One More Reason to Manage Our Diabetes

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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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