“Cost of Consequences” – The Looming Diabetes Epidemic:

What it is now and what it will become if we do nothing

Dr. William Rowley

What’s happening to our children?

During their lifetimes:
1/2 will become obese
1/3 will get diabetes
Earlier disability

Life expectancy ↓ 2-5 yrs

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Increasing Prevalence of Obesity

1990 2005

27%

No Data
Texas Statistics
2015 2030

44% 55%

Adults over 20 y/o Obesity Health costs for TX = $13 B/yr

<10% 10-14% 15-19% 20-24% 25-29% 30-34% 35-39% 40-44% 45-49% 50-54% 55-60% >60%

Sources: CDC Behavioral Risk Factor Surveillance System; Wang & Beydoun, The Obesity Epidemic in the United States –
Gender, Age, Socioeconomic, Racial/Ethnic , and Geographic Characteristics: A Systemic Review and Meta-Regression Analysis. Epidemiol Rev 2007;29:6-
28; Wang, et al, Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic. Obesity 2008;16:2323-
2330
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Increasing Prevalence of Obesity

Duke University found that its
severely obese employees:
• Filed 2X as many workers’
compensation claims
• Had 7 X higher medical costs
• Lost 13 X more days
y of work
Duke University Study. Obesity and Workers’ Compensation. Arch Intern Med. 2007;167:766-773

CEO Council Priorities for the New Administration -

Top Priority for Health Care: FIGHTING OBESITY
Wall Street Journal, 11/24/08

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Increasing Prevalence of Obesity

• Type II diabetes
• High blood pressure & high cholesterol
• H t di
Heart disease and
d strokes
t k
• Osteoarthritis (degenerative joint disease)
• Sleep apnea and respiratory problems
• Gall bladder disease
• S
Some cancers
• Anxiety and depression
All chronic diseases with serious disability and
often premature death
5

Increasing Prevalence of Diabetes

1995 2005

14 Million 23 Million
2015 2025

32 Million 43 Million
Total of diagnosed and undiagnosed cases
<5% 5-8% 9-11% 12-14% 15-17% 18-20%

Sources: CDC Behavioral Risk Factor Surveillance System; Narayan. Impact of Recent Increase in Incidence on Future Diabetes Burden. Diabetes Care 2006;29:2114-2116

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Increasing Prevalence of Diabetes

Diabetes in Texas
2000 2009 2025

Total # 1,373,000 2,235,000 4,128,600

% Diabetes 6.6% 9.2% 13.4%

Annual Cost $10B $17B $31B

Deaths 17,000 24,000 45,000

Sources: CDC Behavioral Risk Factor Surveillance System

Narayan. Impact of Recent Increase in Incidence on Future Diabetes Burden. Diabetes Care 2006;29:2114-2116
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Increasing Prevalence of Diabetes

Diabetes in Metro
Dallas - Fort Worth
2000 2009 2025

Total # 344,000 573,000 1,039,000

36% are culturally diverse
Annual Cost $2.4 B $4.3 B $7.8 B

Sources: CDC Behavioral Risk Factor Surveillance System

Narayan. Impact of Recent Increase in Incidence on Future Diabetes Burden. Diabetes Care 2006;29:2114-2116
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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Increasing Prevalence of Diabetes

Diabetes Complications in Texas
2009

Blindness 2,500

Kidney Failure 4,900

Amputations 7,800

Sources: CDC Behavioral Risk Factor Surveillance System

Narayan. Impact of Recent Increase in Incidence on Future Diabetes Burden. Diabetes Care 2006;29:2114-2116 9

Diabetes Burden on Workers

If onset of diabetes at age 40:

• Quality of life shortened 18-21 yrs
• Lifespan shortened 10 10-14
14 years
• 2-4 X ↑risk dying of heart disease
• Ave. cost of complications $11,000/yr
Narayan, et al. Lifetime Risk for Diabetes Mellitus in the United States. JAMA 2003;290:1884-1890
American Diabetes Association, Indian Health Service
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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Diabetes Burden on Workers

Increased risk if: African Hispanic/ Native
American Latino American

Risk of Diabetes 1.6 X ↑ 2X↑ 2.2X ↑

If diabetic risk of:
Blindness 1.4 X ↑ 2X↑ ↑↑
Kidney Failure 4X↑ 6X↑ 6X↑
Amputation 4X↑ 1.8 X ↑ 3-4 X ↑
Death 1.3 X ↑ 1.4 X ↑ 3X↑

Narayan, et al. Lifetime Risk for Diabetes Mellitus in the United States. JAMA 2003;290:1884-1890
American Diabetes Association, Indian Health Service
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How can we
effectively address
the diabetes
epidemic?
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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Effectively Managing Diabetes

Healthy Lifestyles
80%

60%

Men 1.5%
40% Women 4.2%

20%

0%
Don't Maintain Eat 5 Exercise Do all 4
Smoke Healthy F&V/d 5X30
Wt.

Reeves, Healthy Lifestyle Characteristics Among Adults in the United States, 2000, Arch Intern Med, 2005

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Effectively Managing Diabetes

Healthy Lifestyles
80%70% of premature death is lifestyle-related
Healthy lifestyle can reduce cancer risk 60%,
60%
diabetes risk 90%, heart disease by 80%
Men 1.5%
Exercise is more effective than Women
40%
cholesterol
4.2%

medicine in preventing a second heart attack

20%

50% off allll illness

ill & injuries
i j i in i theth last
l t third
thi d off life
lif can
0% be
Don't
eliminated
Maintain
by changing
Eat 5
lifestyleDo all 4
Exercise

75% of health
Smoke
care costs could
Healthy
Wt.
F&V/d
be prevented
5X30
through
lifestyle modification
Reeves, Healthy Lifestyle Characteristics Among Adults in the United States, 2000, Arch Intern Med, 2005

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Effectively Managing Diabetes

“Our lifestyle is a disease more deadly
than cancer,, war or the plague!”
p g
Most chronic diseases can’t be cured.
“We live longer only because of
modern medicine,
medicine yet many live
wretchedly and far too many die
young.”
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Effectively Managing Diabetes

1. Prevention
Lifetime diabetes risk of 18 y/o man:
• Normall weight
N i ht = 20%
• Overweight = 30%
• Obese = 57%
• Very obese = 70%

How?
• Eat 5 fruits & vegetables a day
• 30 minutes of physical activity 5 X a week
• Stop smoking
• Maintain a normal body weight
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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Effectively Managing Diabetes

1. Prevention
2 Screening – 64 million pre
2. pre-diabetics
diabetics
3. Behavior Modification

Societal peer pressure

4. Effective Mgmt. of Chronic Diseases
Cowie, Full Accounting of Diabetes and Pre-Diabetes in the U.S. Population in 1988-1994 and 2005-2006.
Diabetes Care, 2008;32:287-294
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A Health Care System that Works

Encouraging Employee Health
Acme Employee
Newsletter

July
2012

John is 46 years old

• Smokes
• Overweight
• Brother has diabetes
• Father died of heart attack

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

A Health Care System that Works

John Goes Online

• Takes interactive health-risk assessment

• Secure Personal Health Record produced

• Selects a doctor and makes an appointment

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A Health Care System that Works

John Visits his Healthcare Team
• Quick diagnostic testing
• Dr. Jane reviews
i John’s
h ’ record
d
• Conversation is to-the-point
• Agree to a plan of action & goals
ƒ Help to quit smoking
ƒ Changes
Ch in
i diet
di t and
d activities
ti iti
ƒ Treat high BP, cholesterol & diabetes
• Therapies prescribed & guidance given

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

A Health Care System that Works

Effective Use of Technology

Targeted therapies
Noninvasive monitoring

Wireless capture
Text prompts Facilitated Disease Network
Personal health record

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A Health Care System that Works

John Takes Action on his Health
• Exercise program at work
• ‘Diet manager’ at local grocer
• Stop-smoking program
• Home biomonitoring → PHR
• Online “patients like me” support
• 6 months
th later
l t
ƒ Stopped smoking
ƒ Lost 20 pounds
ƒ Diabetes, BP, and lipids controlled
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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

A Health Care System that Works

Life-long
continuity of
care

Collaborative
team of
providers

Electronic
El t i
Education Shared record
and decision-
coaching making

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Benefits of Diabetes Control

• Training to help people self-manage
diabetes prevents hospitalizations
ƒ Every $1 invested saves $8
$8.76
76
• Early diagnosis and effective treatment
ƒ Reduces severe vision loss 50-60%
ƒ Reduces amputations 45-85%
ƒ Reduces kidney disease 30-70%
ƒ Red ces
Reduces heart
hea t disease and stroke
st oke 33
33-50%
50%

• Monthly cost to employer of diabetic:

ƒ Well controlled blood sugar: $25
ƒ Poorly controlled blood sugar: $120
http://diabetesatwork.org
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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Benefits of Diabetes Control

Relationship between HbA1c and Productive Relationship between HbA1c and
120%
Capacity Absenteeism
4.0%
Capacity

100%

e Rate
3.0%
80%
Productive C

Absentee
60% 2.0%
40%
1.0%
20%

0% 0.0%
≥10 9 to 9.9 8 to 8.9 7 to 7.9 6 to 6.9 ≥10 9 to 9.9 8 to 8.9 7 to 7.9 6 to 6.9
HbA1c Level HbA1c Level

Relationship between HbA1c and Medical Cost

per Year “HbA1c” is a blood test of
$5,500 blood sugar
g control over
time
Medical Cost per Year

$5,000

$4,500
• Normal is less than 6.5
• Excellent control of
$4,000

diabetes is less than 7

$3,500

$3,000
≥10 9 to 9.9 8 to 8.9 7 to 7.9 6 to 6.9
HbA1c Level

http://diabetesatwork.org
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Asheville Project
Patient Self-Management Program
• Sponsored by Employer – an investment
• Employees with diabetes volunteer
• Receive diabetes education
• Lab, glucometer, meds - no co-pays
• Meet with trained pharmacist
• Collaboration with doctor

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Asheville Project
Results at 5 Years
Ave. Glycosylated Hemoglobin LDL Cholesterol
7.6
6.7 121
95

Total Individual Diabetes Medical Costs

Ave. Ann. Diabetic Sick-Leave $7,248
58%
12.61 $6,127
$4 651
$4,651
Savings

6.01

APhA Foundation data

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We can’t
W ’t solve
l
diabetes without
addressing obesity!

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

All it takes is personal responsibility

Obesity is a
Personal Choice
Individual
R
Responsibility
ibili is
i the
h
Proper Answer
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All it takes is personal responsibility

2005 Health Behaviors Survey
Percent of Overweight Active Duty
61.6
58.3
60 55.2
51 2
51.2
50
Percentage

40

30

20

10

0
1995 1998 2002 2005

13% were obese

Since then have seen dramatic
increase in obesity due to the
stresses of two ongoing wars
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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

All it takes is personal responsibility

Our Obesogenic Environment

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It’s going to take shared responsibility on the part
of all elements of society to overcome this! 31

Its Health Care’s Responsibility

• Bariatric surgery
g y works

• Only 2 FDA approved medications

• Doctors don’t tell you

to lose wt. or exercise

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Federal Government Approach

“Individuals, not the federal government, are
responsible for whether they maintain healthy diets.”

Powerful lobbies and partisan politics limit progress:

NIH & CDC doing obesity research, HHS value-

based purchasing initiatives
33

State Obesity Efforts

2006 University of Baltimore Obesity Report Card Map

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Changing Communities
Start with children – Somerville, MA

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America’s Obesogenic Environment

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

America’s Obesogenic Environment

Growing Portion Size
20 Years Ago Today

2.4 ounces 6.9 ounces

333 calories 590 calories
210 calories 610 calories
6.5 ounces 20 ounces
628 Calories 1450 Calories
85 calories 250 calories

Designed to be Irresistible
Layering Compelling
ƒ Fat ƒ Texture
ƒ Salt ƒ Smell
ƒ Sugar ƒ Combinations of
ƒ Flavors experiences
David Kessler, The End of Overeating: Taking Control of the Insatiable American Appetite, 2009
37

America’s Obesogenic Environment

Change Our Views on Eating
Eat food. Not too much.
Mostly plants.

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Bringing Activity Back into Life

Redesigning the built environment

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What Can Employers Do?

Bringing activity back into the workplace

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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

What Can Employers Do?

Bringing healthy behavior back into the
workplace

41

What Can Employers Do?

Have a well designed wellness program

Health Risk Appraisal Health Education

Advice Nurse
Nutritional Counseling
• Customized to employee needs
• Measure return on investment
O li Support
Online S t
Financial Incentives
• $150 for health risk appraisal
• $20/mo for fitness center
• $14 per 1% weight lost
• $150 if quit smoking
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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Conclusions

Healthy, productive
employees are your
most valuable asset
Creating and maintaining
them is to a great extent
your responsibility
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Conclusions
• Employers can not afford to wait…
ƒ For Congress to pass health care legislation
ƒ For
F society
i to wake
k up and d change
h
• 10 ways to Cut Healthcare Costs
2. Develop a healthy workforce
4. Make health a community effort
~ Value-based
V l b d health
h lth insurance
i design
d i
• There are solutions that work for you

http://www.cdc.gov/leanworks/
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“Cost of Consequences” – The Looming Diabetes Epidemic:
What it is now and what it will become if we do nothing

Institute for Alternative Futures

www.altfutures.com 45

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