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Diabetes Programs

Hospitals must use education to drive patient outcomes and contain healthcare costs

Diabetes may well be the healthcare snowball from hell. Consider these icy statistics from the American Diabetes Association (ADA):

  • 29.1 million Americans, 9.3% of the population, have diabetes
  • 21 million Americans have diagnosed diabetes
  • 8.1 million Americans have undiagnosed diabetes (27.8% of diabetes is undiagnosed)
  • 1.7 million Americans age 20 years or older are newly diagnosed with diabetes each year, 4,660/day, one every 19 seconds. 12.3% of all people in this age group have diabetes •
  • Age 65 years or older: 11.2 million American age 65 years or older (25.9% of all people in this age group) have diabetes.

Here's some more factual frost to freeze your optimism: There will be many more diabetics in the future. 37% of U.S. adults aged 20 years or older have prediabetes, according to the ADA, which computes to roughly 86 million Americans aged 20 years or older who have prediabetes.

Additionally, researchers have projected that diabetes incidence will increase from what had been the 2008 norm of about 8 cases per 1000 to about 15 cases per 1000 by 2050. And total diabetes prevalence (diagnosed and undiagnosed cases) is expected to increase from 14% (in 2010) to an estimated 25 to 28% prevalence in the U.S. adult population in 2050.1

SEE ALSO: Maximizing the Success of Population Health

In addition to the human expense of health comorbidities, diabetes also brings on an avalanche of healthcare costs - immense burdens to both patients and the healthcare system. According to the ADA, in 2012 Americans with diabetes incurred $306 billion in total direct medical costs, and of that amount, the direct medical costs attributed specifically to diabetes was $176 billion. The ADA further noted that individual Americans with diabetes had annual medical expenditures 2.3 times higher than they would have in the absence of diabetes ($13,700 vs $5,800 per year). 2

And there is more to the patient cost story. A commentary by W. H. Herman, MD, MPH, published in Diabetes Care (April 2013) noted that Americans with diabetes also incur about $69 billion in annual costs related to absenteeism, reduced productivity both at work and at home, diabetes-related disability and premature mortality, as evidenced by an ADA 2012 study.2

Diabetes Education
In addition to new diabetes drugs and high technology treatment devices, one of the best ways to slow the predatory snowball is through diabetes education programs. "There can never be too many educational programs," Laura Rooney, DNP, APRN, FNP-BC, DCC, BC-ADM, FAANP, UTHealth School of Nursing.

When setting up a diabetes education program, Rooney said a facility should begin by reviewing the two accrediting agencies: American Diabetes Association (ADA) and American Academy of Diabetes Educators (AADE). "In order to receive reimbursement from Medicare, and then private payers, a diabetes program must be accredited by one or both of these agencies," she explained, adding there is really no benefit in having both accreditations, ". other than the name recognition that comes with either group."

Once a facility decides which organization they will follow and from whom it will eventually seek accreditation, an internet search of the individual websites will provide details, steps to be taken, and cost of the survey which would ultimately result in accreditation. "AADE, for instance, outlines step-by-step what each program must contain in order to receive accreditation using the '7 Healthy Behaviors' [healthy eating, being active, monitoring, taking medication, problem solving, reducing risks and healthy coping]," Rooney explained. "While there is room for variation in interpretation of the standards and guidelines, ADA and AADE both have resources to help the new programs meet critical objectives that will enable the educational program to pass and audit and receive accreditation."

Keeping the Program Robust
Rooney told ADVANCE that once such programs are up and running, they are generally managed by diabetes educators or those individuals certified in advanced diabetes management (BC-ADM).  "The credentials of a program director, along with other positions within the program such as educators and clinicians, are mandated by the accrediting body. For most, educators must hold one of the certifications (BC-ADM or CDE), and be a registered nurse, physician or pharmacist," she said.

While some hospitals have regarded diabetes programs as budget leaks, even to such an extent that they have closed existing programs, others have seen the bigger picture. Rooney noted, "Diabetes education programs, if run correctly, can be financially advantageous. But certainly it takes a lot of work to see a positive margin on them. The success of the program really must lie within the improved outcomes for patients with diabetes, and the overall lowering of healthcare dollars for diabetes. Patients who have successfully completed a diabetes self-management education program typically experience fewer complications from advanced disease, along with fewer trips to the emergency room, saving valuable resources. So while a programs may not be big revenue producer, if it can break even the success is in the long-term outcomes.

Additionally, now that reimbursement is being tied to outcomes, there is more incentive for facilities to run successful programs. "In inpatient settings, reimbursement will be tied to readmissions. In other words, if a patient is discharged from the hospital and readmitted for the same diagnosis within a certain period of time, generally 30 days, then the hospital will not be reimbursed for the second admission," reminded Rooney. "If we successfully educate our patients and connect them with community resources, this will not only improve patient outcomes, but will also help to contain healthcare costs."

Asked if she had an overarching message to send to other providers giving care to people with diabetes, Rooney boiled it down this way: "Diabetes is a complicated disease that must be managed every day, many times throughout the day. Nursing has always excelled at educating and empowering patients, and doing the same for patients with diabetes is no different.  But  too often patients are given a diagnosis of diabetes, told about checking blood sugars, medication side effects, avoiding hypo-/hyperglycemia and lifestyle changes all in one 15-minute clinic visit," said Rooney. "Clearly this is less than effective. What is needed is a period of time for the individuals to come to terms with the disease, and then to attend a supportive program that will connect them to community resources."

"We must continually reinforce the need for lifestyle changes, "Rooney advised. "The research indicates that weight loss and healthy activity will improve insulin resistance, help to stabilize blood sugars and slow the progression of the disease. As the numbers of people with diabetes continue to rise, we will be needed more than ever to help interpret the medical findings for our patients. Nursing is poised to take the lead on this issue."

1. Boyle JP, et al. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Population Health Metrics 2010; 8:29. doi: 10.1186/1478-7954-8-29.

2. American Diabetes Association. Economic Costs of diabetes in the US in 2012. Diabetes Care 2013;36:1033-1046.

Valerie Neff Newitt is on staff at ADVANCE. Contact:

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I was diagnosed with type 2 Diabetes and put on Metformin on May 21st, 2014. I started the ADA diet, using it as directed for weeks – still my blood glucose did not get below 140. I questioned my doctor about my options and he said I would be on metformin the rest of my life – until moving to insulin. Meds were the only option he gave me. Then, I found the Diabetes Destroyer book ( review: ) It made sense and opened my eyes to the possibility of all natural, home diabetes treatment. I started to implement David Andrew’s methods the very next day. I’ve lost over 40 pounds and 7 inches on my waist in a month. I have more than enough energy to workout twice daily and still power through. I almost fell for the trap the pharms have set up for people like us, but I got lucky. Open your minds people and try alternative methods, these corporations are making their money from us being sick.

Brian HigginsSeptember 28, 2015
Cambria Heights, NY


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