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DIABETES TODAY
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 double.

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 Prevention.

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.

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