Routine Exams Can Save Diabetics From Serious Problems
Every year, 24,000 people with diabetes go blind.
Virtually all of these cases are preventable--but the victims don’t get eye exams in time to detect their problems and to arrange treatment that could save their vision.
This lack of information makes them pay a disastrously high price.
That is why the American Diabetes Assn., the American Academy of Ophthalmology and the American Assn of Health Plans, a trade group, are launching a national campaign this month to remind diabetics to get their eyes checked.
A routine eye exam can cost anywhere from $50 to $150, and many employers don’t include vision care as part of their health insurance coverage for workers. So the exam expenses might come directly out of the consumer’s pocket.
However, HMO members who have diabetes are automatically covered for the cost of vision care. There is no extra payment for the eye exam--only the regular $10 or $20 office visit co-payment.
Knowing that routine eye exams are covered by insurance is just one of the things that diabetics should be aware of. Another thing to know is that when you get a physical exam, be sure the doctor checks your feet (diabetics are prone to get hard-to-heal wounds and cuts that could lead to amputation).
Diabetics also should get a hemoglobin blood test four times a year. This is required for diabetics and is covered by health insurance. For those diabetics without insurance, however, the total expenses can run several hundred dollars a year. Too often, patient attitudes are a bar to effective treatment.
“There is a particular mind-set in some people, an idea of the inevitability of the disease,” said Linda Gledhill, executive director of the American Diabetes Assn. office in Los Angeles. “They will say, ‘Well, it runs in my family, there is nothing I can do about it.”’
Trying to overcome this attitude is the association’s mission at events like the fair at Olvera Street in downtown Los Angeles last month, where 10,000 people lined up for free blood screenings and cholesterol measurements. It will be held again next year. The association’s Orange County office also holds an annual street fair in the spring, and conducted a daylong session at Santa Ana High School last month with information and publications in Spanish.
The disease hits especially hard at minority communities. The incidence of diabetes is about 5% in the white population, but soars to 12% or more among African Americans and people of Asian descent, and may run as high as 20% or more among some Latinos. In various Native American tribes, the incidence is 25% and more.
Diabetics comprise less that 10% of the nation’s Medicare population but consume at least a quarter of all Medicare dollars because they are prone to have other costly, and sometimes fatal, diseases.
As the increasingly indolent American population gains weight--physical education is a mandatory high school course only in the state of Illinois--many more people become candidates to develop diabetes. The single biggest risk factor is obesity, as people eat more and exercise less.
Just 2.5% of Kaiser health plan members were diabetics a decade ago, a figure that has jumped to 6% today, said Dr. Jim Dudl, co-director of the regional diabetes project at the Southern California Permanente Medical Group, based in Pasadena.
Prevention is possible, he noted, citing a recent federal study showing the benefits of placing at-risk people on a low-fat, low-sugar diet and persuading them to stick to an exercise plan for 30 minutes, five times a week. The incidence of diabetes for this group was slashed 60% compared to another group of people who did not make changes in their dietary or exercise habits.
Dudl and other physicians have to cope with the fact that many people will ignore the dangers of obesity and develop the disease anyway. For those patients, special efforts are underway in California as businesses, insurers and physicians collaborate on a joint effort to control diabetes.
Under the lead of the Pacific Business Group on Health, which represents major employers that provide health coverage for 3 million people, the corporations and insurers joined forces to develop disease treatment standards. Diabetes was the first target of their project, the California Cooperative Health Reporting Initiative.
Some 13 health plans agreed on standards, which were distributed this summer to thousands of doctors throughout California. The aim is to help ensure that a person who switches health plans won’t get conflicting advice about blood sugar levels or cholesterol readings that suggest he is a full-fledged diabetic, or merely at risk.
“We needed consensus guidelines everybody can agree to,” said David Hopkins, director of health information improvement for the Pacific Business Group.
The reporting group does more than issue standards. It uses the power of the computer to combine pharmacy and patient medical information to generate rosters of diabetics. These are sent to medical groups with reminders to the doctors to reach out to patients for treatments and checkups. The patients are sent educational materials and reminders to seek out the doctors for their regular visits.
A doctor can “write an elegant treatment plan and provide excellent advice, but if a patient does not follow up, it doesn’t do any good,” said Dr. Lance Lang, a vice president and senior medical officer at Health Net, an HMO.
“Even though you plan for Mrs. Jones to come back at certain times, maybe she doesn’t return for an office visit,” he said. The constant reminders are vital.
About half the patients with diabetes and its complications fail to visit the doctor for regular follow-up care, said Kaiser’s Dudl. It might be even worse if not for an aggressive outreach program by Kaiser and other health plans. Kaiser sends mailings to its diabetic members, and follows up with phone calls urging people to get their examinations.
Even Medicare beneficiaries, who presumably are more careful about health issues as they get older, may not take advantage of opportunities to get free care.
The foundation of the American Academy of Ophthalmology runs a special eye-care project with the federal government, offering free eye exams, diagnosis and treatment to Medicare beneficiaries who have not had an eye exam in the past three years. It is available to people over 65 except those who are enrolled in Medicare HMOs or in Veterans Administration health programs. This means the bulk of the Medicare population is eligible.
A special mailing was sent in 1999 to 350,000 diabetic Medicare beneficiaries nationwide who had not had a recent eye exam, telling them of the free services. Only 7,000 took advantage of the offer.
“It’s a pretty pitiful showing, and we have some good epidemiologists trying to figure out why people don’t use this service,” said Dr. C.P. Wilkinson, a member of the academy’s board of trustees.
He emphasized that the free care is available to Medicare beneficiaries, regardless of whether they have diabetes.
Information on the free eye exam is available from the ophthalmologists’ foundation at (800) 222-3937 (222-EYES). All co-payments and deductibles are waived by participating doctors who volunteer their services. A separate phone information line with advice and services for diabetics is available at (800) 628-6733.
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Bob Rosenblatt welcomes your questions, suggestions and tips about coping with the changing world of health care. You can contact him by writing Bob Rosenblatt, Health, Los Angeles Times, 202 W. 1st St., Los Angeles, CA 90012, or by e-mailing bob.rosenblatt@latimes. com. Dollars & Sense runs the second Monday of each month.
