Diabetes afflicts one in 12 Californians. It causes early death and disability for millions and costs the state $27.6 billion annually in health care and related expenses.
In 20 years, diabetes rates are expected to double in the United States.
But the disease doesn’t have to wreak that kind of havoc. Diabetes can be avoided in many people with intensive diet and exercise counseling, according to a 2002 study by the National Institutes of Health and the Centers for Disease Control and Prevention.
Based on its findings, the CDC has developed a 16-week course, the Diabetes Prevention Program, for people with pre-diabetes – those whose blood sugar levels are elevated, but not yet high enough for a diagnosis of diabetes.
But most Californians have no access to the program because Medicare and Medi-Cal and most private insurers won’t cover it.
Medicare won’t reimburse for the cost of the program because the services are often delivered by laypeople, not medical professionals. California opted not to pilot a diabetes prevention program for low-income people with an Affordable Care Act grant for experimental Medi-Cal programs. And private insurance companies are not yet convinced that the diabetes prevention pencils out, saving more money than it costs.
“If we don’t ramp up prevention, society as a whole is really going to be paying a higher price,” said Ann Albright, who directs diabetes programs for the CDC.
Taking the program nationwide would prevent or delay some 885,000 diabetes cases. It would cost $22 billion, but still represent a savings of nearly $6 billion in medical expenses related to diabetes over 25 years.
But the government’s actual efforts are far more modest.
The Affordable Care Act authorized the CDC to create a national program four years ago with just $20 million in funding, and it’s grown slowly.
San Jose’s Indian Health Center offers the the course for free, and on a warm Tuesday evening, more than a dozen people—all of them at risk for the disease— are gathered for their third session.
“Touch your elbow to your knees,” health center staffer Ramin Naderi gently ordered as the group marched in place in a circle in the center’s parking lot.
“It ain’t gonna happen,” said Joshua Nichols, a 15- year old high school student who weighs in at 350 pounds and struggled to execute the move.
“It’s me wanting to be more successful in life,” Joshua said by way of explaining why he’s attending with his parents, Josh, Sr., and Dita Nichols, both 40. All three of them said they need to lose weight.
“I like my carbs deep fried,” Josh Sr. said ruefully. After being turned down for lap band surgery because Medi-Cal wouldn’t pay, the two elder Nichols hope that exercise, healthy eating and the camaraderie of the group will help take the pounds off and restore their health.
The Nichols and their colleagues are learning to write down everything they eat, while calculating each food’s calories and fat content.
They’ve shared the week’s successes, as well as a dinner of creamy tomato soup, a half turkey BLT sandwich on whole wheat and an apple, parsed the meal’s calorie, fat and carb count, and heard from a dietitian about how to spot and cut the fat in their diets.
The program, which serves people with Native American ancestry, works by showing their students they can control their own health, Naderi said.
“They think they’re doomed…There are people who walk around and say you’re not Indian if you don’t have diabetes.”
Some 16 percent of Native Americans have the disease. African-Americans, Latinos and Pacific Islanders are also at higher risk than whites.
In addition to peer support, the Indian Health Center program offers one-on-one time with a dietitian, fitness trainers and a marriage and family therapist to help participants lose about seven percent of their body weight and exercise two and a half hours a week.
The goals are modest but the daily struggles are hard, said Dana Kent, M.D., of the Natividad Medical Foundation, who runs a scaled-down version of the CDC’s program—mostly for immigrant farmworker families in the Salinas Valley.
Many of her students harvest lettuce, broccoli, artichokes and berries, but they can’t always eat those foods because of cost, she said.
What’s more, some new immigrant parents are so eager for their children to fit in that they indulge their kids’ desires for sodas, hot Cheetos and other temptations they see on TV.
“They want to be parents who have popular kids,” Kent said.
Still with education and support, people change, she noted. Her surveys show that people who attended plan meals more frequently, eat more fruits and vegetables and exercise more. Kent’s program doesn’t measure blood sugar levels in its participants. But Jan Vasquez, of the Indian Health Center said her students are tested for as long as six years after completing the course, and just one or two program alums develop diabetes each year.
But the reach of programs like Vasquez’ and Kent’s are limited, largely because of lack of insurance coverage.
The CDC website lists only 15 local diabetes prevention programs in California, most of which serve far fewer than 100 people per year. They range from free of charge for some grant-funded programs to $429 at the Long Beach YMCA to $1152 at the Community Hospital of the Monterey Peninsula.
Congress could give the program a major boost by passing HR 962, the Medicare Diabetes Prevention Act, sponsored by Congresswoman Susan Davis, a Democrat from San Diego. The bill would allow Medicare to cover the 16-week course and allow laypeople to teach it.
The bill, which was introduced in 2013, hasn’t yet made it to a vote, but Tekisha Everette, director of government affairs for the American Diabetes Assn., which backs the bill, said she remains hopeful that legislators will take up the matter after this fall’s mid-term elections.
At the Indian Health Center, Jan Vasquez the associate director of its diabetes prevention program said she could reach many more people like the Nichols family if more funding were available.
Josh Nichols, Sr. said he and his wife are depending on the center’s classes to help them live longer and more healthfully.
“We’ve been together since we were 14,” Nichols said. “We want to live another 40 years together.”