This post was written by Gerald Bernstein, MD, FACP, Director, Diabetes Management Program, Friedman Diabetes Institute at Mount Sinai Beth Israel.
In part 1 of this series, we looked at the overwhelming numbers of people with diabetes or prediabetes. In part 2, we looked at the critical role of structured education. Now, in part 3, we will look at a potential intervention.
Remember, over 40% of the US population over the age of 20 has either diabetes or prediabetes. Both are progressive stages of the same disorder and both have enormous risks attached to them. The solution to a problem of this enormity can best be approached by a partnership of private philanthropy, governmental support and institutional buy-in. (Although things may change, it does not look like there will be a federally mandated national diabetes program in the near future.) The underlying premise is that great institutions do great things.
The Big Picture
If we look at the changes in health-care delivery in New York City and the greater metropolitan area in recent years, we see institutions coalescing to garner large population segments. Examples are Columbia and Cornell; Long Island Jewish Hospital, North Shore and Lenox Hill; Montefiore, Albert Einstein and a number of hospital scattered through out the Bronx and Westchester; and, of course, our own Mount Sinai Health System, which includes Mount Sinai Hospital, Beth Israel, Roosevelt, St. Luke’s and others.
Each of these systems has large numbers of people with diabetes or prediabetes, all of whom need attention. In addition, the entire population of these behemoths should undergo regular screening to detect the earliest abnormality in blood glucose as we understand it today. For all of these groups, this requires looking at a means of reducing health costs in the future by preventing the twin peaks of vascular complications: macro (cardiovascular), which may lead to early stroke and heart attacks; and micro (microvascular, or small vessels), which can cause blindness, kidney failure, limb loss and other complications.
Ideal Approach: Dedicated Centers for Diabetes Education and Management
The ideal approach would be a series of diabetes education and management programs at dedicated centers staffed by diabetes educators and support personnel. In this scenario, every patient with any of the diabetes states or a positive risk profile is automatically referred to such a program. This is part of patient responsibility and could result in some health insurance premium reduction as an inducement.
The diagnosed patients are provided education in all aspects of diabetes, and with the help of the electronic medical record, all the quality care parameters are checked and completed (eye and foot exams, vaccines, etc.) This takes a big burden off primary care physicians, allowing them to see more patients and spend more time with them. Ancillary programs with organizations like the NYC Parks Department, the Runners Club and The Achilles Club all provide support.
Significant Funding Required
The cost of this intervention would be significant and beyond the budgets of provider institutions. This calls for funding by organizations like the Bill & Melinda Gates Foundation, the federal Centers for Disease Control and philanthropy in general. Aggressively applied, this approach could break the back of the impending disaster that is expected to occur in the next 25 to 35 years, as the number of people with early vascular events exponentially rises. If left unchecked, this growing problem will result in a less effective population trying to get along in a changing, competitive world.
You have now learned about the extent of the growing problem of diabetes, the problem solvers who will educate patients and health care professionals, and the philanthropic, governmental and institutional structure needed for them to deliver effective results. If we go back to the fact that close to 50% of the US population is at risk for diabetes and its complications, it doesn’t take much to see the need for such intervention.
To learn more about diabetes and the Friedman Diabetes Institute at Mount Sinai Beth Israel, please visit our website.