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Friday, November 01, 2002

By Christopher Snowbeck, Post-Gazette Staff Writer

The number of diabetes hospitalizations in Pennsylvania increased by more than 40,000 cases between 1997 and 2001 -- a 16.8 percent jump.

And in 2001, cases in which diabetes was either the primary or secondary diagnosis accounted for more than 16 percent of all inpatient hospitalizations in the state.

Those are just two of the study findings in a new Pennsylvania Health Care Cost Containment Council report released today. It echoes numerous reports that have documented the growing diabetes problem here and across the country.

Diabetes is a chronic disease in which the body does not produce enough or properly use insulin, a hormone needed to convert blood sugar into energy. While some hospitalizations are unavoidable, good preventive care can often keep diabetic patients out of the hospital.

Long-term complications of diabetes that can force a hospitalization include toe, foot or leg amputation, heart disease and stroke. The disease itself can force hospitalization if blood sugar levels get dangerously out of control.

The new study found that while the hospitalization rate for diabetes increased across all age groups, the largest increases came in the 30-to- 39 and 40-to-49 age groups. African Americans had the highest hospitalization and amputation rates.

It found that counties in Western and northeastern Pennsylvania tended to have hospitalization rates for end-stage renal disease -- another complication of diabetes -- that were higher than the statewide average. In Allegheny County, for example, the hospitalization rate for end-stage renal disease was 28.1 percent higher than the state average.

The study examined the cases of Pennsylvanians being treated in state hospitals who were discharged between Jan. 1 and Dec. 31, 2001. It is part of a state-sponsored effort to combat diabetes.

In October 1998, the General Assembly mandated that private and group health insurance plans cover the cost of supplies such as insulin, blood glucose monitors and testing strips used by diabetics to monitor and treat their disease. The hope was to prevent both the human suffering and financial blows that come with poor management of the disease.

Joe Martin, spokesman for the council, said the results from the new study shouldn't suggest that the law was passed in vain.

"I think what it simply signals is that this is a huge public health problem and that even though there's a lot of activity going on to try and combat this disease, we have to continue to be more aggressive about it," Martin said. Had the Legislature not acted, the current numbers could be a lot worse, he added.

Diabetes primarily takes two forms:

Type 1 diabetes usually appears in children or young adults and accounts for 5 percent to 10 percent of all diagnosed cases. Patients do not produce enough insulin, so they must receive daily insulin injections.

Type 2 diabetes is the most common form. While most people with Type 2 control their disease through oral medications, diet and exercise, about 40 percent require daily insulin injections.

The study found that while hospitalizations for Type 1 diabetes have decreased over the past few years, those for Type 2 have increased steadily.

Dr. Wayne Evron, associate director of the Joslin Center for Diabetes at West Penn Hospital, said a growing part of his practice is identifying patients at risk of developing Type 2 diabetes and helping them prevent it through diet, exercise and medication.

He said diabetes numbers are on the rise for several reasons.

A big part of the problem is that people are just too big.

But it's also that the fasting blood-sugar count, which serves as the definition of diabetes, has been lowered in the past five years. That means some patients who are called diabetics today wouldn't have been five years ago, Evron said.

Many racial and ethnic minority groups tend to have higher rates of diabetes, he said, so the country's growing diversity has added to the diabetes numbers. And people are living longer with the disease.

Pennsylvania had the sixth-highest rate of diabetes cases in the nation during 2000 and West Virginia ranked second that year, according to the latest national numbers available from the Centers for Disease Control and Prevention. The rankings were driven largely by the older populations in both states, but Pennsylvania and West Virginia residents suffered from diabetes at a higher rate than the national average even when accounting for age.

Locally, the Pittsburgh Regional Healthcare Initiative released numbers in February that showed that diabetes is more of a problem in southwestern Pennsylvania than elsewhere in the state.