Managed Care - December 2008 - (Page 33)

Prediabetes: Prevalent and Preventable But Underdiagnosed and Undertreated Endocrinologists say early treatment is essential, but health plans as a group are not yet on the same page diabetes may suffer consequences of the full-blown diabetes, such as lowered resistance to infection and increased risk for heart disease and stroke. According to guidelines published by the Amern November, the Centers for Disease Control ican Diabetes Association in January 2008, “there and Prevention reported an alarming statistic: is growing evidence that at glucose levels above Laboratory and claims data collected from normal but below the diabetes threshold, now rehealth plans and state and federal databases ferred to as prediabetes, there is a substantially insuch as Medicare showed that at least 1 in 4 adults creased risk of cardiovascular disease and death.” — nearly 57 million people — have prediabetes. To address that threat, the American College of But what’s worse is that using data from the fedEndocrinology (ACE) and the American Associaeral 2006 National Health Interview Survey tion of Clinical Endocrinologists (AACE) is(NHIS), the CDC found that only 4 percent of sued a consensus statement in July recomadults (about 8.8 million people) are told by mending a comprehensive treatment regimen their physicians or health plans that they are for patients with prediabetes. They call for prediabetic. (The NHIS is an annual household specific guidelines on lifestyle changes and probability survey, conducted through face“pharmaceutical intervention where approto-face interviews. The 2006 survey included priate.” 24,275 people over 18.) The call for “pharmaceutical intervention” is somewhat controversial, however. It is only Problem in perception According to experts, including the Ameri- “We know the risk in the last several months that treating prefactors for precan Diabetes Association, too few physicians diabetes,” says Sue diabetes with metformin or other oral medications is gaining favor among endocrinoloand health plans view prediabetes as a condi- Kirkman, MD, of gists — at least for patients who fail to change tion that should be treated aggressively. Pre- the ADA. “They their lifestyles and diets. diabetes is defined by the American Diabetes are clear. More As of now, there are in fact no pharmacoAssociation (ADA) as blood glucose levels that people need to be screened.” logic therapies approved by the FDA for preare higher than normal but not yet high vention of the conversion of prediabetes to enough to be diagnosed as diabetes. The diabetes. The ACE and AACE statement calls for Agency for Healthcare Research and Quality says consideration of using metformin to address the that a person with prediabetes is 5 to 15 times as problem, and for oral medication when needed. likely to develop type 2 diabetes as someone with“Although lifestyle can clearly modify the proout it. gression of patients toward overt diabetes, it may Considering that diabetes kills nearly a quarter not be sufficient,” said Alan J. Garber, MD, a promillion people a year and costs more than $714 bilfessor of medicine at Baylor College of Medicine in lion annually — $116 billion in excess medical exHouston and chairman of the committee issuing penditures and another $58 billion in lost producthe consensus in a public statement. “Medications tivity — the prevalence of prediabetes is troubling. may well be required, particularly in high-risk A study by the Lewin Group of health plan and groups.” federal health databases, also released in November, The ADA recommends that clinicians counsel found that the annual health cost of prediabetes is patients with prediabetes on loss of 5 percent to 10 $25 billion a year. That is because people with preBy Martin Sipkoff Contributing Editor I DECEMBER 2008 / MANAGED CARE 33

Table of Contents Feed for the Digital Edition of Managed Care - December 2008

Managed Care - December 2008 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor ICD-10 Offers Huge Opportunity, Challenge Part D at a Crossroads Plans Can Weather the Financial Crisis DM vs. Medical Home? Tackle Prediabetes Reasonable Approach to Morning Sickness Formulary Files Tomorrow's Medicine Outlook

Managed Care - December 2008

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