One of the fastest growing epidemics in America, and the world, doesn't have enough health care providers (HCPS). Not even close.
So how are we going to handle the flood of diabetes patients coming at our health care system like a tsunami?
Close to 25 million Americans have diabetes, and amazingly, nearly 25 percent don't know they have it. Almost another 60 million Americans have lined up to get type 2 diabetes; they have pre-diabetes. Most people with pre-diabetes will get type 2 diabetes within five to 10 years if they don't normalize their weight and get active.
Diabetes is the fifth leading cause of death in America; it kills more people than breast cancer and AIDs combined. It ranks number one in direct health costs, consuming one out of seven healthcare dollars. In 2007 the financial cost of diabetes-related doctor visits, medications, hospitalizations, surgeries and treating complications was $116 billion. Adding the costs for lost wages, reduced productivity and disability, the cost is $174 bilIion.
Diabetes is also exploding around the world, in Western Europe and underdeveloped nations, particularly China, India and the Middle East.
China now has more people with diabetes than any other nation, topping the world at 92.4 million. Approximately 26 per cent of the population of Kuwait suffers from diabetes or its implications. The International Diabetes Federation (IDF) estimates that close to half a billion people around the world will have diabetes in 2030 - that's less than 20 years away.
Here's the rub: diabetes requires patients manage the state of their diabetes, and their blood sugar, every day through dozens of informed decisions around medicine, food, activity, stress and sickness. If patients don't know how to do this they will likely get devastating diabetes complications. Given the numbers, we have one diabetes educator, someone trained to work specifically with diabetes patients, per roughly 1,700 patients. If I include patients with pre-diabetes, we have one educator for roughly 5,700 patients.
3 things that are making the state of diabetes worse:
1. Most GPs are not current on diabetes
Most patients see their local family doctor for diabetes. Most GPs had a half- or one-day lecture in medical school on diabetes. Very few are current on the constantly-changing 'Standards of Care' that provide guidelines for diagnosis, medication and all stages of treatment.
To make matters worse, some GPs won't prescribe insulin to their patients, even when necessary, because they aren't knowledgeable about insulin and educating and titrating (dosing) patients on it. And there's little incentive as it's time-consuming and frankly doesn't pay.
2. Not enough endocrinologists for patients
Endocrinologists specialize in hormone imbalances and are the treating specialist for diabetes. According to Andrew Stewart, M.D., chief of the endocrinology division at the University of Pittsburgh, there's an endocrinologist shortage and patients typically wait three to nine months to see their endo, and many endocrinology practices are no longer accepting new patients. "Seen another way," Stewart says, "there are some 4,000 M.D. endocrinologists to care for approximately 25 to 100 million patients who might reasonably wish to be seen by an endocrinologist."
Fewer medical students are going into endocrinology. Chronic conditions like diabetes are a time-thief and a financial drain for endos. Further, despite the need for endocrinologists, the number of training programs in the United States to train M.D.s in endocrinology has declined over the past decade. The Accreditation Council for Graduate Medical Education reported in 2008 that there were 122 accredited M.D. endocrinology fellowships in the United States. In 1996 there were 140.
#3. Not enough diabetes educators for patients
Diabetes educators are on the front lines helping patients learn how to manage their condition. Coast to coast there are only about 15,000 diabetes educators. Now think about how many more are coming -- patients, not educators. Diabetes educators are not increasing in number, and in many areas of the country they are dwindling. Not surprising given the flood of patents, including now children, huge workloads, pay, burn-out and retirement.
Further, becoming a diabetes educator is not easy, there is no direct route. Most of these impassioned Florence Nightingales fall into it. They may be a nurse or dietitian and there's an opening for someone in their clinic or hospital to learn diabetes on the job. We'd do well to create a course curriculum that provides an easier route.
No one will deny we have an exploding population of patients and a dwindling team of health care providers. In fact, the incidence of diabetes around the world is rising so quickly that the IDF, for the first time in 58 years, has decided that beginning in 2011 they will meet once every two years instead of every three.
Find another hospital, no beds available
"I have this picture in my head," said a diabetes educator I interviewed, "of the future where patients come into the hospital with an ailment other than diabetes, and they're lined up waiting in the hallway because all the beds are filled with diabetics."
This week I'll be at the annual conference of the American Association of Diabetes Educators in San Antonio, Texas August 3-8th. Around 6,300 educators who have found the funds to attend will gather to get more credits, learn, bond and get reinspired to continue to do the incredibly important work that they do.
I will be presenting at the conference about a model for improved patient care that includes a new way for educators and patients to work together creating more success for both.
I'll also be checking the pulse of this over-extended workforce and hoping I can report back with some good news.
Follow Riva Greenberg on Twitter: www.twitter.com/diabetesmyths
It's fascinating that some comments decry the lack of focus on cures in the "conventional" medical realm. Meanwhile, they propose drastic behavioral changes on the part of the patient, but they either fail to acknowledge that these are not cures or they simply say that they are cures.
Whether a diabetic gets to a normal blood sugar by injecting insulin or by eliminating carbohydrates from his diet, the diabetes is not cured. In either case, one symptom of the diabetes, high blood sugar, is merely controlled.
If you can call the dietary change a cure, then you can call the insulin a cure. Neither is a cure. Both are treatments.
Type 1 diabetic for 37 years, I'd be dead within a few days without injected insulin.
This is a fantastic article and I wish it were getting more traffic. It should be linked from the homepage for a while.
The comments here are dead on too.
Conk hit the nail on the head: conventional "treatment" is NOT focused on actually curing the disease but rather "managing" it or "controlling" it. In fact, they usually use language like, "as your diabetes progresses...." or "as you develop complications..." as if it is an inevitable outcome that you will get worse. Endocrinologists and other doctors are trained just to test blood sugar and prescribe drugs/insulin. They don't even know that type 2 diabetes did NOT exist before 1920 when certain artificial foods were introduced into the food supply. Nutrition is barely covered, if at all, in medical school. Here are some articles I wrote on this:
http://reverse-diabetes-naturally.blogspot.com/2010/07/type-2-diabetes-did-not-exist-before.html
http://reverse-diabetes-naturally.blogspot.com/2010/07/what-causes-type-2-diabetes-real-answer.html
Katmeyster points out doctors just treating the symptoms. So true!! They do NOT treat the underlying cause which CAN be treated naturally! Also, most of them don't even test actual insulin levels before prescribing drugs that are known to raise insulin! Here's an article I wrote on this:
http://reverse-diabetes-naturally.blogspot.com/2010/08/why-dont-doctors-check-insulin-levels.html
Maxine Fox
http://reverse-diabetes-naturally.blogspot.com/
Diabetes is just one more example of the failure of allopathic medicine to properly treat "disease". There is no disease, there is only nutritional shortcomings or ingestion of a toxin. Both can be cured with natural means. Mother Nature is beautiful in her elegant simplicity.
Here in the SW, diabetes is an epidemic with some native american tribes reporting a reporting a
100% rate.
That seemed hard to believe, so I spent about a minute investigating and found:
http://www.diabeteseducator.org/ProfessionalResources/accred/Application.html
Good luck.
I'll be very interested to see your reporting from the AADE meeting.
I believe that patients need to learn to be the expert on their bodies, but at this point so many don't have a clue as to how to begin or what to believe! I read the comments and disagree that one size fits all and that we don't need more endocrinologists! Exactly who is handling the microbiology of the disease and for some a difficult case? Many people feel they need face to face time to get their head wrapped around a strategy that works for them.
I've been living with diabetes 40 years and I know lots of "stuff", but often it's a puzzle as to what is needed at the moment and my CDE and endo have been an awesome resource for thinking it thru. Plus talking about it with them is a two way street to developing better strategy for everyone!
Thanks for this!