December 16, 2017
Diabetes hits hard in California
LOS ANGELES--A teenage girl walks the hardscrabble streets of Richmond, a Bay Area city, rapping about the challenges of drugs, violence—and diabetes. Here, she says, big dreams are “coated in sugar,” and innocence is “corrupted with Coke bottles and Ho Ho cupcakes.”

She’s performing in a video by a local youth group that counts diabetes, a national epidemic that has hit California hard, as one of the killers in her neighborhood. The disease, which is spreading and driving up health costs, now impacts more than half the state’s adults, especially people of color and the poor.

Experts say it doesn’t have to be that way, that prevention programs can slow the march of the illness and save money at the same time. But efforts to legislate prevention, for example, by taxing the sugary drinks whose consumption contributes to diabetes, have stalled in the face of heavy opposition by the well-funded beverage lobby.

The state will soon begin funding a program for anti-diabetes education, counseling and lifestyle coaching, but it’s a modest investment regarded only as a start.

“Investing more now in diabetes prevention and education will save our state billions of dollars down the road,” said state Sen. Bill Monning, a Democrat from Carmel who has proposed soda taxes in the past and tried unsuccessfully this year to require warning labels on sweetened drinks.

A University of California, Los Angeles study last year found that 9 percent of adults in California have been diagnosed with diabetes, a chronic condition in which the body does not process sugar well and which can lead to blindness, heart disease, stroke and infections resulting in amputations.

Forty-six percent, including about a third of those under 40, are pre-diabetic, with elevated sugar levels that will likely develop into diabetes. That’s 55 percent of the state’s adult population swept up by the disease.

Treating diabetes costs government, private insurers and patients about $27.6 billion a year in California for such expenses as doctor visits, testing, medication, surgery and hospital costs, according to the American Diabetes Association. The state and federal governments shoulder most of that expense through Medi-Cal, which is California’s health program for those living in poverty, and the national Medicare system that covers seniors.

A state audit of the California Department of Public Health diabetes prevention efforts released two years ago said that California lagged in such spending. The state spent about $1 million from the federal Centers for Disease Control and Prevention, a sum that has since grown to $1.4 million, but did not devote state money to such programs. New York, the audit points out, was spending $7.2 million, although some of that money went to anti-obesity programs.

Beginning in July, with the next budget, $5 million in state funds will go toward a nutrition and exercise program for pre-diabetic enrollees in Medi-Cal. That project, based on a CDC model called the Diabetes Prevention Program, can cut the risk of developing diabetes in half, according to the CDC. In addition, it is expected to save about $45 million in treatment expenses over the next five years, said Assemblyman Joaquin Arambula, a Kingsburg Democrat and physician who co-chairs a health subcommittee.

The largest state pension fund, CalPERs, began offering the CDC program to through its insurance plans this year and Medicare will offer it nationally next year. It is also offered by some private insurers.

But adult diabetes, or Type 2, doesn’t get the same attention as some other deadly diseases, such as cancer. Nor is it considered as blameless as Type 1 diabetes, a childhood disease diagnosed when the body produces little or no insulin.

Type 2 is considered mostly preventable by changes in diet and physical activity. But its spread has increased 32 percent in California in the past decade, according to state statistics. The disproportionate impact on low-income communities and people of color may partly explain why it gets short shrift, experts say.

“There’s a general belief that it’s slothful, lazy people making bad choices,” said Dean Schillinger, professor of medicine at the University of California, San Francisco, a leading expert on diabetes and prevention and chief of the state’s diabetes control program from 2008 through 2013. “But if you have to choose between buying a fast-food meal for your family of five for $15 or going to Whole Foods and spending $80 on health food, it’s very rational what people are doing.”

Add to those economics the marketing of beverages and snack foods to children, especially through targeted advertising in low-income communities, and you have a natural intersection for the disease, he said. A federally funded study released this year found that diabetes grew at a rate of 4.8 percent among children each year between 2002 and 2012.

Diabetes is also increasing among white people, Schillinger noted, just not as quickly. Sedentary lifestyles, fat-rich diets and time spent in front of screens large and small cut across all communities.

Another contributor is a healthcare industry that has been primarily focused on treatment instead of prevention, said Monning: “Prevention, including diabetes prevention, is not profit-generating.” (Source: The Orange County Register)
Story Date: December 12, 2017
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