How to control diabetes and its costs - Princeton Diabetes Treatment and Education Center

Business & Health, Feb, 1990 by Anne R. Somers

How to control diabetes and its costs

We can provide better care for less money, but changes are needed in current insurance coverage, this policy expert says.

Joseph Mancuso, age 41, of Yardley, Pa., is a successful, mid-level executive who had lethal eating habits. He lived off a regular diet of fast-food meals and compulsive snacking. His eating behavior was fueled by stress and an hour-long commute to work, during which he routinely ate to relieve his boredom. The result was obesity, high blood pressure, and, in 1988, the onset of adult diabetes.

Over 80 percent of the people who develop Type II diabetes (non-insulin dependent) after age 40 are overweight, like Mancuso, who weighed 337 when he went to see his physician.

For Mancuso and his employer, a New York-based firm, his diabetes could have been costly, both in medical bills and time lost from the job. But Mancuso was fortunate. His family physician referred him to a unique program at the Princeton Diabetes Treatment and Education Center (PDTEC) in Princeton, N.J.

Despite high blood sugar, high cholesterol, and obesity, he was not put on medication or hospitalized. In fact, during a year of treatment, he missed only a few days of work when he was first diagnosed and then was absent only one day a month for PDTEC counseling.

With the help of a team of PDTEC staff members including a physician, nutritionist, podiatrist, psychologist, and nurse educator, Mancuso took control of his life. He changed his diet dramatically, lost weight, and reduced his blood sugar level to normal. He learned how to have good eating habits, to gradually continue to lose weight, exercise, and test his blood three times a day.

Instead of several thousand dollars, which is typical of first year treatment for people with diabetes, Mancuso estimates the total cost of his health care was around $1,000, including $200 for an insulin-testing machine. That's a fraction of the medical costs he was headed for if his diabetes and obesity were left unchecked or if he had been hospitalized for treatment.

The founder and his theory

PDTEC is the brainchild of Arthur Krosnick, M.D., a leading authority on diabetes. Influenced by Boston's famous Joslin Diabetes Clinic, Krosnick envisioned a similar multidisciplinary, one-stop diabetes center in central New Jersey. Krosnick believes that patients who have a chronic disease should be part of the treatment team. Further, they need to become students of their own condition.

The aim of PDTEC is to keep people like Joseph Mancuso from leading a life full of medical problems that all to often befall diabetics. People with diabetes are more than twice as prone as non-diabetics to coronary heart disease and stroke, they include nearly 30 percent of new cases of end-stage renal disease, and constitute one of the major blind groups for all adults.

Lifestyle is critical

It has been recognized for some time that lifestyle plays a critical role in the course and expense of diabetes. When blood sugar levels go unmonitored over long periods of time, diabetics can suffer a variety of ailments including kidney failure, blindness, and foot ulcerations leading to amputations. All of these outcomes are significantly reduced when patients diligently control their own blood sugar levels.

As a result of PDTEC's educational and self-monitoring approach, nearly three-fourths of all PDTEC adult patients and over half of the children were not hospitalized for any reason in 1989.

For those who are hospitalized, stays are on average four days less than the national norm for the disease.

Another success story

Five-year-old Chris Seiz is another PDTEC success story. He is a victim of juvenile (Type I or insulin-dependent) diabetes. If he were like most children suffering from diabetes, he would have been hospitalized--probably several times.

When the child's condition was first diagnosed, he was referred to PDTEC by the family's pediatrician and immediately received care through the center's ambulatory insulin program. From the first day of his treatment, both of Chris' parents were taught to test his blood sugar and to inject insulin twice a day. The family was given extensive counseling on nutrition.

Chris and one of his parents visit PDTEC every three months. The family is in frequent telephone contact with the clinic to monitor his progress. With their first difficult year behind them, the Seiz family has started on a permanent course that involves regular check-ups, adherence to a correct diet, and careful attention to blood sugar levels, measured by the family at home.

Avoiding complications

One of the unfortunate and costly consequences of uncontrolled diabetes that Krosnick is trying to curb is the high rate of amputations. Diabetes is the cause of about half of all amputations that aren't the result of accidents. In New Jersey alone, there was an average of 1,448 amputations per year resulting from diabetes, between 1979 and 1981. By 1986, the number of amputations increased to 1,800 a year at a cost of $23 million, Krosnick estimates. He believes most amputations are preventable primarily through better patient and professional education.