Depression, Diabetes and the Healthcare Crunch
> 6/12/2006 2:21:29 PM

The New York Times Health section, over the last couple of days, has been focusing on diabetes. In their series entitled Bad Blood the writers at the Times have examined the many wide-ranging issues that coalesce to make diabetes one of the most threatening healthcare problems we have ever faced.

At the heart of the epidemic lie the concerns about treatment. Yesterday, the Times featured the story of the Beth Israel Medical Center's diabetes treatment center. After opening in March of 1999, the diabetes center took a proactive approach to helping those with diabetes learn to manage their disease so as not to necessitate costly surgeries like amputations or worse. But, as the article details, treatment of chronic diseases is not good business, whether or not it is effective, and the center closed not too long after its first promising steps.

They did not shut down because they had failed their patients. They closed because they had failed to make money. They were victims of the byzantine world of American health care, in which the real profit is made not by controlling chronic diseases like diabetes but by treating their many complications.

Insurers, for example, will often refuse to pay $150 for a diabetic to see a podiatrist, who can help prevent foot ailments associated with the disease. Nearly all of them, though, cover amputations, which typically cost more than $30,000.

Patients have trouble securing a reimbursement for a $75 visit to the nutritionist who counsels them on controlling their diabetes. Insurers do not balk, however, at paying $315 for a single session of dialysis, which treats one of the disease's serious complications.

The article, while lengthy, is thorough in its discussion of the difficulties of treating diabetes in a way that is both medically effective and economically feasible. Even with little background on the subject, this piece provides an overview that highlights the depth and weight of the problem. One particular section stuck out in describing the issues:

Many doctors who treat diabetics say they have long been frustrated because they feel they are struggling single-handedly to reverse a disease with the gale force of popular culture behind it.

Type 2 diabetes grows hand in glove with obesity, and America is becoming fatter. Undoubtedly, many of these diabetics are often their own worst enemies. Some do not exercise. Others view salad as a foreign substance and, like smokers, often see complications as a distant threat.

To fix Type 2 diabetes, experts agree, you have to fix people. Change lifestyles. Adjust thinking. Get diabetics to give up sweets and prick their fingers to test their blood several times a day.

It is a tall order for the primary care doctors who are the sole health care providers for 90 percent of diabetics.

Another story, from today's Times, examines one particularly difficult, and often complementary issue to diabetes treatment: how to address diabetes concerns in those who are struggling with mental illness. Nearly one out of every five people living with a mental illness has diabetes, a rate that is twice that of the general population. There has long been a connection between diabetes and depression, but studies have shown that often other mental illnesses come with increased risk of diabetes.

This subset of diabetes sufferers also come with their own complications and issues. For those dealing with mental illness, often a mental health practitioner is the only doctor they'll see, and many times, concerns over weight and other health issues take a backseat to the mental afflictions. Beyond that, the very drugs that help ease the mental health problems can prove dangerous as they have been linked to greatly increased risk of diabetes. Add on top of all this memory problems, mood swings, voices and many other symptoms of mental health problems and one can see how diabetes can start to seem like a death sentence.

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