Implementation of the Affordable Care Act Must Lead to Adequate Diabetes Screening
On Wednesday, July 14, the Obama Administration joined medical professionals and leaders from the health community to announce preventive health care coverage made available under the Affordable Care Act. Under this act, new insurance plans are required to provide preventive care without cost-sharing, which will remove financial barriers for many Americans for preventive services that can help alleviate disease and reduce costs.
The American Diabetes Association believes that while this is laudatory, relying exclusively on the United States Preventive Services Task Force (USPSTF) "A and B" recommendations, will not lead to adequate screening of patients at risk for diabetes. Blood glucose screening is one of the most essential tools for detecting diabetes and something that should be part of a basic package of benefits and services.
Under the new rule, asymptomatic adults with sustained high blood pressure will have access to diabetes screening and adults and children will have access to obesity screening and counseling through their clinician at no cost. Ensuring that patients with other risk factors, such as a family history of diabetes or who are obese, also have access to preventive screenings at low or no cost will allow for earlier diagnosis and subsequent prevention of dangerous and costly complications.
Through implementation of the Affordable Care Act we must ensure that patients at high risk of diabetes are screened for the disease when they see their primary care physician. Nearly 6 million of the 24 million Americans living with diabetes have not been diagnosed. There is an additional 57 million Americans with pre-diabetes, and nearly 93 percent do not know it. If left untreated, diabetes leads to costly and dangerous complications such as blindness, amputation, heart disease, and kidney disease. Relying solely on the USPSTF recommendation, which gives an 'I' statement to blood glucose screening for any asymptomatic patient not experiencing high blood pressure, will continue to leave millions of Americans undiagnosed and in danger of facing otherwise avoidable health complications such as blindness, amputation, heart disease, and kidney disease.
We are supportive of the provisions that cover obesity screening and other diabetes-related prevention services. We look forward to working with the Obama Administration and Congress to ensure that people have access to diabetes screenings, as well as to the preventive services that help to manage the disease and prevent complications following diagnosis.
American Diabetes Association guidelines (below) recommend screening for individuals who meet the common risk factors for diabetes. These criteria are consistent with those used in scientific studies of diabetes prevention.
- All adults who are overweight and have additional risk factors:
- Physical inactivity
- First degree relative with diabetes
- Members of high risk population groups
- Women diagnosed with gestational diabetes or who delivered a baby weighing >9 lb.
- Hypertension (high blood pressure) or cholesterol abnormality
- Other clinical conditions associated with resistance to the effects of insulin
- In the absence of the above criteria, testing should begin at age 45 years
- If results are normal, testing should be repeated at least at 3 year intervals, with consideration of more frequent testing depending on initial results and risk status.
The American Diabetes Association believes that targeted diabetes screening as outlined by the our recommendations and supported by the National Institute of Diabetes and Digestive and Kidney Diseases, and are in line with risk factors recommended by the Centers for Disease Control and Prevention must be considered a covered preventive service. Doing so will meet the dual goals of the Affordable Care Act, that is emphasizing prevention and reining in healthcare costs.
The American Diabetes Association is leading the fight to Stop Diabetes and its deadly consequences and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, our mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. For more information please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit www.diabetes.org. Information from both these sources is available in English and Spanish.
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