Study Shows Impact Of Diabetes On San Diego Health Care Costs
May 20, 2014 1:13 p.m.
Sue Babey, co-author, senior research scientist at UCLA Center for Health Policy Research
Athena Philis-Tsimikas, M.D., Scripps Whittier Diabetes Institute
MAUREEN CAVANAUGH: This is KPBS Midday Edition, I am Maureen Cavanaugh. Our top story on Midday Edition, diabetes has been a growing health problem in the US. Now a new study by the UCLA Center for health policy research finds that diabetes is also adding significantly to healthcare costs in California. In fact, the lead author of the study says that statistics shows the rising rates of diabetes to be not only devastating to patients, but to the whole healthcare system. I would like to welcome my guests, Sue Babey and Doctor Athena Tsimikas. Thank you for coming in. Still, the talk with you start with you. Tell us how this report Out and the decision to look at the link between diabetes and the cost of hospitalization.
SUE BABEY: Nationally diabetes rates have tripled in the last thirty years. Diabetes is a very costly condition with very serious complications. We wanted to look at the impact diabetes is having on the healthcare system and healthcare costs in particular. We used hospitalization data for the state of California from 2011 and looked at hospital patient age 35 and older and looked at how many of them had diabetes it diagnosis regardless of their reason for being in the hospital.
MAUREEN CAVANAUGH: A third of the people had diabetes, they did have the condition even if it wasn't the primary reason they were hospitalized, is that right?
SUE BABEY: That's right and that 30% is quite a bit higher than the prevalence of diabetes in the general population which is about 11% for the age group in California.
MAUREEN CAVANAUGH: Does that tell us that people with diabetes have a likelihood of being hospitalized more than people without?
SUE BABEY: I think the data does suggest that with the diabetes diagnosis you may be more likely to end up in a hospital and your hospital stay is likely to cost more.
MAUREEN CAVANAUGH: How much is the additional cost that the study found to San Diego hospitals?
SUE BABEY: In San Diego we found $120 million in additional costs for patients with diabetes compared to Patients who do not have diabetes.
MAUREEN CAVANAUGH: How does that compare to counties around the state?
SUE BABEY: It varies quite a bit from County to County but San Diego is one of the highest.
MAUREEN CAVANAUGH: Of all of the counties in California?
SUE BABEY: Of all of the counties in California. A little bit lower than Los Angeles and it is the second highest.
MAUREEN CAVANAUGH: Imperial County has more than 41% of its suffering from diabetes and that percentage of patients with diabetes is the highest in California, isn't it?
SUE BABEY: Yes it is, Imperial County has the highest proportion of hospital patients with diabetes.
MAUREEN CAVANAUGH: Why does diabetes contribute to the high cost of hospital stay? What other treatment might somebody need who has diabetes if they are in the hospital for a broken leg, that somebody that does not have diabetes would not need?
ATHENA TSIMIKAS: It is not necessarily the direct treatment of diabetes relative to the cost. It really could be a longer link of length of stay because infection may pursue longer. High blood sugars have a poor healing rate, so you cannot heal as quickly. All of those things, if you're in the hospital for several several days longer, add it to the cost as well. We're looking at ways to help modify blood sugars while you're in the hospital, they have to do a lot before landing in the hospital as well.
MAUREEN CAVANAUGH: And for people who do have diabetes is the condition itself likely to make you sick or in some way that would sort of make you go into the hospital for something that is not diabetes related, just sort of part of that condition?
ATHENA TSIMIKAS: Absolutely. Blood sugar as a molecule that runs through the bloodstream can attach to proteins throughout the body. When it does that, it can attribute to many complications. It can worsen kidney disease, worsen heart disease, and when you have a heart attack some of that might have been worsened because of the high blood sugars that contributed to the original development of the disease. Same with amputations. The high blood sugars drove the decrease in blood flow to the limbs and we try to improve that situation it is much harder in the hospital when you don't have great blood flow. Wound healing rate, infections, all of those contribute.
MAUREEN CAVANAUGH: Before we go much farther I would like you to remind us what diabetes is so we are all on the same page. How does someone become diabetic, what is diabetes type I and II?
ATHENA TSIMIKAS: There are essentially two types of diabetes that can develop. We used to think that type I diabetes, which is an autoimmune disease when antibodies in your own body turn against cells in the pancreas that produce insulin and destroy them. It used to be a disease of childhood, but now we're finding it in adults. This can be very sudden and results in no ability to lower your blood sugar because you do not have insulin to lower it. That is 5 to 10% of our population. The larger population is type II diabetes. We used to think this was a disease of adults and now we're seeing it can occur from children from the age range of ten and older. We are seeing people with higher blood sugars, prediabetes occurring in the teens. They secrete insulin, but not high enough doses. Or high enough amounts to bring budget are down. There is also resistant to the effects of insulin, all contribute into high what sugar levels. The ultimate event in type I and type II are higher blood sugars which then contribute to some of the complications if we do not treat them appropriately and don't handle them appropriately.
MAUREEN CAVANAUGH: Your report breaks down the percentage of patients with diabetes and hospitalizations by ethnicity, and you found disturbing trends. Tell us about the rate of diabetes among the Latino population, African-Americans, and native Americans.
SUE BABEY: When we looked at the hospital patients who had diabetes by race and ethnicity, we have 42% of Latino patients hospitalized have diabetes. About 40% of African-American and American Indian and Asian-American patients have diabetes. This is considerably higher than white patients were only 27% have diabetes.
MAUREEN CAVANAUGH: Do we know the factors involved in the higher rate of diabetes?
SUE BABEY: There are probably a number of factors that come into play and Doctor Athena Tsimikas can also comment on this, but Latinos and African-Americans are also at higher risk for developing diabetes in the first place. They may also in some cases not have access to care that is as good as for white patients.
MAUREEN CAVANAUGH: What are the factors, the physical factors that might make a Latino woman more susceptible to developing diabetes than her white friend?
ATHENA TSIMIKAS: The difference between race and ethnicity is probably more likely due to genetics. There is an underlying predisposition within different races and ethnicities. The environment does contribute, if you don't have access to exercise, food that might be what we consider more healthy, that results in raise in obesity rates and can trigger the onset of diabetes. Environmental factors are huge conservations. If I can just add, within our own Scripps hospitals here, we see that variation in rates of patients with diabetes across our five hospitals. 21% up in the north at Encinitas have diabetes. In Chula Vista with a higher Latino population 40% of the population has diabetes committed to the hospital. We see that in our health system here and it reflects in the studies, which I find fascinating.
MAUREEN CAVANAUGH: You made a important point, that is the numbers that we're getting from this report are actually things that you see on a daily basis in hospitals around San Diego. This is not just a theoretical exercise, this is something that is actually impacting all patient care at San Diego hospitals. I don't want to put you on the spot, but if you could sort of broad rate, have you seen this kind of problem of more and more patients with diabetes increasing over the years, is this something that you have been seeing build?
ATHENA TSIMIKAS: Absolutely. We actually have statistics we tracked back ten years. I look at the rates ten years ago and some of our hospitals it was 7% that are now 20 to 25%. In Chula Vista it is remarkable how that rise has occurred. We have definitely seen over the last ten years and unfortunately I do not see a slowdown.
MAUREEN CAVANAUGH: When we hear about diabetes, we usually hear conversation quite a bit about diet. Is that the fundamental problem?
ATHENA TSIMIKAS: It is probably quantity and although diet is certainly when we say diet, and sugary drinks are cited in the study as well, those are cited because it is so easily to take on extra calories in the form of liquid and sugary drinks. When you are consuming higher quantities it leads to weight gain which also triggers diabetes to occur. So, if we limit the quantity and have variation and everything in moderation, it still holds true today. It has a big effect. You have to combine that with exercise and other things also. It is everything altogether.
MAUREEN CAVANAUGH: Sue, the message of this study that we are getting is that people who are diabetic are hospitalized a bit more and also the cost of their hospitalization is more expensive than someone who does not have diabetes. But the real message of the study is not to demonize people with diabetes but to remind people that in many cases this disease is preventable, right?
SUE BABEY: Yes, that is absolutely right. But we would really like to see happen is ensuring that there is appropriate access to care with people with diabetes so they are less likely to end up in the hospital, and can manage their condition. But also increase efforts in prevention of diabetes that fewer people develop type II diabetes in the first place.
MAUREEN CAVANAUGH: Tell us about screenings for diabetes, is that a simple blood test?
ATHENA TSIMIKAS: It is a simple blood test, and generally recommended be done in your physicians office because sometimes you get general screenings and a positive number comes back with just a fingerstick glucose, those meetings are not always accurate and sometimes there are not followed. If anyone does have a positive screening, we want to make sure that it is all it up with a not left. A simple fasting blood sugar can do it, we have a three-month test that shows you an average what sugar of the past three months called the hemoglobin A-1 C and that most recently has been approved by the American Diabetes Association as a method of screening as well. Both of those are very easy tests to do. Prediabetes is a warning sign that you may get diabetes in the feature or complete onset of diabetes. It is interesting in hospitals, once in a while they do show up for hot attacked or one of their other infections, people are told they have diabetes when they never even knew it. It is a markable finding, and an appropriate screening in the physicians office may have indicated that many years before and may have prevented that.
MAUREEN CAVANAUGH: And someone gets the diagnosis of diabetes or prediabetes, can you reverse the condition by lifestyle changes?
ATHENA TSIMIKAS: That is a great question, you definitely can have an effect by changing your lifestyle. It can both reverse it or at least the demise the amount of medication that is needed to handle it.
MAUREEN CAVANAUGH: In other words, if you're given the diagnosis of having a prediabetic edition, if the change your diet or exercise, you might be able to go in to your doctor six months later and have the same screening with normal blood sugar levels?
ATHENA TSIMIKAS: That is correct, it usually is associated with some percentage of weight loss as well. Some studies say if you reduce 7 to 10% body weight it will reverse or stabilize the condition.
MAUREEN CAVANAUGH: This study also has public policy recommendations, take us through a few of those if you would. We talked about legislation on sugary drinks, what else would you like to see done?
SUE BABEY: We like to see reimbursement for screenings so that more people are able to get early screening, ideally. We would like to see more efforts around prevention and this includes sugary drinks, activities like you mentioned, and also making sure that people have access to of the food, making sure that people have access to places to engage in physical activities.
MAUREEN CAVANAUGH: Walkable communities, that kind of thing. And that is not just up to one patient as you say here, this is something that public policy change or recommendation or some sort of community effort is going to have to bring about, is that right?
SUE BABEY: That is right, these are things that are really going to require individuals to work with communities and also in some cases with California legislature to encourage them to enact policies that would support these kinds of activities.
MAUREEN CAVANAUGH: This whole study is about the fact that when you have diabetes you may be more likely to go to the hospital, or hospitalization is going to be more expensive. You have more tips for people who do have diabetes that will help them stay out of the hospital?
ATHENA TSIMIKAS: Probably working close with your healthcare team, where I work at the Scripps diabetes Institute, we actually have nurses, dietitians, as well as peer educators, people with diabetes that we specially trained to get the message out on how to best care for your diabetes. All of these people work with their physicians to get the message the patient on what they need to do. Physicians can sometimes be busy. If you can work with the entire team, they have more time to spend with the patient, letting them know for the individual patient what they need to do. Everyone really may need something specific for themselves. That team can focus on what are the issues, and how can they help them as well.
MAUREEN CAVANAUGH: So you can manage diabetes and stay relatively healthy? s is that an option that people have?
ATHENA TSIMIKAS: Absolutely. But there has to do with lifestyle changes, taking medications, we now have nine categories for medications for treating diabetes. When I first started practicing twenty years ago, we had two. So we have many more options now to help manage blood sugar as compared to years ago.
MAUREEN CAVANAUGH: Okay, I want to thank my guests very much.