20 November 2018
TUESDAY, Nov. 20, 2018 (HealthDay News) — For Americans with diabetes, high-deductible health insurance plans may lead to delays in diagnosing and treating dangerous blood vessel diseases, a new study suggests. “People with diabetes in high-deductible health insurance plans compared to people with diabetes without high-deductible health insurance had delays in care for macrovascular complications of a month to three months,” said the study’s lead author, Dr. Frank Wharam. He’s director of the Harvard Pilgrim Health Care Institute’s division of health policy and insurance research. Macrovascular complications are problems related to large blood vessels, such as those leading to the heart and brain. These include heart disease, stroke and peripheral artery disease — a condition that affects blood supply to your limbs. People with diabetes have a greater risk of macrovascular complications, and 70 percent of deaths in people with diabetes are linked to these complications, the Harvard study authors said. A high-deductible health insurance plan has a deductible of $1,000 or more per year, according to the study. That means someone must pay at least $1,000 of their health care costs before their insurance starts paying for any health care expenses. The researchers said that some plans have deductibles as high as $7,000 per person, per year. Nearly half of Americans insured in employer-provided health care are enrolled in high-deductible health insurance plans, according to a new report from the U.S. Centers for Disease Control and Prevention. And those high-deductible costs may keep people from seeking care, at least for a little while, the study found. To see what effect deductibles had on care for those blood vessel diseases, the researchers reviewed data for up to four years on nearly 34,000 people with diabetes who previously had low-deductible ($500 or less a year) insurance and then had high-deductible insurance ($1,000 or more a year). The researchers compared them to a group of almost 300,000 people with diabetes who had low-deductible health insurance throughout the study period. When the study began and both groups had low-deductible health insurance, the researchers saw no difference in how quickly patients received care for symptoms, diagnosis or treatment of macrovascular complications. When members of the smaller group transitioned to the high-deductible insurance care, they delayed going to the doctor for their first symptom of macrovascular disease by 1.5 months. They waited almost two months for their first diagnostic test and just over three months for their first procedure-based treatment. Wharam said his previous research has shown that a delay for certain problems could lead to serious complications. “If you have a skin infection and go to the doctor on day one, you could be walking out with a bottle of pills to treat the infection. If you wait till day seven, you could end up hospitalized,” he explained. Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, said the study highlights shortcomings in insurance coverage in the United States. “This study shows once more the problems we have in our health system. Deductibles are another barrier to treating diabetes and cardiovascular disease,” said Zonszein, who wasn’t involved with the study. “Patients are benefitting less and less from insurance, and we continue to treat the complications of diabetes instead of paying for prevention,” he said. Wharam said if your employer offers you a choice, or you have options on your state’s health care exchange, look closely at what your costs for each plan will be. He noted that people with diabetes often have a lot of health care costs. So it might make more sense to pay a higher monthly premium to lower your out-of-pocket costs from deductibles and copays. But it depends on your particular situation. He also suggested seeing if your employer offers a health savings plan. These can help spread the cost of health care throughout the year. Whatever your health care situation, Wharam said if you need care, you should get it. “If you have diabetes, our study shows there’s a delay in care. It might be conscious or subconscious, but there’s a delay. Patients should seek care [without regard to] the cost,” he said. Results of the study were published in the Nov. 20 issue of Annals of Internal Medicine. More information The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about paying for diabetes care.
02 October 2018
TUESDAY, Oct. 2, 2018 (HealthDay News) — The number of Americans with diabetes who wind up in hospitals with serious infections, or who develop them while in the hospital, is on the rise. Between 2010 and 2015, the number of diabetics hospitalized for infections rose 52 percent (from 16 per 1,000 people to 24 per 1,000), according to researchers from the U.S. Centers for Disease Control and Prevention. “People with diabetes are more susceptible to in-hospital infections as compared with people without diabetes, and this risk is increasing,” said lead researcher Jessica Harding, from the CDC’s Division of Diabetes Translation. “The most common infection types in people with and without diabetes were respiratory tract and skin infections,” Harding said. But the rates of infection were seven times higher in people with diabetes, she added. The rise in overall infections is largely driven by increases in patients who develop sepsis while in the hospital, Harding said. “However, we also see in people with diabetes an increase in foot ulcers, coinciding with an increase in lower limb amputations,” she added. Dr. Louis Philipson, director of the University of Chicago Kovler Diabetes Center, said it isn’t clear why diabetics develop more infections. “We do not even have data as to whether the infections occurred in people with more poorly controlled diabetes, though that seems like a reasonable guess,” said Philipson, who is also president-elect for medicine and science at the American Diabetes Association. High blood sugar decreases the activity of the immune system and can cause many changes in tissue, skin and blood flow, all of which can increase the risk of infections, Philipson said. “Exactly which factors are most important here, and whether access to health care played a role, we do not know yet,” he added. Urinary tract, skin and connective tissue infections are associated with high blood sugar levels and poorly controlled diabetes, Philipson explained. Preventing diabetes and reaching the optimum targets for blood sugar control are key to reducing infections. “Along with that, regular visits to a primary care doctor and specialist as needed to get the best foot care, eye care and review of kidney function will go a long way towards preventing complications of diabetes,” Philipson said. For the study, Harding and her colleagues used national hospitalization data from 2000 to 2015. The data captured about 20 percent of all hospitalizations in 46 states, representing more than 96 percent of the U.S. population. The investigators found that people with diabetes are about two to seven times more likely to be hospitalized with an infection than the general population. “Improved access to preventive care, as well as promoting education to reduce risk factors for underlying disease processes, will be essential to decrease the risk of infections in people with diabetes,” Harding said. Dr. Joel Zonszein directs the Clinical Diabetes Center at Montefiore Medical Center in New York City. He said it’s concerning that the majority of patients with diabetes are not treated properly, since high blood sugar levels predispose them to infections. “We have proper ways to treat diabetes, and there should be no excuse why patients shouldn’t be getting the best care,” he said. “More research is not needed — more effective treatment is imperative.” The results of the study were scheduled for presentation Tuesday at the meeting of the European Association for the Study of Diabetes, in Berlin. Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal. More information Visit the American Diabetes Association for more on type 2 diabetes.
01 April 2018
SUNDAY, April 1, 2018 (HealthDay News) — If you have diabetes, it’s time to think about your feet. “Diabetes is a multisystem disease,” Dr. Ronald Lepow explained in a news release from the Baylor College of Medicine in Houston. “Circulation in the feet and legs may be diminished because there are problems with blood vessels that get narrowed or clogged as a result of the diabetes. “A major cause of foot problems in diabetics is lack of blood flow,” added Lepow, a professor of orthopedic surgery at Baylor. This can cause calloused or injured areas on the feet to heal more slowly, which can lead to ulcers or infections. Another problem is that diabetes-related nerve damage can affect the normal oil and moisture on the skin of the feet. That results in dry and cracking skin, which allows bacteria to get in and cause infections or ulcers, Lepow said. What to do? Lepow says it’s important for anyone with diabetes to wash and dry their feet and inspect them for scratches, blisters, injuries, cuts and bruises every day. Once feet are dry, apply a cream that’s at least 20 to 40 percent urea. Proper footwear is also crucial for people with diabetes. Because of the special needs, Lepow suggests seeing a podiatrist for help. For instance, you’ll need a wide and deep toe box. That will allow free movement of your toes and reduce friction and pressure. Also important are a solid sole and cushioning in areas that store-bought shoes typically do not have, he said. Podiatrists also can recommend different types of custom shoe inserts, Lepow said. Also, wear socks that don’t cause friction or pressure. Cotton socks are recommended. People whose feet sweat a lot should wear moisture-wicking socks. And, Lepow said, everyone should wear thicker socks in the winter. More information The American Diabetes Association has more on foot care.