Diabetes Coalition of California
By Jack M. Bertman, M.D.
Mono County Health Officer
Did you know that one out of 22 Californians has Diabetes and is under
treatment for it? And that another one of the same 22 has diabetes but
doesn't know it? As of 1998 over one million Californians had been
diagnosed with diabetes. By the year 2020 this number is expected to
As you can easily tell, the cost of medical care for this large number of
persons is very great. In 1998, the cost for diabetes care in California
was 12 billion dollars. Nationwide the cost was 45 billion dollars. This
figure is for direct medical costs only; costs attributable directly to
diabetes and does not reflect the other health care costs incurred by people
with diabetes. The indirect costs such as disability, work loss, and
premature mortality total another 47 billion nationwide.
The California Diabetes Control Program is a statewide program in the
California Department of Health Services, dedicated to reducing the burden
of diabetes through surveillance, policy development, health communications
and demonstration projects. It collaborates with local, state and national
organizations, and is funded by the Center for Disease Control and
The Diabetes Coalition of California is composed of representatives from the
general public, local health departments, community-based organizations,
voluntary health organizations, universities, professional organizations,
and insurance and pharmaceutical companies. The Coalition is charged with
providing guidance and direction to DHS in developing policy aimed at the
prevention and control of diabetes in California.
The Coalition, through its guideline and professional education committees,
has identified the need to define minimal diabetes care criteria. It has
recognized that health plans should evolve from competing on cost to
competing on quality, and has recommended evidence-based clinical
interventions. Because of a wide variation in clinical practices, and the
need to define "quality" in diabetes care, a set of guidelines has
been developed. These include minimal standards for physical examinations,
laboratory studies, and patient and provider education.
The development of the guidelines and the improved care and monitoring of
persons with diabetes will hopefully lead to some reduction of the costs of
this disease, both in dollars and in personal and family suffering. And it
leads to a basic question about this disease - why are we essentially
treating type 1 diabetes the same way we have been since 1927, when Banting
and Best introduced insulin to the world? Many people think that by taking
insulin or oral medications, diabetics are cured. And if diabetics would
just watch their diet and take better care of themselves they wouldn't
suffer from the complications of the disease, and would lead normal lives.
Although there is some truth in these statements, there is also much
misinformation in them. The life of a type 1 diabetic patient is entirely
consumed with the care and management of his or her disease. This includes
self-monitoring, diet management, self-treatment, and consideration of all
the factors in everyday life that will influence control of blood sugar.
This means attention to some detail every two hours during the day, not
exactly a "normal" life.
although much research is going on in the field, most of it is not
"cure&34; related. The only real cure would be one that provided
functioning insulin and glucose sensing cells to the patient. Transplant
technology is very advanced for many organ systems but has not reached the
level of a routine procedure for pancreas or islet tissue. Many techniques
are being investigated in the field of immunosuppression, and even in
xenotransplantation (using animal tissue) to try to achieve a cure. There
are many impediments to these avenues of research - scientific, political,
economic, and ethical. But with continued effort and the education of the
public a cure can eventually be achieved, and with it will come an end to
the suffering and costs of this all too common disease.