Jim’s Take

The Modern Health Cost Scourge– Diabetes... & What to Do About it

Diabetes is, indeed, a scourge. Almost 1 in 10 American adults has diabetes, and faces – in the absence of proper disease management – a dark future. In fact, although only 8% of Americans have diabetes, it accounts for 25-30% of all health care dollars!

The way diabetes works is that higher glucose levels thickens blood until it can become almost gel-like. The heart and other organs have to work harder to process this thickened blood. Kidneys under such stress are more susceptible to disease. As is the heart.

And the reduced flow of blood from the weakened heart gets less blood to the legs and eyes... and blindness and amputation often follow. Here are some scary facts from the National Diabetes Fact Sheets of recent years:

  • Diabetics are four times as likely to have a stroke as non-diabetics.
  • And three times as likely to have a heart attack.
  • Twice as likely to suffer from depression.
  • Diabetes is a leading cause of blindness.
  • And Kidney disease (it’s the leading cause).
  • And the leading cause of non-traumatic lower limb amputation.
  • A diabetic’s life expectancy is 5-10 years less than non-diabetics.
  • Just preparing this list makes me want to stop and take a mental relief break.

And It’s Costly

Diabetics have twice the ER visits of those without the disease – and you know that the ER copay doesn’t cover the cost of the visit, so even if the employee or dependent isn’t admitted to the hospital, it’s costing your firm money.

And the diabetes frequently IS admitted for a hospital stay. Diabetics have four times the number of hospital days as do non-diabetics.

Annual average health costs from all causes for diabetics (2014) were $16,021 compared to $4,396 for those without the disease.

Absenteeism – diabetics miss three more days of work per year than non-diabetics, and they lose an additional 15 days per year of productivity (American Diabetes Assn: Economic Costs of Diabetes in the US).

Those are dollars that don’t flow to your bottom line. That can’t be used to market your products or services. That aren’t available for employee compensation.

But You Can Fight Back

You really can do something about it. Of course, you need to share risk with your carrier (i.e. partial self-funding of your health plan) to achieve the savings I’m about to outline. We at BBI can steer you to two different vendors to help you shave the cost of diabetic care and generate more bottom line money for your firm.

These vendors’ two approaches are:

Larger employers can retain a firm to help manage diabetes cost at no up-front investment. It is a high-touch approach that integrates with your carrier’s wellness program, and it relies on two things:

  • Providing employees with a $0 cost for normal management supplies (blood test strips and a glucometer to give the sugar readings)
  • One-on-one consultation and behavior modification from an expert.
  • The relationship established via the behavior modification consultant leads to higher participation.

Any size company can use a high-tech/high touch approach through a vendor that -provides a cellular glucometer that does all the testing and recording of results. There is a cost to the program. The cost is slightly more than what the employer is now spending for supplies.

  • Employees, as in the other program, get supplies for $0
  • No need for the employee to track the glucose counts... they are automatically uploaded to a private website that the employee can share with her doctor.
  • Employee gets automatic communications via her cell phone at appropriate times such as when a blood count is high and periodically on a routine basis.
  • The ease of use of the cellular glucometer enhances participation.

The key to the success of these programs is that they make compliance easier and more sustainable. The American Diabetes Association recommends that diabetics test their sugar 3-4 times per day.

Unfortunately, it is estimated that fewer than 20% of diabetics monitor their blood glucose on a regular basis. And there is a demonstrated link between frequency of glucose measurement and glucose levels (see fg. 1).


The more the diabetic tests, the lower his sugar goes, and his or her medical expenses drop with it. The engagement the diabetic employees get is what helps drive the costs lower, and the reduction in the need for medical treatment and the feedback from the plan is what drives employees’ continued participation.

Instead of < 20% properly testing, the level rises to 35-40 % (more, when the employer actively publicizes and emphasizes the program). And they stick with it. One program finds that 79% of the original diabetic population was still participating after 3 years. How dramatic are the savings? Look at these numbers (see fg. 2, fg. 3, and fg. 4).




The opportunity for the employer to save money is there. The technology is there. The experience to make it work is there. All that’s missing is your decision to move ahead. Is your decision there?

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