E. Douglas Gat, MD
In "A Primer on Diabetes", two arguments are presented: 1) Diabetes Mellitus (DM) and its complications have high impact on health and cost, and 2) Interventions can positively impact the consequences of the illness.
So, the big question is: How do we improve the situation for employers?
In Canada, the relatively low prevalence of Type 2 diabetes in the general population means that universal screening is unlikely to be cost-effective. In the workplace, even though diabetes is serious and very costly once complications set in, it takes a lower profile because other conditions have more direct effects, such as musculoskeletal injury, and mental disorders.
You may wonder how well insurers track diabetes as a cause or complication of short and long term disabilities. In my experience, not very closely. Why? No diagnostic information is collected within drug benefit plans, and drug and disability benefit databases are rarely linked. When a diagnosis exists (such as in a disability file), updated information, or complications, or co-morbidities may not be known or reported. Often, we have to make assumptions about the causal condition by considering both approved and ‘off-label’ indications for use of all drugs prescribed.
Frequently, patients with diabetes are not well aware of their condition, do not monitor blood glucose closely, are not fully compliant with their treatment, and have not taken diabetes education classes (e.g., through Ontario’s diabetes centres).
Insurers share an interest with health professionals, employers, and governments in identifying such high risk, high cost people who could be equipped to better manage their health. Such action may defer or prevent use of healthcare services from both public and private health plans, and avoid absence, disability, and life insurance claims.
In terms of action, improved access to better organized primary care would allow health professionals to detect and follow individuals with diabetes. Perhaps insurers could sponsor more claim-related research, using proper scientific methods, and with clear rules to protect privacy and confidentiality. More extensive and effective employer-facilitated screening and education would help plan members self-manage their condition, with complementary and positive results. The challenge now before us: what can your organization do?
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