Cost of diabetes could be $3.35 trillion by 2020

The number of Americans diagnosed with diabetes and the related costs of the disease could reach catastrophic proportions, according to new research by the UnitedHealth Group.

The new projections are alarming, as more than 50% of Americans could have prediabetes or diabetes by 2020, which could carry a healthcare price tag of $3.35 trillion over the decade. New estimates show diabetes and prediabetes will account for an estimated 10% of total healthcare spending by the end of the decade at an annual cost of almost $500 billion –– up from an estimated $194 billion this year, UnitedHealth said in its new report, “The United States of Diabetes: Challenges and Opportunities in the Decade Ahead.”

Estimates in the report were calculated using the same model as the widely cited 2007 study on the national cost burden of diabetes commissioned by the American Diabetes Association, UnitedHealth noted.

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Survey: Most consumers turn to blogs, Facebook for health info

A social media go-to-market strategy is fast becoming a must-have for companies these days, especially those companies operating in the healthcare arena. It’s no longer enough to push patient education out through a branded online page anymore, not with the growing prominence of social media sites. Today, companies need to seed that education across Facebook and Twitter and/or actively engage bloggers and heavy users to successfully get that education out to the masses online.

An Accenture survey released Tuesday found that U.S. consumers seeking medical advice are turning to medical websites, social media sites, online communities and informational websites in far greater numbers than the websites of pharmaceutical companies. According to the survey, of the more than two-thirds (68%) of consumers who go online for health information, slightly more than 1-in-10 regularly turn to a pharmaceutical company’s website to seek information about an illness or medical condition, compared with 92% who more frequently look to other online resources.

That patient traffic helps illustrate the fundamental shift from a predominantly one-way company-to-patient dialogue to enabling a patient-to-patient — and even a patient-to-healthcare-professional dialogue — through the evolution of social networks and online communities.

“Pharmaceutical companies that embrace innovations, such as social networking and communications via mobile devices, and integrate and align their communication strategy across multiple channels will be positioned to have a much greater influence on their patients’ choices and, consequently, realize significant increases in revenue, profitability and sustained competitive advantage,” stated Tom Schwenger, global managing director for Accenture’s Life Sciences Sales and Marketing practice.

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Dialysis: An Experiment In Universal Health Care

Every year, more than 100,000 Americans start dialysis treatment, a form of chronic care given to people with failing kidneys. And for many, the cost is completely free. Since 1972, when Congress granted comprehensive coverage under Medicare to any patient diagnosed with kidney failure, both dialysis and kidney transplants have been covered for all renal patients.

But a new joint investigation between The Atlantic and ProPublica found many problems with dialysis in the U.S.: The cost of treatment is among the world's highest, while the U.S. mortality rate for dialysis patients is one of the world's worst. One in four patients will die within 12 months of starting treatment.

Investigative reporter Robin Fields, who spent the past year reviewing thousands of documents and interviewing more than 100 patients, doctors, policymakers and experts, found systematic failures in the way dialysis centers are set up in the United States.

"At clinics from coast to coast, patients commonly receive treatment in settings that are unsanitary and prone to perilous lapses in care," she writes in a piece that will be published in the December issue of The Atlantic. "Regulators have few tools and little will to enforce quality standards. Industry consolidation has left patients with fewer choices of provider. [And] the government withholds critical data about clinics' performance from patients, the very people who need it most."

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Advocating for Patients with Diabetic Nephropathy

Although no cure exists, pharmacologic and nonpharmacologic measures can help patients prevent onset or progression of diabetic nephropathy to preserve kidney function.

Diabetes is the seventh-leading cause of death in the United States and the primary cause of end-stage renal disease. Diabetic nephropathy is a longterm consequence of diabetes, estimated to affect 20% to 40% of patients with diabetes. Although there is no cure for diabetic nephropathy, by understanding the pathophysiology, preventative strategies, and interventions to slow the progression of this disease, the pharmacist can be better prepared to advocate for kidney function preservation.

Pathophysiology
Although the exact cause of diabetic nephropathy is unknown, several mechanisms have been hypothesized. Hyperglycemia, the formation of advanced glycosylation products, activation of the renin-angiotensin- aldosterone system, and activation of cytokines are all thought to be contributing factors to the progression of disease.

Hyperglycemia appears to cause expansion and injury of the glomerular basement membrane of the kidneys by increasing the renal mesangial cell glucose concentration. Initially, the glomerular mesangium expands by cell proliferation and later by cell hypertrophy. Transforming growth factor beta (TGF-beta) is particularly important in causing the expansion and later fibrosis by stimulating the production of both collagen and fibronectin. Other cytokines that are present in the kidney are also under investigation for their role in diabetic nephropathy.

Advanced glycosylation products are formed as glucose binds reversibly—and eventually irreversibly—to proteins in the kidneys. The glycosylation products can eventually form complex cross-links over time as the hyperglycemia continues and can contribute to renal damage by stimulation of growth and fibrotic factors.

In diabetic nephropathy, the local renin-angiotensin system is activated. Angiotensin II is stimulated and results in constriction of the efferent arteriole of the glomerulus, which results in increased glomerular capillary pressures. Angiotensin II also stimulates renal mesangium expansion and fibrosis through activation of angiotensin II type 1 receptors, and increases the expression of TGF-beta and other growth factors.

Microalbuminuria (30-300 mg/L) may contribute to renal injury associated with diabetic nephropathy. An increase in glomerular permeability causes plasma proteins such as albumin to be secreted into the urine. A portion of these proteins is absorbed by the proximal tubular cells, which can trigger an inflammatory response that contributes to kidney damage. Macroalbuminuria (>300 mg/L), nephrotic syndrome, and eventually renal failure may occur during the later stages of diabetic nephropathy.

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Most diabetics do not change oral health habits after diagnosis

Many active diabetes managers have not changed their oral care habits since being diagnosed, despite the fact they are at higher risk for developing serious complications from poor oral hygiene, according to a study by dLife, a multimedia network serving the diabetes community, and market research firm SoundView Research.

Furthermore, more than half of active diabetes managers surveyed had not been advised by their dentists to take extra care to brush, floss or rinse daily.

"The results of this study show the gulf that exists between perceptions and the connections between diabetes and oral health. Your dental health absolutely affects the control of your diabetes," stated Charles Martin, a dentist, author and founder of DentistryForDiabetics.com. "Inflammation in the mouth coming from gum disease spreads to the whole body. This inflammation increases insulin resistance, cholesterol levels and C-reactive protein levels. So, uncontrolled oral disease can be the hidden factor working against those trying to maintain good control over their diabetes."

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Kidney Transplant Numbers Increase for Elderly Patients

Elderly patients with kidney failure get kidney transplants more often than they did a decade ago, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The results suggest that the chances of receiving a kidney transplant are better than ever for an older patient who needs one.

Kidney failure afflicts nearly half a million individuals in the United States, and 48% of sufferers are 60 years of age or older. Kidney disease patients who obtain a transplant live longer than those that remain on dialysis. Fortunately, living and deceased organ donations are on the rise; however, transplant waiting lists have become increasingly long as more and more people develop kidney dysfunction.

Elke Schaeffner, MD (Charité University Medicine, in Berlin, Germany), along with Caren Rose and John Gill, MD (St. Paul's Hospital, University of British Columbia, in Vancouver, Canada) examined whether elderly patients with kidney failure have better or worse access to transplants now than they did in the past. The study included patients with kidney failure in the United States aged 60 to 75 years listed in the United States Renal Data System between 1995 and 2006.

The study revealed that elderly patients rarely receive a transplant, but they were twice as likely to get one in 2006 as in 1995. (In 2006, they had a 7.3% likelihood of getting a transplant within three years of their first treatment for kidney failure.) Elderly patients now benefit from greater access to organs from living donors and older deceased donors compared to a decade ago. They also die less frequently while waiting for a kidney than they did in the past.

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Diabetes prevalence among Americans may increase to 33%

The rate of diabetes among Americans is on an upswing and likely will reach epic proportions by 2050, costing the government millions.

A new study by the Centers for Disease Control and Prevention and published in Population Health Metrics found that annual diagnosed diabetes incidence (new cases) will increase from about eight cases per 1,000 people in 2008 to about 15 in 2050. The authors also projected that — assuming low incidence and relatively high diabetes mortality — total diabetes prevalence (diagnosed and undiagnosed cases) is projected to increase from 14% in 2010 to 21% of the U.S. adult population by 2050, but noted that  if recent increases in diabetes incidence continue and diabetes mortality is relatively low, prevalence will increase to 33% by 2050.

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