This array of supplies could be used by a person with Type 1 diabetes to manage his or her condition. (Clay Wirestone/Kansas Reflector)
The Kansas Reflector welcomes opinion pieces from writers who share our goal of widening the conversation about how public policies affect the day-to-day lives of people throughout our state. Andy Obermueller lives in Salina. He was diagnosed with Type 1 diabetes at age 8.
Kansas may not have a diabetes “problem.”
That does not mean our state can’t lead the nation in devising a means to address this critical health care issue.
Diabetes comes in two flavors, Type 1, which typically affects kids, and Type 2, which tends to afflict the overweight. Some 11.2% of Kansas residents have some form of diabetes, better than West Virginia (15.7%) but not as good as Colorado (7.5%). What causes the difference? Activity. People who exercise regularly weigh less: Relatively sedentary West Virginians, thus, have twice the incidence of active Coloradans.
Kansas, according to the Centers for Disease Control and Prevention, has an incidence of Type 1 of 12.5 children per 10,000. The Sunflower State has 2.91 million residents, the Census Bureau says, 24% of whom are under age 18. That’s 700,000 kids, or about 8,750 Type 1 diabetics, and roughly 330,000 people with Type 2.
The American Diabetes Association reports one in seven health care dollars is spent treating diabetes. This adds up to a staggering $327 billion a year. On a per-patient basis, those costs are roughly $16,752 per person per year, $9,601 of which is attributable to diabetes. The cost of this disease in our state — before figuring in the cost of complications — is $3.3 billion a year. That’s twice the value of our annual wheat crop.
We can do better. And we should.
Whichever the type, diabetes is a difficult disease. Patients must test their blood-sugar levels frequently — at least four times a day — and take either insulin injections (Type 1) or oral medication (Type 2). And that’s not the half of it: Every calorie and carbohydrate affects blood sugar, as does every erg of exercise and iota of stress. The disease never takes an hour off, let alone a day. Complications can include blindness, hypertension, kidney disease and amputation, among other unpleasantness.
Every day in the United States, 159 people are diagnosed with end-stage kidney disease — the leading cause is diabetes — which necessitates either lifelong dialysis or a transplant. About 500 people a week receive a transplant in the U.S.: Thousands more wait. If you’d like to be tested for possible donation, visit KU Med online.
But more donors, as lovely as that would be, is not the solution I’m suggesting.
First, pay cash for results. The immediate measure of a diabetic’s condition is blood sugar, but the long-term scorecard is another blood test known as the hemoglobin A1C. Taken every 90 days, it measures average blood sugar by examining red blood cells. Studies bear out that long-term A1C performance is the magic bullet for successful diabetes treatment.
Smart, innovative insurers such as Blue Cross and Blue Shield of Kansas could dip into their coffers and cut a $100 check to every diabetic child with a laudable A1C.
If every kid got paid, this would cost Blue Cross about $3.5 million a year. It is, financially, a pittance. But it would be a shrewd investment: The savings over time would be an order of magnitude more significant. Dialysis alone costs about $75,000 per patient per year.
Second: Kansas needs a comprehensive approach to diabetes. While the disease is expensive to treat, it’s far more expensive to leave untreated. Beyond that, improving diabetic care improves diabetic lives. There are simply too many neighbors afflicted with this condition to continue to accept the status quo. If we can do better, should we not?
The secret to diabetes is simple: Data. When patients know their blood sugar, they can address it. Every diabetic learns the target range; all are taught how to dose insulin to cover the food they eat and to correct elevated blood sugar. But while most diabetics should test blood sugar levels at least four times a day, few do. Technology, thankfully, offers a solution. It’s called a continuous glucose monitor. A CGM tests blood sugar almost all the time. It wirelessly beams the info to the patient’s insulin pump, smartphone or — as of recently — Garmin device. Garmin is based in Olathe.
The trouble is, insulin pumps and CGMs are pricey, as are the supplies required to use them. That cost precludes their universal adoption. Diabetics may think twice about using supplies because they’re so spendy. But not using them ultimately costs more, and all of us bear that expense.
In the long term and the short, diabetes management tools are a prudent, cost-saving health care investment, and full coverage by insurance should be mandated by state law.
No insurance company wants higher costs, but every insurer knows that these devices pay for themselves fairly quickly, with fewer doctor and hospital visits among users. They generate a multiple of their cost in long-term savings. This should be incentivized, and the Legislature should work with the insurance commission to devise a strategy.
Diabetics also need nutritional counseling — something our whole sugar- and salt-loving state could benefit from — as well as mental health care. After all, what you feel can be as important as how you feel. Diabetics who feel well mentally do better physically.
Kansas could stand out as a national model by developing a readily available and potentially hugely cost-effective diabetic coaching app. Then we could license it. For that matter, other insurers across the country might well follow suit in paying for A1Cs if the program bears fruit.
Everyone knows someone whose life has been touched, or will be, by this onerous disease. The odds are fairly strong — better than one in 10 — that your life will be affected by diabetes. While more laws are seldom the best solution, in this case, ensuring that Kansans with diabetes can get the treatment they need is an easy and ultimately cash-saving legislative fix. Let’s lead the nation. We can. And we should.
Through its opinion section, the Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.
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