Approximately 24 million Americans are believed to have diabetes, but nearly 6 million diabetics are undiagnosed. Upwards of 60 million Americans are demonstrating signs of pre-diabetes as well, many being unaware of their condition and the associated risks. From an economic standpoint, a new study has concluded that more active screening and treatment for pre-diabetes and undiagnosed diabetes, will actually save money for health care systems overall.
Diabetes, a condition that characterizes either deficient insulin production (type 1), or inability to process and utilize insulin (type 2), can be extremely dangerous, and potentially fatal, when not properly monitored or treated. The dysfunctional insulin mechanisms in diabetics can lead to dangerously high or low blood sugar levels, as well as cell and nerve damage, and a large increase in risk for cardiovascular disease.
For these reasons, it is essential that diabetes be diagnosed early, or even before it develops fully (pre-diabetes), in order to better control the condition before severe damage is done. Pre-diabetes itself comes in various forms, but is most often associated with insulin resistance, and various risk factors, such as obesity and family history of diabetes. Even when these risk factors are recognized, far too many people are not screened regularly for diabetes. Pre-diabetics, of course, are at significantly higher risk for developing diabetes, but it is not definite, as proper treatment and changes in lifestyle can hold off diabetes for a long time, even forever.
Once diagnosed, especially in severe cases, diabetes can be an enormously expensive condition to treat. The hypothesis of the current researchers was that diagnosing diabetes, or people at risk for diabetes, early, will limit the number of expensive severe cases in the future, saving health care systems money. Study co-author Dr. Lawrence Phillips his and his teams objectives; “The economic costs of diabetes threaten the financial integrity of our health care systems. We asked whether there is economic justification for screening for pre-diabetes and unrecognized diabetes since early treatment could help prevent or delay development of diabetes and its complications and reduce associated costs.”
The hypothesis was shown to be correct, through an analysis of 1,259 adults who had been unscreened, and therefore, undiagnosed, for diabetes or pre-diabetes. Through four different types of screening tests (fasting blood glucose test, 50g oral glucose challenge test and random plasma and capillary glucose tests), it was found that 24% of participants had either pre-diabetes or full-on diabetes.
It was concluded by the researchers that the costs of these four tests, in addition to subsequent treatment for those diagnosed, such as with the common diabetes drug metformin, and education for those in need of lifestyle changes, would be less than if this entire group had not been tested. As for specific numbers, through some complex analysis of various factors (such as retesting, false positives and projected development of diabetes untreated), a maximum cost of $186,000 over a three-year period was given to those being screened and treated, as opposed to $206,000 over the three-year period when no screening is performed.
Dr. Phillips concludes, “We found that projected health system costs for screening and either treatment would be less than costs for no screening. These data suggest that screening with preventive management should be implemented widely.” Despite the controversial “moral obligation,” since early diabetes diagnosis would save many lives, health care companies appear to have an economic incentive to encourage people to be screened and treated early for diabetes.
Source: Defeat Diabetes Foundation: Phillips, Lawrence. Korschun, Holly. Emory University news release. June 2009.