Contributor: Frank Lavernia, MD
November is Diabetes Awareness Month and as an endocrinologist, many issues come to mind. Most important are the things we all can do to try to completely prevent diabetes and its complications. Eighty-four million Americans are considered to have prediabetes and 20-30% are at risk of converting to Type 2 diabetes (T2). Knowing this, why do physicians not aggressively confront this issue? We are doing a poor job counseling patients who are at greater risk of developing T2 by not focusing enough on family history, obesity, diet, lack of exercise, and lab values.
Sometimes when we try to educate patients with prediabetes about important life changes before they are living with T2, patients push back and point out that we are making a big deal about something invisible: no visible signs or symptoms yet. And sometimes they dive in and try to change habits, but stop due to any number of reasons or challenges.Our mission should be to continue to push the envelope consistently, and with no timeline. We need to support them in believing that T2 is a threat waiting to rear its ugly head at any time, and in making important, permanent lifestyle changes. The Diabetes Prevention Program study taught us how crucial these lifestyle changes are.
We must also communicate to people with prediabetes that diabetes is a very expensive disease, in terms of both economics and their own health. The costs are due to diabetes complications, many of which are asymptomatic until deep into their disease state. Complications are very expensive to treat. The American Diabetes Association released new research on March 22, 2018 estimating the total costs of diagnosed diabetes have risen to $327 billion in 2017 from $245 billion in 2012, when the cost was last examined. This figure represents a 26% increase over a five-year period. One in seven health care dollars is spent on diabetes treatment and its complications. With more prevention and early intervention, some of the dollars spent on treatment and complications could be dedicated to research and improved clinical care.
Finally, health practitioners must come to the realization that diabetes management has to be a team effort with their patients and the patients' loved ones. I cannot think of any other chronic disease that requires more education, attention, and support than diabetes. Once patients and their families understand what they can do to prevent the start of diabetes, and/or lower the risk of complications, we must encourage the patient-centered decision-making I call the buy-in period. Once the buy-in period begins, I say GAME ON.
Dr. Lavernia has been a practicing diabetologist in South Florida for more than 35 years. He was the founder and director of the North Broward Diabetes Center in Florida. He is an adjunct faculty member of the National Diabetes Education Initiative (NDEI), Vascular Biology Working Group (VBWG), and for the Coalition for the Advancement of Cardiovascular Health (COACH). He is also a member of the American Diabetes Association, American Association of Clinical Endocrinology, European Association for the Study of Diabetes, and the National Hispanic Medical Association. He is a new member of the DiabetesSisters Board of Directors.