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Fighting Diabetes Must Begin and End with Prevention

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Diabetes treatments--from prescription drugs to new surgical procedures--have dominated health headlines this summer. Although it's encouraging to see so much media coverage of diabetes, little attention has been paid to the primary tool in the fight against it: prevention.

The fact is, diabetes has become an epidemic in this country, yet unlike other outbreaks of disease (H1N1, for example), we've yet to mobilize a full-scale prevention effort. That needs to change.

Looking at the numbers, there's a clear upward trend in the incidence of diabetes--the number of new cases of the disease that are emerging. Nationally, 23.6 million Americans currently have diabetes, and an estimated 33% of males and 39% of females born in 2000 could develop the disease in their lifetime. An additional 43 million people nationally have pre-diabetes (meaning that their blood glucose levels are high, which indicates a high risk of developing diabetes).

In New York, the numbers are equally staggering. Today, diabetes affects nearly 1.8 million residents across the State. Approximately one-third of them have the disease and don't know it. Currently, it's estimated that up to 4.6 million New Yorkers have pre-diabetes.

If we don't bolster the effort to prevent diabetes, these numbers could balloon to a quarter of the State's population in years ahead.

Diabetes poses both physical and financial threats; costs related to diabetes in New York State are estimated at $12.9 billion annually, including excess medical costs of $8.7 billion. Even with the best treatments, the costs and resources that would be required to care for that many patients with diabetes would likely overwhelm the system.

Fortunately, that doesn't have to come to pass. Diabetes is a largely preventable and manageable condition, and we know the steps it will take to curb the epidemic.

We know, for instance, that certified diabetes educators, community health workers, and other self-management education strategies can both help prevent diabetes among people at risk for developing the disease and slow the progression of the disease among people who already have diabetes. This type of community-based intervention is also cost-effective, with the benefits outweighing the costs associated with the intervention. Community health worker programs, for example, have been found to reduce emergency room visits and hospitalizations among people with diabetes, reducing mean Medicaid expenditures by 27%.

We also know that expanding access to healthy foods options and opportunities for regular physical activity can further help people control their risk factors and drive down the likelihood that they will develop the disease.

Many of these preventive efforts take place in the community, but physicians and other health care providers also have a central role to play. When clinicians monitor the "ABCs" of diabetes--A1C (a blood sugar test), blood pressure, and cholesterol--they can better help their patients prevent and manage the disease.

There are community- and faith-based organizations and health care providers doing effective work to prevent and manage diabetes in New York State, but we need to do more to accelerate progress and build on successful efforts. We need to focus and leverage resources to spread and sustain effective community-based programs that focus on diabetes education, prevention, and self-management. We need to address some of the environmental factors that impede many New Yorkers' access to affordable healthy foods and safe places to exercise, especially in low-income neighborhoods. We need to provide the right incentives for clinicians to focus on preventive care and help their patients with diabetes to manage the condition effectively.

The solution to what ails us is not always in a pill or a surgery. Reversing New York State's diabetes epidemic requires a holistic approach to help people make the lifestyle changes that are essential for improving blood sugar control, maintaining a healthy weight, and getting the proper care and screenings they need to stay healthy. These approaches to diabetes management aren't as easy as popping a pill, but they are known to be safe and effective. A health system that works to keep us healthy--and not necessarily offer a quick fix--is what New York needs most.