The recently launched U.S. Diabetes Index (USDI) has revealed that 80 percent of all diabetes cases are located in just 20 percent of zip codes. Dr. Gary Puckrein, USDI developer and CEO of the National Minority Quality Forum, hopes that the USDI will help the United States direct its resources to the most affected areas.
Why certain areas are most affected, Dr. Puckrein says, is a question that has no answer as yet. “The obvious response is obesity and lifestyle, but I’m not comfortable with answers like that. First of all, the underlying science is not there to make those kind of quick generalizations about why these populations are the way they are. The smart thing to do is to take a look at these communities in depth and try to get a better understanding of why the prevalence is the way it is, as opposed to giving snap answers that really have no basis in fact.”
The USDI contains more than 30,000 maps, charts, and graphs depicting diabetes prevalence, costs, the uncontrolled and pre-diabetes populations, comorbid conditions, and other important indices. These are all segmented by geography down to the zip code level, and by age, gender, and ethnicity. According to the USDI, almost half of all patients with diabetes are not controlled; only 55 percent of them check their blood sugar at least once a day; and more than half report not visiting their doctor over a 12-month period.
Dr. Puckrein says, “We have to make a real commitment to secondary prevention. Right now, we’re offering a diabetic about six to seven hours a year of professional care. There’s really not a lot of reinforcement in the community to support the self management that we all say is required.”
“What I would also argue very strongly is that we need better technology. The technology that we have to manage diabetes is inadequate. We are fooling ourselves. The disease is so difficult to manage that people aren’t going to be able to manage it unless the technology is better. I don’t know if you’ve ever read the guidelines for medical nutrition for diabetes, but they’re a joke. Nobody in the world is going to do that, let alone read it and then implement it–that’s not happening. We don’t even understand the real difficulty involved in trying to do that. You’re 65 years old and you sit down with a diabetes educator who starts telling you about counting carbs and this and that–these are not things that are easy to do.”
“We’ve just got to get out of the habit of nice sound bites that everybody feels good about but that really don’t address the underlying causes. The focus needs to be patient-centered. We need to understand where the patients are and get them to where they need to be, not simply tell them that they’re misbehaving and don’t know what they’re doing.”
Dr. Puckrein’s colleague at USDI, Dr. Jaime Davidson, adds, ” First of all, we cannot blame it on each other. It’s time for all of us to work together, because if you’re black or white, Asian, Latino, rich or poor, Democrat or Republican, you’re going to develop diabetes. We are all Americans, and we need to work together to improve this problem, because it will be the biggest problem that we have in healthcare, and it’s preventable. Everybody can contribute. This is not a time to trust Providence and do nothing.”
“There are 26 million people with diabetes and two million new patients per year, and the potential complications are very costly. Each patient who goes blind will cost over $100,000 per year. Prevention is a lot cheaper, but nobody wants to pay for that today.
The lawmakers may be very happy at the end of this December, but the problem is that many of those lawmakers only see until December. They don’t see the next year. We need to convince them that these people are not going to disappear. They’re coming back, and they’re going to bite you, and they’re going to bite you big time.”