Diabetes is a worldwide health problem affecting just under 10 percent of the United States population, according to the American Diabetes Association. Though there have been many advances in diabetes care over the past decade, these advances have failed to translate into more patients meeting treatment goals.
The Journal of the American Medical Association recently published a population-based study that suggests only one in four adults with diabetes achieved their treatment goals – a composite of various personal “targets.” The study demonstrated no significant improvement in any individual treatment targets being realized between 2005 and 2016.
Even with advances in insulin pump technology, medications, bariatric surgery and lifestyle modifications, diabetes care still has not meaningfully improved for diagnosed patients on a societal level. But individually, it doesn’t have to be like that. At Advanced Laparoscopic Associates, we aim to give our patients both the treatments and the tools they need to control or even beat their diabetes.
Barriers to Diabetes Management
Treatment and management of type 2 diabetes cannot be a one-size-fits-all approach. It’s more complicated than that, and it’s going to be different for each patient. But, similar barriers to successful diabetes management show up in the JAMA study and others. Here are two of the most common.
Cost of care. This factor plays a major role. According to JAMA, “Having health insurance was the strongest predictor of linkage to diabetes care.” This same predictor played out in other studies. Patients who lacked health insurance, drug insurance, or financial resources were unable to meet their treatment outcome targets. According the American Diabetes Association, in 2017, average medical expenses among people with diagnosed diabetes were 2.3 times higher than what their expenses would have been if they didn’t have diabetes.
Not only the cost of care comes in to play; the cost of a proper diet is also a barrier, and healthy foods required for diabetic management can be. Patients with obesity are particularly at risk for a cost of food barrier.
Patient self-management. Even with proper clinical support and advances in health care, patients bear the burden of managing their disease day-to-day. Optimal self-management is affected by a multitude of personal factors for each patient, including their access to care, their experience with medical care (positive versus negative), their financial status, the presence of co-morbidities and general health status, and other personal circumstances.
Patients’ adherence to their treatment plan, attitude, cultural and personal beliefs, and knowledge about their disease all may affect whether they meet their outcome targets. None of these factors are under the control of the treating clinician, who may be unaware of them.
Obesity and Diabetes
Obesity is the leading risk factor for developing type 2 diabetes, and over 90 percent of patients with diabetes are also overweight or obese. Both obesity and diabetes are also independent risk factors for the development of cardiovascular disease, which remains the leading cause of death for women in the United States.
Weight gain and obesity worsen insulin resistance. Losing weight slows the progression of diabetes complications. Though clinicians may provide options for counseling and behavioral management or referral to weight loss programs, these do not address some of the challenges obese patients face. Medication management becomes more complex and exercising is more difficult, or sometimes contraindicated, in obese patients. Additionally, options such as bariatric surgeries need to be examined, as their role in decreasing other health risks such as diabetes and depression are now starting to be realized.
We Can Help
At Advanced Laparoscopic Associates, we specialize in getting our patients down to a healthy weight through surgical or nonsurgical means. Bariatric surgery should be—and increasingly is—considered a first-line treatment for diabetes in addition to obesity.
If you have diabetes and a body mass index (BMI) of 35 or greater, you may be a candidate for bariatric surgery. If you don’t qualify, you still have options. We are dedicated to helping people live their best and healthiest lives, so request an appointment at ALA. Our bariatric experts will be with you every step of the way, from initial consultation to treatment, surgery, recovery and beyond.