The Great Diabetes Epidemic:

A Manifesto for Action

We Have An Epidemic

We Have An Expensive Epidemic

2000 2010 2015 2025$0

$100

$200

$300

$400

$500

$600

$132

$299

$373

$514

Actual and Projected Expenditures

Billi

on $

Patients with Diabetes Cost Medicaid 300% More Than Patients without Diabetes

Without diabetes With diabetes$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$4,568

$14,229

Average Annual Medicaid Charges

Diabetes is Not Just Another Chronic Disease

5,205

4,374

3,288

1100

1,000

2,000

3,000

4,000

5,000

6,000

Diabetes Cancer Heart Disease HIV

New Cases Per Day

Diabetes: a classic public health problem

• Prevention is difficult to “achieve by individual clinicians and patients alone; it requires integrated disease management and organized systems of care.”

• The magnitude and persistence of the increase in obesity and diabetes “suggest these problems are beyond the capacity of individual health care delivery systems

Three Stages of Prevention• Primary• Keep pre-diabetes from developing

• Secondary• Prevent pre-diabetes from progressing

• Tertiary• Prevent complications from developing

Start with Tertiary Prevention—Prevent the BAD Complications

•Blindness•Amputations•Dialysis, and•CVD

Components of Tertiary Prevention

• Community Diabetes Control Council

• Screening for Diabetes and Pre-diabetes

• Diabetes Registry• Community Diabetes Care Center

• Secondary Prevention• Primary Prevention