Diabetes: pathophysiology, management, and clinical outcomes

Diabetes is one of the major non-communicable diseases today. In the U.S., approximately 9% of the general population have diagnosed or undiagnosed diabetes, with a further 37% estimated to be pre-diabetic (CDC, 2016). The disease increasingly imposes a significant morbidity, economic, mortality, and psychological burden on individuals, families, communities, healthcare organizations, as well as the government. This paper discusses a number of issues relating to diabetes. These include: past and present funding initiatives; past and present quality initiatives; the relationship between diabetes care quality and healthcare coverage; and diabetes care in the U.S. and UK.

Funding Initiatives

In the U.S., initiatives aimed at preventing diabetes are funded by both the government and private entities. Public funding is executed through the Division of Diabetes Translation (DDT), a unit of the Centers for Disease Control and Prevention (CDC) (CDC, 2016). DDT funds health departments at the state and local government level in support of programs aimed at preventing or postponing the onset of type 2 diabetes and enhancing health outcomes for diabetic patients. Other federal initiatives include the Special Diabetes Programs (dedicated mainly to diabetes research) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (a program of the National Institutes of Health). Further funding for diabetes initiatives is availed through the National Diabetes Prevention Program, a public-private partnership that brings together several stakeholders committed to reducing the risk and prevalence of diabetes (CDC, 2016). These include government agencies, healthcare organizations, community organizations, employers, as well as private insurers.

Quality Initiatives

Several initiatives have been undertaken over the years to improve the quality of diabetes care, particularly focusing on improving evidence-based practice, expanding care access, and reducing disparities. The initiatives have involved both the government and private entities. The federal government has particularly been on the forefront in terms of enhancing the quality of diabetes care. Major federal initiatives include CDC's Diabetes Prevention and Control Program, the National Public Health Initiative on Diabetes and Women's Health, Healthy People 2010, the National Diabetes Education Program, and the National Diabetes Program of the Indian Health Service (AHRQ, n.d.). These initiatives focus on a broad range of quality issues relating to diabetes, including funding, information management, multidisciplinary care, improving quality of life, reducing health inequalities, patient education, provider training, case management, and integration of evidence into practice.

In addition to federal initiatives, there have been public-private initiatives. One of the major public-private quality improvement initiatives is the National Committee for Quality Assurance, a national, not-for-profit organization established in 1991 with the aim of enhancing performance measurement across a wide array of healthcare issues, including diabetes (Agency for Healthcare Research and Quality [AHRQ], n.d.). The program provides healthcare organizations with guidelines for measuring health care quality. An initiative more specific to diabetes is the National Diabetes Quality Improvement Alliance, a community of public and private organizations founded in 2001 to develop nationally-applicable metrics for measuring diabetes outcomes (AHRQ, n.d.).

Diabetes Care Quality and Healthcare Coverage

Access to health insurance is without a doubt a significant predictor of health outcomes. This is particularly true for diabetes. In the U.S., 23% of adults aged 18 to 64 years had no form of healthcare coverage as of 2010 (Casagrande & Cowie, 2012). This is a significant proportion of the population. Lack of healthcare coverage usually hinders access to care; it hampers routine care and preventive care (Jackson, Lozano & Carpentier, 2016). For diabetic patients, the importance of regular check-ups and preventive interventions cannot be overemphasized. They ensure frequent monitoring of disease progression, associated co-morbidities, as well as metabolic aspects. Covering the cost of these services from the pocket can be a challenge for a considerable proportion of the population, hence the need for insurance.

The absence of insurance often means irregular eye examinations, foot examinations, as well as hemoglobin and blood glucose monitoring, consequently resulting in disease progression and the proliferation of co-morbidities. Indeed, diabetic patients without health care coverage exhibit poorer health outcomes compared to their insured counterparts (Zhang et al., 2009; Casagrande & Cowie, 2012). They are characterized by a greater incidence of diabetes-related complications such as hypertension, reduced quality of life, and a higher risk of mortality, with disadvantaged groups such as the poor and minorities being the most affected (Jackson, Lozano & Carpentier, 2016).

Diabetes Care in the U.S. and UK