Stopping Diabetes Before It Starts-Scientific Research

 

November 14^th is National Diabetes Day and diabetes is the number seven cause of death in the US, resulting in nearly 85,000 deaths annually. (National Center for Health Statistics, 2020) Many people globally are dying because they can’t afford their insulin, which results in diabetic ketoacidosis, when cells dehydrate and the body stops functioning. According to the World Diabetes Organization, there are over two million deaths worldwide annually, due to high glucose resulting in ketoacidosis. Children’s hospitals in the US report a rate of death of .25 out of 100,000 from Diabetic ketoacidosis (DKA) and the United Kingdom reported .21 out of 100,000 deaths of children and youths. (Denis Daneman, 2001) There are also an equal number of deaths from cerebral edema. This means that 54 people under the age of 19 died from diabetes due to hypoglycemia or DKA in the United States in 2009 and it is now estimated at 185 deaths. (US Census Bureau, 2010) One of the reasons for the increase is the escalating unaffordability of insulin, which is ten times more expensive in the US than any other country. (Rajkumar, 2020)  This article features scientific research on the cause of Type1 Diabetes and the imminent potential for a cure.

The Cure

Benaroya Research Institute is the global principal investigator in the T-1 study and has the largest bank of T-cells from which it has multiple active studies devoted to understanding the cause of diabetes and how to cure this terrible disease. Dr. Marika Bogdani leads a team of researchers studying the Hyaluronan deposits in islet cells and how that precedes insulin dependent diabetes. Her research findings were recently published in Springer Nature. (Marika Bogdani, 2020) Substantial deposits of cellular hyaluronan (HA) are characteristic of insulin dependent diabetes and her recent research investigated HA accumulation in islet cells prior to disease progress to diabetes. Her study used BioBreeding rats from 40 days of age until diabetes onset.  Pancreas tissue from 15 non-diabetic organ donors who were positive for the islet autoantibodies and 14 control donors, were analyzed for HA islet cell staining and the presence of insulitis. Here are her team’s findings:

·        1.   50% of the donors positive for islet autoantibodies showed large accumulations of HA, four times that of the control samples.

·        2.  Further, 21% of the islet cells contained the largest HA accumulations based on the HA-stained areas.

·        3.  Among those seven donor samples, 4 did not show islet immune-cell infiltrates, which means HA accumulated independently and in the absence of inflammatory cells in those which were positive for islet autoantibodies.

·         4. The accumulation of HA islets was evident up to 8 weeks prior to the onset of insulitis, which starts the pancreatic damage eventually resulting in the need for insulin. HA cells were largest in the donor rats at high risk of developing Type 1 diabetes.

·        5.  Insulitis was first detected in 9 to 10-week-old rats, where HA deposits were abundant in the islets and was associated with expansion of immune cell infiltrates, leading to an 85% loss of their beta cells.

The global T-1 study already has the ability to identify persons at risk of Type-1 Diabetes, an auto-immune disease which is prevalent in family groups. Bogdani’s research aims to identify those at risk and find a way to reprogram islet cell activity to prevent the HA mutations which result in pancreatic damage. The goal is to stop diabetes before it starts.

https://www.benaroyaresearch.org/our-research/diabetes-clinical-research/find-study

 Support for Those Living with Diabetes

I have been involved with the Lown Institute’s Right Care Alliance since 2005 and their current Affordable Insulin advocacy is an issue close to my heart. The group is hosting a nationwide Zoom program on Sunday, November 15, for those who care to participate, it is from 11:00AM to 1:00PM Pacific time. Here is a link to the program to register:

https://www.eventbrite.com/e/insulin-story-slam-tickets-124914732327

 Trouble Affording Insulin

Here are some organizations which may be able to help with insulin access.

Insulin for Life USA is a nonprofit that reclaims unused insulin and provides it to people globally.  There are 90,000 children throughout the world with Type 1 Diabetes.

https://iflusa.org/#:~:text=Insulin%20for%20Life%20USA%20is,to%20these%20life%20saving%20necessities.

Pharmaceutical makers of insulin do have patient assistance programs which can provide free insulin for a period of time, these include; Nova Nordisk, Sanofi Aventis, and Eli Lilly.

Any hospital emergency department in the US must provide insulin on an emergency basis, so if you have skipped doses and are in danger please go to an ER within 24 hours of missed doses. It doesn’t matter if you have insurance, they must provide treatment. Hospitals have medical assistance programs which provide substantial subsidies for patients who are income challenged.

If you are rationing insulin because you can’t afford your refill, call your clinic and explain your dire need and they should be able to provide a free sample.

If you use the traditional insulin which was originally derived from the pancreas of cows and pigs, but is now lab produced with E Coli bacteria, it is less expensive. The typical price in 2018 for Novolin, the needle and syringe insulin variety, was $24.88 for a vial. (Harrar, n.d.) The current list price for laboratory produced Humalog (U100-10ml) is $274.70 for 1,000 units. Perhaps Novolin won’t work as well but it will keep you alive. One hundred units of Novolin is $58 today if you buy it online. However, like everything else in healthcare, what you actually pay depends on your insurance plan.

Subsidized Medical Insurance

If you lack medical insurance, enroll in the Affordable Care Act, which has federal subsidies for the monthly premiums, based on your income, so this program could make your insulin more affordable. And there is no discrimination because of pre-existing conditions. Word to the wise, the Trump Administration and the Republicans have been trying to get rid of the Affordable Care Act, known as Obamacare and there is a Supreme Court case to be heard on November 10^th regarding the Commerce Clause and the validity of the act. If the Trump-packed court rules the law invalid, about 22 million people will lose their medical insurance. Further, the act mandated coverage for pre-existing conditions for all, which impact well over 100 million people, which were formerly denied access to health insurance.

This is the healthpolicymaven signing off encouraging you not to sign blanket releases when consenting to a medical procedure, do indicate that for which you consent and decline.

 Roberta Winter is an independent journalist and health policy analyst who accepts no money from anyone in the healthcare, insurance, pharmacy, or medical supply sectors. Her guidebook to the US healthcare system was published by Rowman and Littlefield in 2013.

https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

 

Works Cited

Denis Daneman, M. B. (2001, May 24). Diabetes-Related Mortality-A Pediatrician's View. Diabetes Journals, 10(5), 801-802. doi:https://doi.org/10.2337/diacare.24.5.801

Harrar, S. (n.d.). Free Insulin: Strategies for Getting It When You Can't Afford Your Prescription. Retrieved 11 10, 2020, from Ontrack Diabetes.com: https://www.ontrackdiabetes.com/live-well/diabetes-management/free-insulin-strategies-getting-it-when-you-cant-afford-your-prescript

Marika Bogdani, C. S. (2020). Hyaluronan deposition in islets may preced and direct the location of islet immune-cell infiltrates. Springer Nature. doi:https://doi.org/10.1007/s00125-019-05066-7

National Center for Health Statistics. (2020, 11 9). Diabetes Facts. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/fastats/diabetes.htm

Rajkumar, S. V. (2020). The High Cost of Insulin in the United States-An Urgent Call to Action. Mayo Clinic Proceedings. Mayo Foundation for Medical Education and Research.org. doi:DOI:https://doi.org/10.1016/j.mayocp.2019.11.013

US Census Bureau. (2010). US Census Brief-Population By Sex and Selected Age Groups-2010 Census. US Commerce Department-Census Bureau. Retrieved 11 9, 2020, from https://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf

 

 

Why Diabetes Prevention and Management and the U.S. Health Care System Are At Odds

Diabetes Current-State and Changes to Come

Unless you are Cro-Magnon-man and just emerged from a glacial field you are probably aware of some of the 2010 health care reforms. This article reviews how the United States got to be in such poor shape, health-wise and how some provisions of the 2010 reforms will create incremental changes.
Since I am nearly finished with my second book, the Russell Guide for Diabetes: Type I or Type II This Could Happen To You, let me share some mind boggling information about this scourge. The American statistics on this disease have a huge impact on government funded health plans, including Medicare and these metrics from the CDC explain why :
• The proportion of diagnosed diabetics in the United States has increased by more than 50% since 2007; 17.7 million in 2007 and 25.5 million in 2010
• Fully one third of the U.S. population is expected to be diabetic by 2025; 115 million
• In 2010 18.7% of the 25,564,000 U.S. residents diagnosed as diabetic were African Americans and 10.2% of that number were non Hispanic ( White)
• More than 90% of all diabetics are Type II, which is controllable by diet and exercise
• The CDC estimates that 33% of the country is in pre-diabetic mode in 2011

Obesity
Type II Diabetes is caused from obesity and a diet high in simple sugars and carbohydrates (think fast food, doughnuts, etc,) Being over-weight significantly increases your chances of becoming diabetic. I think it is time we Americans call a-spade-a-spade, so if one of these criteria fit you are fat:
1. 20 lbs. over weight-Yes, you are fat
2. 50 lbs. overweight-This qualifies you as obese
3. 100 or more lbs. overweight-Then you are exogenously obese
4. Body Mass Index or BMI exceeds 30 you are fat
5. If you have to replace the shocks on the driver’s side of your car more frequently than the passenger side, this is a clue that your girth has impacted vehicular performance.
6. If you have broken chairs in your house or someone else’s by sitting in them, yes my friend you are fat.
7. If you need to buy your clothes at Tacoma Tent and Awning, need I say more?
It is time we as Americans put down the doughnuts and look in the mirror. The country needs to go on a 12-Step Program for Over Eaters Anonymous. No more excuses, just bust a hump and get out there. Like everyone else I have had to battle-the-bulge as I’ve aged, but so far I do not qualify in any of the categories above.

Diet
Food is fuel and it really does matter what you consume. If you are going to persist in a diet that is high in simple sugars, lacking in fiber, and complex carbohydrates, it is similar to starving your body of essential food, so it craves more food. Diets which are high in “the whites” meaning white rice, white pasta, white bread, and sugar cause spiking in glycogen which is what the body creates when it breaks down food. Foods that convert to simple sugars cause the glycogen rush and over time damage the pancreas which ultimately ceases to work properly. At that point, listlessness, fatigue, and a sudden weight loss may be symptoms of diabetes. The United States has at least 5 million more people who are undiagnosed diabetics. The later diabetes is diagnosed the worse the damage is to the body systems. Here are some tips on wise food choices:
1. The large pizza is not intended for one person
2. 32 ounces of a soda-you may as well drink three beers calorically speaking; put down that big gulp unless you want the catheter that goes with it when you are on kidney dialysis later

What Happens If America Doesn’t Slim Down
Diabetes was the 7th leading cause of death in the United States as reported by the CDC for 2006 and it is advancing all of the time. And death from diabetes is not a quick process, but a torturous route of injections, circulatory problems (including amputations), hyper tension, and kidney failure. In the United States, 40% of diabetics end up on kidney dialysis. These metrics contrast sharply with other industrialized countries that have much lower renal failure rates, such as Austria at 30% or 34% in Germany. Life expectancy for someone on kidney dialysis in the United States is only a few years.

The link between heart failure and kidney dialysis is pronounced and a 2011 study showed that 36.1% of dialysis patient had high blood pressure, 38.2% had a history of heart infection, and 25% had excessive weight gain between dialysis sessions. All of these symptoms are exacerbated by the dialysis treatment process in the United States, which pushes patients to conform to business practice hours and not optimal clinical outcomes.

What are the Costs
The U.S. Medicare program has financed the cost for kidney dialysis for all persons who have Social Security numbers and are legal residents since 1973. President Nixon signed the legislation and at that time renal dialysis cost $12,273 per patient and 11,000 people needed it in the country. Fast forward to current time and dialysis now costs $77,000 per patient and there are over 350,000 people on it. The vast majority of people on dialysis are diabetic, with age being correlated with an increased incidence of renal failure. In 2010, Medicare spent 20 billion dollars on the renal dialysis program.

What Can Be Done
The vast majority of renal dialysis centers in the United States are operated by for-profit companies, like DaVita, fueled by Medicare’s reimbursement policy which rewards the process not clinical outcomes for dialysis centers. This may all be changing with President Obama’s endorsement of the Comparative Effectiveness Research Institute in 2010. This institute will look at clinical processes and outcomes across systems and compare them to global data to find ways for improvements. For example, the mortality or death rate for patients on kidney dialysis is much worse in the U.S.A. than in other industrialized countries, so this needs to be reviewed. And of course, a much greater percentage of American diabetics end up on dialysis than in other countries.

Another aspect of the 2010 Health care reforms was to require insurance companies to offer wellness or preventive care benefits. In my former career in the insurance business there was always a lot of teeth gnashing over offering preventive benefits because the industry promoted the idea the employees should pay for this service themselves. The industry also discouraged low co-payments or cost sharing as a means to lower the insurance premiums for the employer group. The problem with this mentality is it is inherently short term and the health of a person is a long term process. This is just one example of how the insurance industry has been at odds with promoting health for our country. Though it should be obvious, let me state that by mandating a base level national health surveillance system, such as an annual physical, offered gratis, we can find the people that are hypertensive or pre-diabetic and prevent more serious health damage. By reaching out and treating people earlier we will save money in government funded health programs. In order to accomplish this goal as a nation the country needs to continue to look at aligning provider incentives and reimbursements to promote national health not just a medical service. The goal of the country should be to work towards optimizing the health of its citizens not just treating their illnesses and injuries . If private sector insurance is to be a part of that equation, disease prevention services that are measureable and effective need to be included. Perhaps another model could include national clinics where physicals are administered by public health officials, which would provide privacy for the employee who may not wish to share his personal health metrics with the employer. Despite all of the HIPAA privacy hype, I can assure you there are a myriad of ways for an employer to discover employee health data, especially for a group which is self-insured.

On that note the healthpolicymaven is going to sign off and log my eight miles, which I have averaged per day this year. I recommend that you also slam down that pizza and put on your shoes.

This article was written by Roberta E. Winter, MHA, MPA and may be reprinted with her permission.