Diabetes Spending Dips in States: NCSL Report
Source: National Conference of State Legislatures
State and federal spending to combat diabetes decreased slightly in 2013 compared to the previous year, according to a new report from the National Conference of State Legislatures (NCSL). The report, “States Address the Costs of Diabetes: A 50-State Budget Survey for Fiscal Year 2013,” tracks the funds specifically appropriated by state legislatures for diabetes in FY 2013. It also reviews the funding provided by the Centers for Disease Control and Prevention (CDC) to states in FY 2012 for Diabetes Prevention and Control Programs (DPCPs), as well as changes in grant funds received from the CDC.
The total of state and federal funding appropriated by state legislatures specifically for diabetes prevention and control was $11,347,038 in FY 2013, compared to $11,947,129 in FY 2012, a difference of about 5 percent. Those figures, however, do not represent total spending by states on diabetes. The CDC also supports state efforts through grant programs, providing roughly $27 million per year.
Self-report of Diabetes and Claims-based Identification of Diabetes Among Medicare Beneficiaries (PDF)
Source: National Center for Health Statistics
Objective— This report compares self-reported diabetes in the National Health Interview Survey (NHIS) with diabetes identified using the Medicare Chronic Condition (CC) Summary file.
Background— NHIS records have been linked with Medicare data from the Centers for Medicare & Medicaid Services. The CC Summary file, one of several linked files derived from Medicare claims data, contains indicators for chronic conditions based on an established algorithm.
Methods —This analysis was limited to 2005 NHIS participants aged 65 and over whose records were linked to 2005 Medicare data. Linked NHIS participants had at least 1 month of fee-for-service Medicare coverage in 2005. Concordance between self-reported diabetes and the CC Summary indicator for diabetes is compared and described by demographics, socioeconomic status, health status indicators, and geographic characteristics.
Results— Of the Medicare beneficiaries in the 2005 NHIS, 20.0% self- reported diabetes and 27.8% had an indicator for diabetes in the CC Summary file. Of those who self-reported diabetes in NHIS, the percentage with a CC Summary indicator for diabetes was high (93.1%). Of those with a CC Summary indicator for diabetes, the percentage self-reporting diabetes was comparatively lower (67.0%). Statistically significant differences by subgroup existed in the percentage concordance between the two sources. Of those with self-reported diabetes, the percentage with a CC Summary indicator differed by sex and age. Of those with a CC Summary indicator for diabetes, the percentage with self-reported diabetes differed by age, self-rated health, number of self-reported conditions, and geographic location.
Conclusions— Among Medicare beneficiaries who self-reported diabetes in NHIS, a high concordance was observed with identification of diabetes in the CC Summary file. However, among Medicare beneficiaries with an indicator for diabetes in the CC Summary file, concordance with self-reported diabetes in NHIS is comparatively lower. Differences exist by subgroup.
Diabetes Care for Clients in Behavioral Health Treatment
Source: Substance Abuse and Mental Health Services Administration
Reviews diabetes and its link with mental illness, stress, and substance use disorders, and discusses ways to integrate diabetes care into behavioral health treatment, such as screening and intake, staff education, integrated care, and counseling support.
Sodium Intake in Populations: Assessment of Evidence
Source: Institute of Medicine
Despite efforts over the past several decades to reduce sodium intake in the United States, adults still consume an average of 3,400 mg of sodium every day. A number of scientific bodies and professional health organizations, including the American Heart Association, the American Medical Association, and the American Public Health Association, support reducing dietary sodium intake. These organizations support a common goal to reduce daily sodium intake to less than 2,300 milligrams and further reduce intake to 1,500 mg among persons who are 51 years of age and older and those of any age who are African-American or have hypertension, diabetes, or chronic kidney disease.
A substantial body of evidence supports these efforts to reduce sodium intake. This evidence links excessive dietary sodium to high blood pressure, a surrogate marker for cardiovascular disease (CVD), stroke, and cardiac-related mortality. However, concerns have been raised that a low sodium intake may adversely affect certain risk factors, including blood lipids and insulin resistance, and thus potentially increase risk of heart disease and stroke. In fact, several recent reports have challenged sodium reduction in the population as a strategy to reduce this risk.
Sodium Intake in Populations recognizes the limitations of the available evidence, and explains that there is no consistent evidence to support an association between sodium intake and either a beneficial or adverse effect on most direct health outcomes other than some CVD outcomes (including stroke and CVD mortality) and all-cause mortality. Some evidence suggested that decreasing sodium intake could possibly reduce the risk of gastric cancer. However, the evidence was too limited to conclude the converse—that higher sodium intake could possibly increase the risk of gastric cancer. Interpreting these findings was particularly challenging because most studies were conducted outside the United States in populations consuming much higher levels of sodium than those consumed in this country. Sodium Intake in Populations is a summary of the findings and conclusions on evidence for associations between sodium intake and risk of CVD-related events and mortality.
Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies
Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies
Source: British Medical Journal
To determine whether individual fruits are differentially associated with risk of type 2 diabetes.
Prospective longitudinal cohort study.
Health professionals in the United States.
66 105 women from the Nurses’ Health Study (1984-2008), 85 104 women from the Nurses’ Health Study II (1991-2009), and 36 173 men from the Health Professionals Follow-up Study (1986-2008) who were free of major chronic diseases at baseline in these studies.
Main outcome measure
Incident cases of type 2 diabetes, identified through self report and confirmed by supplementary questionnaires.
During 3 464 641 person years of follow-up, 12 198 participants developed type 2 diabetes. After adjustment for personal, lifestyle, and dietary risk factors of diabetes, the pooled hazard ratio of type 2 diabetes for every three servings/week of total whole fruit consumption was 0.98 (95% confidence interval 0.96 to 0.99). With mutual adjustment of individual fruits, the pooled hazard ratios of type 2 diabetes for every three servings/week were 0.74 (0.66 to 0.83) for blueberries, 0.88 (0.83 to 0.93) for grapes and raisins, 0.89 (0.79 to 1.01) for prunes, 0.93 (0.90 to 0.96) for apples and pears, 0.95 (0.91 to 0.98) for bananas, 0.95 (0.91 to 0.99) for grapefruit, 0.97 (0.92 to 1.02) for peaches, plums, and apricots, 0.99 (0.95 to 1.03) for oranges, 1.03 (0.96 to 1.10) for strawberries, and 1.10 (1.02 to 1.18) for cantaloupe. The pooled hazard ratio for the same increment in fruit juice consumption was 1.08 (1.05 to 1.11). The associations with risk of type 2 diabetes differed significantly among individual fruits (P<0.001 in all cohorts).
Our findings suggest the presence of heterogeneity in the associations between individual fruit consumption and risk of type 2 diabetes. Greater consumption of specific whole fruits, particularly blueberries, grapes, and apples, is significantly associated with a lower risk of type 2 diabetes, whereas greater consumption of fruit juice is associated with a higher risk.
Inappropriate and Questionable Medicare Billing for Diabetes Test Strips
Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
In 2011, Medicare allowed approximately $1.1 billion to 51,695 suppliers for diabetes test strips (DTS) provided to 4.6 million beneficiaries. Recent investigations and prior OIG studies have found that DTS is an area vulnerable to fraud, waste, and abuse. CMS implemented the Competitive Bidding Program in 2011 to reduce payments for durable medical equipment, prosthetics, orthotics, and supplies and help reduce fraud and abuse. Mail order DTS is included in the Competitive Bidding Program, but non-mail order DTS currently is not.
HOW WE DID THIS STUDY
We analyzed Medicare-allowed 2010 and 2011 DTS claims and inpatient claims from hospitals and Skilled Nursing Facilities for beneficiaries associated with allowed 2010 and 2011 DTS claims. In addition, we identified suppliers that billed amounts that were unusually high-according to at least one of six measures of questionable billing-that were subsequently allowed by Medicare, and we determined the geographic areas for these questionable-billing suppliers. Finally, we determined the extent of questionable billing before and after implementation of the Competitive Bidding Program.
WHAT WE FOUND
In 2011, Medicare inappropriately allowed $6 million for DTS claims billed (1) for beneficiaries without a documented diagnosis code for diabetes, or that inappropriately overlapped with (2) an inpatient hospital stay, or (3) an inpatient Skilled Nursing Facility stay. Further, we found that $425 million in Medicare-allowed claims-made by 10 percent of DTS suppliers-had characteristics of questionable billing. Suppliers in 10 geographic areas nationwide were responsible for 77 percent of questionable billing. However, the Competitive Bidding Program appears to have reduced questionable billing for mail order DTS in Competitive Bidding Areas (CBA). Similar reductions in questionable billing did not occur in non-CBA areas or for non-mail order DTS.
WHAT WE RECOMMEND
CMS partially concurred with two of our recommendations: CMS should enforce existing edits (system processes) to prevent inappropriate DTS claims, and CMS should increase monitoring of DTS suppliers’ Medicare billing. CMS concurred with two other recommendations: CMS should provide more education to suppliers and beneficiaries about appropriate DTS billing practices, and CMS should take appropriate action regarding inappropriate Medicare DTS claims and suppliers with questionable DTS billing.
Ethnic Differences in the Relationship Between Insulin Sensitivity and Insulin Response: A systematic review and meta-analysis
Human blood glucose levels have likely evolved toward their current point of stability over hundreds of thousands of years. The robust population stability of this trait is called canalization. It has been represented by a hyperbolic function of two variables: insulin sensitivity and insulin response. Environmental changes due to global migration may have pushed some human subpopulations to different points of stability. We hypothesized that there may be ethnic differences in the optimal states in the relationship between insulin sensitivity and insulin response.
RESEARCH DESIGN AND METHODS
We identified studies that measured the insulin sensitivity index (SI) and acute insulin response to glucose (AIRg) in three major ethnic groups: Africans, Caucasians, and East Asians. We identified 74 study cohorts comprising 3,813 individuals (19 African cohorts, 31 Caucasian, and 24 East Asian). We calculated the hyperbolic relationship using the mean values of SI and AIRg in the healthy cohorts with normal glucose tolerance.
We found that Caucasian subpopulations were located around the middle point of the hyperbola, while African and East Asian subpopulations are located around unstable extreme points, where a small change in one variable is associated with a large nonlinear change in the other variable.
Our findings suggest that the genetic background of Africans and East Asians makes them more and differentially susceptible to diabetes than Caucasians. This ethnic stratification could be implicated in the different natural courses of diabetes onset.
Canalization is the way in which organisms develop phenotypic robustness as a response to genetic or environmental perturbations. This process ensures the stability of critical biological processes like blood glucose regulation. Canalization of this trait can be represented by a hyperbolic function of two underlying variables: insulin sensitivity and insulin response, as primarily described by Kahn et al. (1,2).
Global migration in the early history of Homo sapiens placed people in new environments, resulting in novel diets, food scarcity, different climates, and exposure to novel pathogens. These changes may have shifted population averages of factors that influence insulin sensitivity and secretion. They include body size, body composition, energy expenditure, storage, and heat production. As these factors changed, they may have disclosed cryptic genetic variation or adopted novel mutations, leading to disruption of the unique point of stable equilibrium of ancestral populations. As this process continued over hundreds of millennia, specific genetic and environmental perturbations may have pushed some subpopulations to different points of stability (1,3–5).
We hypothesized that there may be ethnic differences in the optimal states in the relationship between insulin sensitivity and insulin response and that these differences may depend on a population’s genetic or evolutionary history. To assess this hypothesis, we performed a systematic review and a meta-analysis of studies of the insulin sensitivity index (SI) and the acute insulin response to glucose (AIRg). Our analysis was done in cohorts in any of the three major ethnic groups: Africans, Caucasians, and East Asians. We found significant differences between the groups.
Surveillance for Certain Health Behaviors Among States and Selected Local Areas — United States, 2010
Source: Morbidity and Mortality Weekly Report (CDC)
Chronic diseases (e.g., heart disease, stroke, cancer, and diabetes) are the leading causes of morbidity and mortality in the United States. Engaging in healthy behaviors (e.g., quitting smoking and tobacco use, being more physically active, and eating a nutritious diet) and accessing preventive health-care services (e.g., routine physical checkups, screening for cancer, checking blood pressure, testing blood cholesterol, and receiving recommended vaccinations) can reduce morbidity and mortality from chronic and infectious disease and lower medical costs. Monitoring and evaluating health-risk behaviors and the use of health services is essential to developing intervention programs, promotion strategies, and health policies that address public health at multiple levels, including state, territory, metropolitan and micropolitan statistical area (MMSA), and county.
The findings in this report indicate substantial variations in the health-risk behaviors, chronic diseases and conditions, access to health-care services, and the use of the preventive health services among U.S. adults at the state and territory, MMSA, and county levels. Healthy People 2010 (HP 2010) objectives were established to monitor health behaviors, conditions, and the use of preventive health services for the first decade of the 2000s. The findings in this report indicate that many of the HP 2010 objectives were not achieved by 2010. The findings underscore the continued need for surveillance of health-risk behaviors, chronic diseases, and conditions and of the use of preventive health-care services.
Awareness of Prediabetes — United States, 2005–2010
Source: Morbidity and Mortality Weekly Report (CDC)
In 2010, approximately one in three U.S. adults aged ≥20 years (an estimated 79 million persons) had prediabetes, a condition in which blood glucose or hemoglobin A1c (A1c) levels are higher than normal but not high enough to be classified as diabetes (1). Persons with prediabetes are at high risk for developing type 2 diabetes, which accounts for 90%–95% of all cases of diabetes. Each year, 11% of persons with prediabetes who do not lose weight and do not engage in moderate physical activity will progress to type 2 diabetes during the average 3 years of follow-up (2). Evidence-based lifestyle programs that encourage dietary changes, moderate-intensity physical activity, and modest weight loss can delay or prevent type 2 diabetes in persons with prediabetes (2). Identifying persons with prediabetes and informing them about their increased risk for type 2 diabetes are first steps in encouraging persons with prediabetes to make healthy lifestyle changes. However, during 2005–2006, only approximately 7% of persons with prediabetes were aware that they had prediabetes (3). To examine recent changes in awareness of prediabetes and factors associated with awareness among adults aged ≥20 years, CDC analyzed data from the National Health and Nutrition Examination Survey (NHANES). This report describes the results of that analysis, which indicated that, during 2009–2010, approximately 11% of those with prediabetes were aware of their condition. Furthermore, during 2005–2010, estimated awareness of prediabetes was <14% across all population subgroups, different levels of health-care access or use, and other factors. In the United States, persons with prediabetes, including those with regular access to health care, might benefit from efforts aimed at making them aware that they are at risk for developing type 2 diabetes and that they can reduce that risk by making modest lifestyle changes. Efforts are needed to increase awareness.
Source: Morbidity and Mortality Weekly Report (CDC)
Although diabetes mellitus most often is diagnosed in adulthood, it remains one of the most common serious chronic diseases of childhood (1). Youths with diabetes are at risk for diabetes-related mortality because of acute complications that can result from the condition (2), including diabetic ketoacidosis and hypoglycemia (3). In the United States in 2010, an estimated 215,000 persons aged ≤19 years had diagnosed diabetes (3). Medical care for diabetes has improved considerably in recent decades, leading to improved survival rates. However, recent trends in diabetes death rates among youths aged <10 years and 10–19 years in the United States have not been reported. To assess these trends, CDC analyzed data from the National Vital Statistics System for deaths in the United States with diabetes listed as the underlying cause during 1968–2009. This report highlights the results of that analysis, which found that diabetes-related mortality decreased 61%, from an annual rate of 2.69 per million for the period 1968–1969 to a rate of 1.05 per million in 2008–2009. The percentage decrease was greater among youths aged <10 years (78%) than among youths aged 10–19 years (52%). These findings demonstrate improvements in diabetes mortality among youths but also indicate a need for continued improvement in diabetes diagnosis and care.
Medicare Contractors Lacked Controls To Prevent Millions in Improper Payments for High Utilization Claims for Home Blood-Glucose Test Strips and Lancets
This report summarizes the results of our individual reviews of the 4 contractors that processed claims for home blood-glucose test strip and/or lancet supplies (test strips and lancets) for Jurisdictions A through D, which included all 50 States, 5 territories, and the District of Columbia. Medicare Part B covers test strips and lancets that physicians prescribe for diabetics. The quantity of test strips and lancets that Medicare covers depends on the beneficiary’s usual medical needs.For calendar year 2007, based on our analyses of our individual samples of the four contractors, we estimated that the contractors improperly allowed for payment a total of approximately $271 million in claims that we identified as high utilization claims for test strips and/or lancets. Of this amount, we estimated that the contractors improperly paid a total of approximately $209 million to suppliers.Of the 400 sampled claims for test strips and/or lancets that we reviewed at the 4 contractors, 303 claims (76 percent) had 1 or more deficiencies, including:
(1) The quantity of supplies that exceeded utilization guidelines was not supported with documentation that specified the reason for the additional supplies, the actual frequencies of testing, or the treating physicians’ evaluation of the patients’ diabetic control within 6 months before ordering the supplies;
(2) There was no supporting documentation that indicated refill requirements had been met;
(3) Physician orders were missing or incomplete; or
(4) Proof-of-delivery records were missing.We recommended that CMS:
(1) Ensure that contractors implement system edits recommended in our individual reports,
(2) Ensure that contractors are enforcing Medicare documentation requirements for claims for test strips and/or lancets, and
(3) Consider the results of our reviews when developing and evaluating coverage and reimbursement policies related to test strips and lancets.CMS concurred with all of our recommendations.
Individuals differ in the response to regular exercise. Whether there are people who experience adverse changes in cardiovascular and diabetes risk factors has never been addressed.
An adverse response is defined as an exercise-induced change that worsens a risk factor beyond measurement error and expected day-to-day variation. Sixty subjects were measured three times over a period of three weeks, and variation in resting systolic blood pressure (SBP) and in fasting plasma HDL-cholesterol (HDL-C), triglycerides (TG), and insulin (FI) was quantified.1 The technical error (TE) defined as the within-subject standard deviation derived from these measurements was computed. An adverse response for a given risk factor was defined as a change that was at least two TEs away from no change but in an adverse direction. Thus an adverse response was recorded if an increase reached 10 mm Hg or more for SBP, 0.42 mmol/L or more for TG, or 24 pmol/L or more for FI or if a decrease reached 0.12 mmol/L or more for HDL-C. Completers from six exercise studies were used in the present analysis: Whites (N = 473) and Blacks (N = 250) from the HERITAGE Family Study; Whites and Blacks from DREW (N = 326), from INFLAME (N = 70), and from STRRIDE (N = 303); and Whites from a University of Maryland cohort (N = 160) and from a University of Jyvaskyla study (N = 105), for a total of 1,687 men and women. Using the above definitions, 126 subjects (8.4%) had an adverse change in FI. Numbers of adverse responders reached 12.2% for SBP, 10.4% for TG, and 13.3% for HDL-C. About 7% of participants experienced adverse responses in two or more risk factors.
Adverse responses to regular exercise in cardiovascular and diabetes risk factors occur. Identifying the predictors of such unwarranted responses and how to prevent them will provide the foundation for personalized exercise prescription.
Introduction:Arab populations have many similarities and dissimilarities. They share culture, language and religion but they are also subject to economic, political and social differences. The purpose of this study is to understand the causes of the rising trend of diabetes prevalence in order to suggest efficient actions susceptible to reduce the burden of diabetes in the Arab world.Method:We use principal component analysis to illustrate similarities and differences between Arab countries according to four variables: 1) the prevalence of diabetes, 2) impaired glucose tolerance (IGT), 3) diabetes related deaths and 4) diabetes related expenditure per person. A linear regression is also used to study the correlation between human development index and diabetes prevalence.Results:Arab countries are mainly classified into three groups according to the diabetes comparative prevalence (high, medium and low) but other differences are seen in terms of diabetes-related mortality and diabetes related expenditure per person. We also investigate the correlation between the human development index (HDI) and diabetes comparative prevalence (R = 0.81).Conclusion:The alarming rising trend of diabetes prevalence in the Arab region constitutes a real challenge for heath decision makers. In order to alleviate the burden of diabetes, preventive strategies are needed, based essentially on sensitization for a more healthy diet with regular exercise but health authorities are also asked to provide populations with heath- care and early diagnosis to avoid the high burden caused by complications of diabetes.
A new report shows that adults (aged 18 and older) who had a mental illness in the past year have higher rates of certain physical illnesses than those not experiencing mental illness. According to the report by the Substance Abuse and Mental Health Services Administration (SAMHSA), adults aged 18 and older who had any mental illness, serious mental illness, or major depressive episodes in the past year had increased rates of high blood pressure, asthma, diabetes, heart disease, and stroke.For example, 21.9 percent of adults experiencing any mental illness (based on the diagnostic criteria specified in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) in the past year had high blood pressure. In contrast, 18.3 percent of those not experiencing any mental illness had high blood pressure. Similarly, 15.7 percent of adults who had any mental illness in the past year also had asthma, while only 10.6 percent of those without mental illness had this condition.Adults who had a serious mental illness (i.e., a mental illness causing serious functional impairment substantially interfering with one or more major life activities) in the past year also evidenced higher rates of high blood pressure, asthma, diabetes, heart disease and stroke than people who did not experience serious mental illnesses.Adults experiencing major depressive episodes (periods of depression lasting two weeks or more in which there were significant problems with everyday aspects of life such as sleep, eating, feelings of self-worth, etc.) had higher rates of the following physical illnesses than those without past-year major depressive episodes: high blood pressure (24.1 percent vs. 19.8 percent), asthma (17.0 percent vs. 11.4 percent), diabetes (8.9 percent vs. 7.1 percent), heart disease (6.5 percent vs. 4.6 percent), and stroke (2.5 percent vs. 1.1 percent).
+ Full Report (PDF)
Ethnicity, Metabolism and Vascular Function: From Biology to Culture
We live in a multicultural society. Data from the US 2000 census illustrate that the population is quite heterogeneous: 75% of the population is of Caucasian origin, but look at the numbers for the other racial/ethnic populations. These numbers have now actually changed. The most recent data show that the Latino population now comprises 13.9% of the US population, followed by the African American population. And as you can see, there are other minority populations in the country.
Why is that relevant? It is relevant because we recognize that type 2 diabetes affects different populations in different ways. In this graph, you can see that the prevalence of type 2 diabetes is significantly higher in most of these minority groups in comparison to the white population. In this case, the European population represents what we usually see in this country in the white population. Keep in mind that these data are in people between the age of 45 and 74 years, and the rates of diabetes are 1.5, 2, 3 times higher than in the white population, with the highest prevalence of diabetes in terms of percentage of the population being demonstrated in the Pima Indians.
The Pima Indians are an American Indian group (most live in the state of Arizona) that has the highest rates of diabetes in the world: 70% of all Pima Indians above the age of 35 years have type 2 diabetes. They have a tremendous genetic risk for the disease, and they develop diabetes at very high rates. There is a very interesting natural “study” that occurred many years ago. The Pima Indians represented just a single group at some point in the past, but they divided into two groups: one that resides in the state of Arizona and another group that migrated to the northern part of Mexico (Sonora state). Although the populations are genetically identical, their rates for diabetes are very different.
Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes
Source: New England Journal of Medicine
In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone. Further study will be necessary to assess the durability of these results.
Fraud Alert for People with Diabetes
Source: U.S. Department of Health and Human Services, Office of Inspector General
Criminals who plot to defraud the Government and steal money from the American people have a new target: people with diabetes.
Although the precise method may vary, the scheme generally involves someone pretending to be from the Government, a diabetes association, or even Medicare, calling you. The caller offers "free" diabetic supplies, such as glucose meters, diabetic test strips, or lancets. The caller may also offer other supplies such as heating pads, lift seats, foot orthotics, or joint braces, in exchange for the beneficiaries’ Medicare or financial information, or confirmation of this type of personal information. Additionally, you may receive items in the mail that you did not order.
These findings show that in these women, there is a positive association between rotating night shift work and the risk of developing type 2 diabetes. Furthermore, long duration of shift work may also be associated with greater weight gain. Although these findings need to be confirmed in men and other ethnic groups, because a large proportion of the working population is involved in some kind of permanent night and rotating night shift work, these findings are of potential public health significance. Additional preventative strategies in rotating night shift workers should therefore be considered.