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Larry Smith, ADA Chairman of the Board

The prevalence of diabetes in America is well documented, and the incidence rate of the disease is growing on an almost daily basis.

Type 2 diabetes, which is typically triggered by poor lifestyle choices, has become a focus of many state and local programs aimed at keeping children and adults active and eating healthy so that they might avoid the disease and its serious co-morbid complications.

For 2006, the American Diabetes Association (ADA) reports there are 20.8 million Americans who currently have diabetes and another 41 million who have been given the designation of having "pre-diabetes." In the past two years alone, there has been a 14 percent increase in Americans with diabetes. The ADA predicts that if the country continues on its current path, one-third of all children born in 2000 will develop the disease at some point in their lives. For minority children born in 2000, that figure jumps to a full 50 percent.

Certainly there are ways to buck the trend, but additional research, preventative programming and disease management require funding and patient access.

Larry Smith, chairman of the board of the ADA, notes that the organization has successfully lobbied for and gotten passed in 46 states plus the District of Columbia, legislation that requires insurance programs to cover diabetic supplies and education. Of the four states that do not have such measures –– Alabama, Idaho, North Dakota and Ohio –– Smith pledges to continue fighting to see that diabetics have access to information and supplies. The fight is most critical in Alabama and Ohio, he explains, noting that Idaho and North Dakota already have some protections for diabetics in place.

However, Smith warns, all of the state progress could be overridden if federal legislation, particularly the Health Insurance Marketplace Modernization Act, passes. Although a measure did pass the House, S1955 introduced by Sen. Michael Enzy (R-Wyo.), failed in a cloture vote back in May.

"But," warns Smith, "the Senate Majority Leader has said it could come back up."

While the stated premise of the bill is to make offering healthcare coverage affordable to small businesses, something the ADA certainly supports in theory, Smith says in practical application this measure allows employers to override state mandates and leaves a loophole that could result in diabetics being denied coverage for supplies.

"We continue to oppose federal cuts to Medicaid that would weaken coverage," he added of another access issue on which the association has been very vocal.

In addition to protecting or expanding access to care, the ADA is also extremely concerned with access to research and program funding.

The Centers for Disease Control's Division of Diabetes Translation (DDT) runs state-based prevention and control programs based upon NIH research and established best practices. However, funding currently only exists to run comprehensive programming in 28 states, leaving 22 states without much more than basic monitoring services.

"We've suggested a $20.8 million increase (in DDT funding) that would represent $1 for every American who has diabetes," said Smith.

As it stands, the House Appropriations Committee has passed a budget that would increase DDT funding by $5.8 million with the parallel Senate committee suggesting a $2.2 million increase. President Bush's budget, however, calls for cuts to the CDC prevention program for the second straight year.

"At this point, we would be thrilled with the $5.8 million," Smith said of the House proposal.

Also of concern are cuts to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The Bush Administration budget calls for $11 million in cuts for the coming year.

"The NIH budget has been cut and may be cut again," said Smith. "We're obviously lobbying for an increase."

Currently, the Senate is suggesting a $2.8 million increase for NIDDK, which Smith calls "a drop in the bucket," but it beats the $10 million in cuts proposed by the House.

Although last year diabetes' research cuts were actually smaller than for many other disease states, Smith says that the number of grant proposals receiving funding has dropped dramatically in recent years.

"In the area of diabetes research, historically somewhere in the 18-20 percent of proposed grants would get funded," he said. "Now, it's in the 9-10 percent range. We'd like to see it start creeping back up and heading in the right direction." Otherwise, "we may find ourselves losing a generation of diabetes researchers."

Smith points out that even with increased awareness, diabetes is growing at 7-8 percent a year, and the mortality rate has increased by about 45 percent since 1987.

"The mortality rate from diabetes is going up while the mortality rate from heart disease and most cancers are going down," he stated.

The reason, Smith continued, is linked to the myriad of complications that come with the onset of diabetes ranging from blindness to lower limb amputation to end stage kidney disease.

If in the short-term funding for research, prevention and control continues to be cut, Smith is worried about the long-term effects in terms of actual pain and suffering, loss of productivity and hard medical costs.

"It's a penny-wise and pound foolish system we seem to be under," he said. "By spending a few hundred dollars now, you can avoid the $30,000-$50,000 in cost for complications down the line."







November 2006

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