Helping New Jerseyans Get a Handle on How to Prevent, Manage Diabetes

Andrew Kitchenman | March 2, 2015 | Health Care
Bill would fund education programs in the state, which has nation's third-highest rate of obese kids at future risk for disease

diabetes spending
As New Jersey faces a demographic time bomb from diabetes that could devastate the next generation, healthcare researchers and policymakers are trying to head off the looming crisis.

Of New Jersey children ages 2 to 5 in low-income households, 16.6 percent are obese, which elevates their risk for diabetes. This childhood obesity rate ranks third in the country.

In addition, the state already has an estimated 700,000 residents with diabetes, as well as two to three times as many with “pre-diabetes” – elevated blood-sugar levels.

One proposal for dealing with the problem – legislation sponsored by Assemblyman Herb Conaway Jr. (D-Burlington) and recommended in a Harvard Law School Center for Health Law & Policy Innovation report — is to require the state’s Medicaid program to reimburse providers for education programs to teach people how to prevent the disease or better manage its complications.

“This bill will, I hope, be regarded as a common sense measure that will save money in the healthcare system and will — more important than that — save and extend the life of people who suffer from diabetes,” said Conaway, who is also an internal-medicine doctor.

Stephen Habbe, advocacy director for the American Diabetes Association, said New Jersey must do more to address the diabetes epidemic.

“While many people do well with managing their diabetes, many other do not do well – they’re at risk of disabling complications: blindness, lower limb amputations, kidney failure, heart attack and stroke,” Habbe said, noting that 1,971 New Jerseyans died from diabetes in 2009, the most recent available count. In addition, in 2012, there were $5.4 billion in direct healthcare costs for treating diabetes in the state, as well as $2.4 billion in indirect costs, such as from people with diabetes missing work.

The legislation would cover expenses for educating people with diabetes, pre-diabetes and gestational diabetes, an elevated-blood-sugar-level condition that affects pregnant women.

Cooper Health System dietician Francine Grabowski said that along with the need to provide information about having a healthy diet, being active and actively monitoring blood-sugar levels, self-management of diabetes focuses on practical problems, including how to inject insulin, the medication used to manage the condition.

“Taking insulin is a skill that needs to be learned,” including how to use the syringe, rotate injection locations, and eat the right foods at the right time, Grabowski said.

She recalled a patient who required nine visits before she learned how to successfully use an insulin pen to inject herself. But once she was able to manage her blood-sugar levels, the patient was able to stop using insulin, Grabowski said.

While Grabowski’s work in Camden is funded through a grant, she said the state bill is necessary to ensure long-term funding. “It’s unconscionable to not provide diabetes education” to Medicaid recipients, she said.

The National Institutes of Health found that such programs reduce the incidence of diabetes by 58 percent over a three-year period, and reduce the diabetes risk by 71 percent for people 60 and older, noted Michael Johnson, director of association initiatives for the Elizabeth-based Gateway Family YMCA.

The Harvard report also recommended that healthcare advocates and policymakers in New Jersey work at the national level to push for diabetes self-management education to become a freely available preventive-care service available under the provisions of the Affordable Care Act.

Other recommendations in the 180-page report include: increasing the number of people who participate in the federally funded nutrition program for women, infants and children (WIC) and use food stamps; increasing access to healthy food in areas without supermarkets; increasing participation in school-lunch programs, and encouraging more primary-care doctors to work in underserved areas.

The Assembly Health and Senior Services released the bill by a 11-1 vote in February, with Assemblyman Erik Peterson (R-Hunterdon, Somerset and Warren) casting the only no vote. Sen. Joseph F. Vitale (D-Middlesex) sponsored the Senate version of the bill, which has been referred to the Senate Health, Human Services and Senior Citizens Committee.