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Column - "Diabetes Prevention Program Could Save Money and Lives"


Location: Washington, DC

Senator Susan Collins

As the founder and co-chair of the bipartisan Senate Diabetes Caucus, I have learned a great deal about this devastating disease that affects people of every age, race and nationality. A new report by the American Diabetes Association confirms that diabetes carries staggering costs, in both human and economic terms.

Nearly 26 million Americans, both adults and children, have diabetes, including some 90,000 Mainers. Another 79 million Americans have pre-diabetes and are at risk of developing the disease. Diabetes is the leading cause of kidney failure, blindness in adults, and amputations not related to injury. It is a major risk factor for heart disease and stroke, and is among the top 10 causes of death in the United States.

As the Ranking Member of the Senate Special Committee on Aging, I was particularly alarmed to learn that one-third of Americans over 65 - almost 10 million seniors --have been diagnosed with Type 2 diabetes and one-half are at risk of developing the disease.

The report reveals the increasing financial burden that diabetes is placing on our nation. The total estimated costs of diabetes have risen to $245 billion, up from $174 billion in 2007, a 41 per cent increase. Medical expenditures for people with diabetes are more than double than for those without the disease, and, as a consequence, one in five health care dollars are spent caring for individuals who have been diagnosed with diabetes.

Type 2 diabetes has become a health problem of epidemic proportions. Left unchecked, by 2020, an estimated 52 percent of adults will either have Type 2 diabetes or pre-diabetes. This would overwhelm our health care system, bankrupt Medicare and Medicaid, and could actually lower the average life expectancy for Americans for the first time in more than a century.

I have introduced bipartisan legislation that could save the federal Medicare program billions of dollars by allowing millions of beneficiaries to take part in a proven diabetes prevention program. At the same time, the Medicare Diabetes Prevention Act also could save or improve countless lives.

This legislation would provide Medicare beneficiaries access to the National Diabetes Prevention Program, which is a structured, 16-session program focusing on healthy eating and physical activity that has been shown to reduce the onset of Type 2 diabetes in those most at risk for the disease by nearly 60 percent.

Under this program, seniors would have the opportunity to be assessed for diabetes risk during their normal annual checkup or at another time as determined by their physician. Medicare beneficiaries who were at a high risk for diabetes could then go to a certified Diabetes Prevention Program in their community, or their physician could offer the Diabetes Prevention program within their own practice, or contract with an organization to provide the program. For example, the YMCA of the USA is already offering the National Diabetes Prevention Program at more than 300 sites in 30 states, but seniors must pay out of pocket to participate in the program.

Currently, one out of every three Medicare dollars is spent on people with diabetes. These costs are projected only to go up as the population ages. Spending on Medicare beneficiaries with pre-diabetes and diabetes is estimated to be about $2 trillion during the 2011 to 2020 period, with $1.7 trillion of that total paid for by the federal government.

Pre-diabetes often can often be reversed through changes in diet and exercise. Research has shown that these kinds of community-based interventions work and can reduce a pre-diabetic patient's risk of getting the disease by 71 percent in adults over 60. It is estimated that implementing community-based diabetes intervention programs nationally could save $191 billion over the next ten years and potentially reduce the number of individuals who move from pre-diabetes to diabetes by three million by the end of the decade.

Since I founded the Senate Diabetes Caucus, funding for diabetes research has more than tripled from $319 million in 1997 to more than a billion dollars last year. As a consequence, we have seen some encouraging breakthroughs in diabetes research, and we are on the threshold of a number of important new discoveries. Research is vital, especially for those with Type 1, or Juvenile, diabetes as well as for those young adults who have developed Type 2. At the same time, however, we must not neglect proven methods of preventing pre-diabetes from escalating.

Three large private insurers already are providing the National Diabetes Prevention Program for their pre-diabetic beneficiaries through local YMCAs. By their calculations, the program is so effective in reducing the incidence of Type 2 diabetes that they save four dollars for every dollar they invest in the program. By covering the program through the Medicare program, the federal government can make the same wise investment in seniors' health. To not provide coverage for these services under Medicare would be penny wise and pound foolish.

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