Prevalence of diabetes continues to grow

The AVMA Group Health and Life Insurance Trust is feeling the financial impact of diabetes. From October 2006 to September 2007, the GHLIT paid diabetes-related claims totaling nearly $1 million. According to Medco, the pharmacy benefits manager for 60 million individuals, diabetics account for more than 15 percent of total drug spending yet represent just 5 percent of the U.S. population.

Diabetes is growing in prevalence for several reasons, including a population that is aging, increasingly sedentary, and overweight. Diabetes is diagnosed in more than one million individuals each year, a number the Centers for Disease Control and Prevention expects will increase 165 percent by 2050. Medco also predicts that, with annual spending increasing by more than 14.5 percent for diabetes treatments, they will overtake cholesterol medicines as the fastest growing therapeutic category by 2009.

Associated with such long-term complications as blindness, cardiovascular disease, stroke, kidney failure, amputations, and nerve damage, diabetes is the sixth leading cause of death. In fact, it may rank even higher as a result of underreporting of the disease as the underlying cause of death.

Diabetes is also expensive. The CDC reports that in 2002 (the most recent figures available), diabetes cost $132 billion, including $92 billion in direct costs and $40 billion in indirect costs such as disability payments, time lost from work, and premature death.

Type 2 diabetes is the most prevalent form of the disease, accounting for 90 percent to 95 percent of diagnoses. It is closely associated with obesity, which affects approximately 80 percent of all type 2 diabetics, as well as with aging, family history, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity.

The symptoms of type 2 diabetes develop gradually and include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds and sores. If left untreated, type 2 diabetes can result in decreased production of insulin to the point where glucose builds up in the blood, leaving the body unable to make efficient use of its primary fuel source.

Prediabetes is also prevalent, with the condition being diagnosed in an estimated 54 million U.S. adults. Prediabetes raises the risk for heart disease and stroke and, left unchecked, often develops into type 2 diabetes within 10 years.

Now the good news

The good news is that it is possible to reverse the course of prediabetes, as well as to control type 2 diabetes without insulin, through a healthy diet and exercise.

The Diabetes Prevention Program, a three-year study conducted by the National Institutes of Health and supported by the CDC, found that diet and exercise that resulted in a 5 percent to 7 percent weight loss (10 to 14 pounds for someone weighing 200 pounds) lowered the incidence of type 2 diabetes by nearly 60 percent. Also, while the study found that some medications may delay the development of diabetes, it showed conclusively that diet and exercise were more effective.

To that end, the American Diabetes Association recommends that type 2 diabetics and prediabetics follow a healthy meal plan and exercise program designed to fit their schedules and eating habits. (More information can be found online at www.diabetes.org.)

For healthier eating, the ADA recommends selecting vegetables and fruits from a rainbow of colors to maximize variety; eating nonstarchy vegetables such as spinach, carrots, broccoli, and green beans with meals; incorporating dried beans and lentils into meals; and eating fish two or three times a week. Also, replace processed grain products with whole grain foods, such as brown rice or whole wheat spaghetti; use nondairy food products; and cook with liquid oils instead of solid fats, which can be high in saturated and trans fats.

Other tips include watching portion sizes, replacing sugar-sweetened drinks with water or calorie-free beverages, and cutting back on high-calorie snack foods and desserts such as chips, cookies, cakes, and full-fat ice cream.

The ADA also recommends increasing physical activity, which helps insulin work well, improves blood circulation, keeps joints flexible, and aids in weight loss. It can also lower blood glucose, blood pressure, and cholesterol; reduce the risk for heart disease and stroke; relieve stress; and strengthen the heart, muscles, and bones.

Guidelines include 30 minutes of aerobic exercise on at least five days per week to work muscles and increase the heart and breathing rates. Strength training with weights or elastic bands several times a week will build strong bones and muscles, which helps to burn more calories, even at rest. Five to 10 minutes a day of flexibility exercises can keep joints flexible and reduce chances of injury during other activities.

Along with exercise routines, the ADA suggests finding opportunities to increase activity throughout the day. It can be as simple as walking instead of driving when possible, taking the stairs, or parking at the far end of a shopping center.

Finally, a team of health professionals trained to focus on different areas of the body can help a diabetic determine the best course of management and treatment. This team, which typically includes a primary care physician, endocrinologist, nurse educator, registered dietician, ophthalmologist, mental health professional, podiatrist, dentist, and exercise physiologist, can also address diabetes-related issues as they arise.

The AVMA GHLIT program is underwritten by New York Life Insurance Company (NY, NY 10010). For more information on AVMA GHLIT plans, including eligibility, rates, renewal provisions, exclusions, and limitations, or to find a GHLIT agent in a particular area, call the Trust office at (800) 621-6360.