted by Katherine |
  4. Per your scenerio, being overweight + diabetic = dead. I’ve already had enough health care folks treat me as if I don’t exist - guess this will make it final so they don’t have to worry about ever seeing me in their office.

    Even though I have had some minor diabetes education with an educator years ago, most of what I know has been found out on my own study. I find the medical system today sucks! Finding all the alternative methods that I can do outside of our current US system is the future. Age, job and insurance losses are only going to increase.

    Posted by 9982tx |
  5. Fran, I frequently recognize that I am very fortunate that we have good insurance and that we can afford for me to have diabetes. As for those who cannot, please talk to your doctor about programs by the pharmaceutical companies that can help you get the medications you need. Requests need to go through your doctor, as I recall. I believe that Lilly has a program to provide insulin. Strips may be a bit more difficult. However, store-brand meters and strips (such as WalMart’s house brand) are less expensive than the name brands. Good luck to you.

    Jan Chait

    Posted by Jan Chait |
  6. Great article, Jan. It’s useful to differentiate between “diabetes education,” and “diabetes self-management education.” The cost/effectiveness of Self-Management Education has been proven. Just learning information about diabetes, without developing self-management skills, is not nearly as effective.

    As others have written, good self-management education is not always available, often not very affordable, and/or not presented in culturally sensitive and appropriate ways. Even if it’s available, doctors don’t always value it or refer patients for training.

    The stuff about triaging people with chronic illness out of care is very scary. Triage in a real crisis is often necessary. Otherwise, the rich get triaged in and the poor get left in the cold, or the system gets overwhelmed. People with diabetes, though aren’t any less likely to survive than anyone else, so why the exclusion?

    MORE IMPORTANT…what kind of crisis are they talking about? The last “flu pandemic” was 90 years ago. Why should there be another one now? Are they planning on starting another one?

    We’ve been frightened with one “crisis” after another for 6+ years, starting with 9/11. The government has taken away many American freedoms by saying that “national security” is threatened by some crisis or other. Will the next one be a “flu” started in some lab somewhere? Apologies if I sound paranoid, but as I recently heard, “If you’re not paranoid, you haven’t been paying attention.”
    David

    Posted by David Spero RN |
  7. Thank you for alerting me to this article. My wife has diabetes, and I am a polio survivor. I am the Immediate Past President of The Polio Society, a nationwide advocacy group for polio survivors. Rest assured that we take matters like this very seriously.

    I have found the article mentioned in Ms. Chait’s post, and that led me to the official report, which is here: Flu Report

    Posted by egrebenstein |

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