The path toward a healthier and more fiscally sound America

When partisanship abounds, it is difficult to find a topic on which all policymakers agree.  But on World Diabetes Day, it’s clear that diabetes is a devastating disease ravaging the health of our nation and resulting in avoidable healthcare costs. This is one area of medicine where the key to improving the health of our country and addressing unsustainable health care spending truly is prevention.

The annual cost of diabetes care in the U.S. is estimated to be $245 billion, with $176 billion in direct medical costs. But the important thing to know about type 2 diabetes, the most common form of the disease, is that it is not only preventable, but serious complications—kidney failure, blindness, lower-limb amputations, and cardiovascular disease—can be avoided.

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What’s keeping us from making progress in diabetes prevention? 

Currently universal screening recommendations for individuals without symptoms apply only to those with elevated blood pressure. Those patients should certainly be screened; diabetes can significantly increase the severity of heart disease. But given the serious impact of diabetes on a life and the low risk and cost of a screening blood test, many physicians are already screening patients for other reasons. Medicare reimburses for broadened screening criteria as well.

Now, fortunately, the U.S. Preventive Services Task Force is not far behind.

The Task Force is an independent panel of experts in primary care, convened by the Agency for Healthcare Research and Quality.  Last month, the Task Force proposed new draft guidelines aimed at reaching a greater percentage of individuals at risk for diabetes, aligning with guidelines already published by the American Diabetes Association, American Association of Clinical Endocrinologists, and other major medical organizations. The new recommendations support screening for adults over the age of 45 with additional risk factors including, history of gestational diabetes, weight, family history, race or ethnicity. 

Given that there are 86 million adults in this country who are at higher risk for diabetes because they have prediabetes, as well as an estimated 8 million others who have undetected diabetes, this is a much needed and welcomed change.

Additionally, early diagnosis and prevention of diabetes is the most important step in combating the health care costs associated with diabetes that threaten to cripple our health care system. Generally, health care costs for people living with diabetes are more than double the costs for those without diabetes. One in every three Medicare dollars is spent on people living with diabetes.      

The Task Force also updates the type of testing it recommends, endorsing the test often used to diagnose and manage diabetes – commonly referred to as a hemoglobin A1c test – as a viable screening option.  As many doctors and the millions living with diabetes know, this blood test is “more convenient’’ for patients and providers because it can be used at any time, without fasting. With more than half of seniors over the age of 65 with prediabetes or undiagnosed diabetes, it’s time for Medicare to also cover and reimburse for non-fasting blood tests, so seniors can more quickly and easily get screened.

The draft changes in the Task Force guidelines are also significant from an insurance perspective because once a screening test can be declared “certain preventative,” the Affordable Care Act mandates insurers cover the full cost of the service. As a result, paying out-of-pocket for screening would no longer be a barrier for millions of adults at risk for diabetes.

Screening is a critical first step toward addressing diabetes – an epidemic that now affects more than 29 million Americans, including the millions who go undiagnosed each year. Along with patients, professional groups, trade associations, non-profits and others in the diabetes community, we applaud the Task Force for proposing these much-needed changes to the screening guidelines.

For the health of our country and economy, it’s time to adopt the right policy and practice solutions to finally bend the curve on diabetes.  World Diabetes Day serves as a reminder of why it’s so important to achieve this milestone. 

Daschle served in the Senate from 1987 to 2005 and was Majority Leader from 2001 to 2003. He is the founder and chairman of The Daschle Group, A Public Policy Advisory of Baker Donelson that provides strategic advice on key national issues including health care, energy, transportation and the environment.  Frist, M.D., served in the Senate from 1995 to 2007 and was Majority Leader from 2003 to 2007. He is a nationally acclaimed heart and lung transplant surgeon.