Spotlight on Diabetes
November is National Diabetes Awareness Month, and November 14 was World Diabetes Day. With the increased obesity epidemic and rise in related chronic diseases in the United States, diabetes treatment and prevention has been a growing concern of Congress. Diabetes is a major cause of illness and death in the United States and is becoming more prevalent. According to the Centers for Disease Control and Prevention (CDC), nearly 21 million Americans had diabetes in 2005, an increase of 2.2 million since 2002. Although RAND's relevant work has focused on chronic disease more broadly, findings from a range of studies have highlighted concerns about diabetes from several perspectives. These include the likely impact on Americans' future health status and medical costs, the implications of recent trends in drug benefit design for the management of diabetes, and the quality of outpatient care for diabetes.
The prevalence of diabetes rises dramatically with age; estimates of the prevalence vary from 10% to 20% for persons aged 60 and older. However, within the past decade, the disease has increasingly affected Americans at younger ages. The increase in diabetes, particularly among younger individuals, is attributable primarily to rapidly rising rates of obesity and largely accounts for the rising rates of disability among the young, especially those in the 30-to-39 age group. The lifetime burden of the disease is substantial. A RAND study estimated that the life expectancy for people with diabetes was 3.1 years lower on average compared to those without diabetes; their medical costs were, on average, $2,400 higher annually and $16,000 higher over their lifetimes. Interestingly, the study also found that these estimates do not necessarily foreshadow a huge cost increase for Medicare, because the high costs of the disease are offset by the decrease in life expectancy.
Prescription drugs are instrumental to the management of diabetes once it has developed. In recent years, many prescription drug benefit plans have shifted a growing share of drug costs onto consumers in an effort to contain costs and to make consumers more cost-conscious. However, this trend may also contribute to lower rates of use of needed drugs. A series of RAND studies examined the relationship between increased cost sharing and the use of medical services. The studies showed that for each 10% increase in cost sharing, prescription drug spending (and thus use) decreases by 2% to 6%. However, for some chronic conditions, including diabetes, higher cost sharing is associated with increased use of other medical services, more than offsetting savings on prescriptions. Therefore, the long-term effect of the trend toward higher prescription cost sharing appears highly uncertain for people with diabetes.
Although considerable agreement exists about the standards for treating diabetes, there are substantial gaps in delivering needed care. A RAND study of quality of care delivered to American adults nationwide found that quality varied substantially for different chronic conditions. People received recommended care for diabetes less than half the time, which was less frequently than observed for other common chronic conditions, such as hypertension, asthma, coronary artery disease, and depression. Other RAND studies also found significant gender disparities in quality of care for diabetes. In a study of the quality of ambulatory care in managed-care settings, women with diabetes received lower-quality care on several measures. For example, among both Medicare-insured and privately insured patients with diabetes, women were 16 percent less likely than men to achieve control of cholesterol, an important consideration for persons with type 2 diabetes, which increases the risk of developing heart disease.
There may be an upside to this gloomy picture: Type 2 diabetes is a preventable disease, largely through modifications in diet and exercise. RAND has been at the forefront of efforts to improve understanding of environmental and behavioral risk factors that contribute to diabetes and how these can be reduced. RAND work has also focused on improving care and management for diabetes along several dimensions: improving quality indicators and screening tools, outlining the design of prescription drug plans that promote adherence to treatment regimens, modeling the long-term health and economic benefits of improved diabetes prevention and care, and identifying physician practice patterns that reduce the risk of cardiovascular disease among patients with diabetes.
Obesity and Disability: The Shape of Things to Come
Future Health and Medical Care Spending of the Elderly: Implications for Medicare
A Systematic Review of the Adverse Effects of Prescription Drug Cost Sharing
The First National Report Card on Quality of Health Care in America
Women with Heart Disease and Diabetes Less Likely than Men to Receive Appropriate Outpatient Care
David M. Adamson
David M. Adamson, Ph.D (English studies, University of California, Los Angeles), is deputy director of communications for RAND Health. Drawing on his background in technical communication and the teaching of writing, he works with RAND Health staff to clarify the message of their research and to help communicate technical findings to policymakers and other non-technical audiences. He also develops and teaches communication workshops for RAND staff. Adamson works very closely with the Office of Congressional Relations to gear RAND Health research to policy audiences, including drafting each Health Congressional Newsletter.
Read more work by Dr. Adamson »
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