LOS ANGELES — As steadily increasing rates of diabetes drive health care costs higher in Los Angeles County, providers and consumer advocates say prevention is the best way to reduce financial and personal effects of a disease many believe has reached “epidemic proportions.”
A troubling list of diabetes-related statistics is long and growing longer:Over the past 30 years, adult diabetes rates have nearly tripled nationally; In California, adult diabetes has jumped 35% over the past decade; One in three children born today in the U.S. is expected to develop diabetes in his or her lifetime; Among Latino and African-American children, the rate is higher — about half the Latino and African-American children born today will develop diabetes; and In California, 60% of adults and 38% of children are overweight or obese, conditions that increase the likelihood of type 2 diabetes, as well as stroke, heart disease and certain types of cancer.
Using 2011 hospital patient discharge data and annual financial data from the Office of Statewide Health Planning and Development, a May policy brief from the UCLA Center for Health Policy Research found almost one-third of all hospitalized patients ages 35 and older in the state had diabetes.
In L.A. County, diabetes rates were higher among racial and ethnic groups, according to the UCLA report. Among hospitalized Latinos, almost half — 43% — had diabetes. Among hospitalized African-Americans and Asian-Americans/Pacific Islanders, 38% had diabetes, according to researchers.
“Los Angeles’ numbers are perfectly representative of the state as a whole, if not slightly higher,” said report co-author Harold Goldstein, executive director for the California Center for Public Health Advocacy.
A March 2013 report from the American Diabetes Association found that “among states, California has the largest population with diabetes and thus the highest costs, at $27.6 billion.” UCLA’s brief found that for patients with diabetes, regardless of the primary diagnosis, hospital stays were $2,200 higher than for patients who didn’t have diabetes, adding an extra $1.6 billion every year to California’s hospitalization costs.
“For patients and their families, diabetes is not just about taking insulin, but about watching food intake, balancing medication and getting exercise — all to prevent problems caused by diabetes, including amputations, nerve damage, blindness, heart disease, kidney disease and even premature death,” Goldstein said. “Diabetes affects most bodily systems one way or another, yet approximately 95% of diabetes cases are preventable.”Coordinated Care Is the Goal
Ying-Ying Meng — senior research scientist at UCLA’s health policy center, co-director of its chronic disease program and lead author of the brief — said education is key.
“Just as we said in the brief, we need to do more to promote understanding of diabetes. We definitely need to encourage healthy eating and healthy food environments. More education needs to be done so people understand that sugar leads to overweight and obesity and that leads to diabetes. I think it’s still an uphill battle and that not enough people — policymakers and the general public — are connecting these dots,” Meng said.
Jeffrey Guterman, chief research and innovation officer at L.A. County’s Department of Health Services Ambulatory Care Network, said the problem is particularly acute in Los Angeles. In an article published by NIH, Guterman and colleagues wrote that “diabetes is a growing public health problem throughout the United States, but perhaps nowhere is the need for control quite as urgent as in Los Angeles County.”
Guterman said Los Angeles County’s Disease Management Program for uninsured and underinsured low-income patients with diabetes, asthma and heart failure has changed to deal with the spread of diabetes. The program, described in a 2008 report to HHS, was launched in 1998.
“We’re still running it with great results, but now we’ve developed a more organized system of care for patients, rather than doctors just seeing patients who had the fortitude to wait in the queue for months,” said Guterman. “In L.A. County DHS, almost 80% of primary care is done in the ambulatory care network — the free-standing multispecialty comprehensive health centers and smaller health centers. The safety net is much stronger as a coordinated system of care than as chaotic care. We believe every patient with clinical need deserves a primary care provider and medical home — someone who knows them and who they can trust with continuity, and we’re beginning to deliver that,” Guterman said.
Changes include a shift to patient-centered medical homes in L.A. County, he said. The medical home care model emphasizes team-based care.Higher Risks for Ethnic Groups
High-risk communities must stop diabetes before it starts, said Xavier Morales, executive director of the Latino Coalition for a Healthy California.
“Diabetes is a silent killer in the Latino community, and research — including a 2011 study — shows that many of us have a genetic variance that predisposes us,” he said. “Plus, we’re just not making the link between excess sugar-sweetened beverage consumption and diabetes.”
According to a 2010 report from the University of Southern California, Hispanics are genetically susceptible early in life to the negative health effects of high sugar consumption and fat accumulation in the liver, which can lead to diabetes and other serious conditions.
The Latino Coalition holds community forums in L.A., to “raise the critical consciousness about the health impacts of both sugar consumption and the negative impacts also associated with high fructose corn syrup — a common sweetener in sodas — and its connection to Latinos’ health. As public health professionals, with this magnitude of health impacts, we have no choice but to act,” Morales said.
Earlier this year, California lawmakers considered a bill proposing a health warning label for sugary drinks sold in the state. The California Center for Public Health Advocacy, the California Medical Association, the California Black Health Network and the Latino Coalition for a Healthy California joined forces to co-sponsor SB 1000, the Sugary Drink Safety Warning Act by Sen. Bill Monning (D-Carmel).
The bill was defeated in the Assembly Health Committee last month.Tackling Diabetes at its Roots
Sandra Poole, policy director for the California Black Health Network advocacy group, said that as part of its curriculum, the network collaborates with church pastors who counsel their congregations about diabetes.
“We’re already assessing policy direction for the next year, discussing how to share concerns with legislators, and other ways to work effectively within our communities,” she said.
At the Asian and Pacific Islander Obesity Prevention Alliance (APIOPA) in Los Angeles, Executive Director Scott Chan lamented diabetes prevention and self-management resources only available in English and Spanish and cited the importance of cultural relevance.
“For example, we talk about utilizing the My Plate [the U.S. Dept. of Agriculture nutrition guide] to teach community members about food portions,” Chan said. “However, many Asian cultures do not eat from a plate but from a bowl. How do we encourage Asian community members with diabetes to create lasting changes in their food and health choices without having them forfeit their culture?”
APIOPA has been working with the county’s public health department, as well as the American Diabetes Association to re-tool current resources for Asian and Pacific Islander communities, he said.
Both Goldstein and Guterman think these types of early preventive measures can stimulate big payoffs later.
“Start with screenings for pre-diabetes and then enact policies that require health insurers to pay for education and support. There are proven strategies to turn this problem around,” said Goldstein.
“The social determinants of health, diet and physical activity have much more impact than medical determinants,” Guterman said. “The epidemic of diabetes cannot be overstated, and nothing we can do in terms of treatment can come close to the impact of really making sure that from the youngest ages on, our children eat better and increase physical activity.”