Local nurses, doctors fight uncompensated, uphill battle to stop spread of diabetes

    One night every three months, as many as 45 people across Lawrence with blood sugar between the normal and diabetes levels make their way to Conference Room A in the basement of the Lawrence Memorial Hospital, said Patricia Hohman, advanced registered nurse practitioner and certified diabetic educator for the Lawrence Memorial Hospital Diabetes Education Center.  They listen to a local doctor give a free volunteer presentation on personal treatment - mostly dieting, exercise and weight loss, Hohman said.  Then they leave, knowing another three months will pass before they receive any more counseling or support.

    They suffer from pre-diabetes, a condition that incurs the same side effects as type II diabetes - fatigue, extreme pain in their feet and legs and others - but that fewer insurance providers pay to treat because pre-diabetics still have blood sugar levels below the diabetes mark, said Dr. Paul Morte, a neurologist at Lawrence Neurology. 

    Morte said pre-diabetics often have blood sugar counts just below the level of type II diabetes, the condition when people can no longer produce enough insulin for their weight, and need the same type of counseling diabetics receive from places like the LMH Diabetes Education Center. 

    "There are lots of people who are pre-diabetic," Morte said. "If the insurance companies would pay for more counseling, if they were willing to pay the dieticians and life-style counselors, you'd have less diabetes." 

     Hohman said she has been frustrated by how insurance providers refuse to pay for pre-diabetes treatment and volunteers her time to organize the LMH Diabetic Education Center pre-diabetes class as a way to reach pre-diabetics despite the insurance providers' lack of support.  Hohman said that while she wishes insurance providers would pay for more individual treatment, she does not expect them to change.

    "That's not how insurance companies work," Hohman said.  "We've had so many (pre-diabetic) people referred (to the LMH Diabetic Education Center), but insurance wouldn't pay for it."

    Mary Beth Chambers, a public relations representative of Blue Cross Blue Shield of Kansas, said Blue Cross Blue Shield of Kansas, one of the leading private medical insurance companies in the state, offers a Healthy Options Care Management Program for diabetics after diagnosis.  She said the program provides diabetics with educational materials in the mail and one-on-one lifestyle counseling from a nurse.  Chambers said the program excludes pre-diabetes patients, though.

    "All of our policies (for pre-diabetics) exclude weight loss benefits," Chambers said.  "A member would have to cover it themselves."

    Similarly Don McLeod, a public affairs specialist
for the Centers for Medicaid and Medicare Services said Medicare pays
for diet and exercise services for diagnosed diabetics but refuses to
cover these services for its pre-diabetic elderly patients.

    "We don't pay for pre-stuff," McLeod said.  "We just don't do that." 

    Hohman said she believes paying for pre-diabetic
treatment would actually save insurance companies money by lowering
their future cost of complications from increasing diabetes nationwide.

    "We have lots of people that already have
complications when diagnosed (with diabetes)." Hohman said.  "It
takes years to have a
complication."      

    Hohman said a study two years ago found 58 percent
of pre-diabetics who receive treatment - including counseling for
dieting, exercise and weight loss - can prevent diabetes. 

    "It can be prevented," Hohman said, "if you catch it below full-blown diabetes."

    Dr. Morte said type II diabetes now is expanding far beyond a disease just for the elderly.

    "I see it everyday," doctor Morte said of type II
diabetes.  "Everything is changing now.  We're starting to
see young people with type II diabetes.  It's an epidemic, even in
adolescence."

    Hohman said overweight young adults who smoke, do
not exercise and have a family history of diabetes have an extra high
risk for developing it.

    "Usually people in their 20's aren't worried about
it," Hohman said of type II diabetes, "but we've seen increases in all
age groups.  We've seen 20-year-olds (with type II diabetes)."

      Hohman said the Diabetes Education Center
also offers a free class the second Wednesday of every month for
patients who already have diabetes that pre-diabetics are welcome to
attend.  Morte presented for the November class, the first LMH
diabetes or pre-diabetes class he has attended, on neuropathy, one
painful diabetes side effect Morte said also occurs in pre-diabetics
when the nerves of their bodies begin to deteriorate.

    Morte said that until insurance providers pay for
more one-on-one pre-diabetic counseling, free pre-diabetic and diabetic
classes like the ones offered by the LMH Diabetic Education Center may
be the best and only bet for decreasing the rapid spread of diabetes in
the United States.

    "There are a number of different anonymous programs
set up in cities, and they're free.  Maybe we need diabetics
anonymous." Morte said.  "If people are pre-diabetics, and have it
(diabetes) in their family history, maybe they'd be willing to go to
that."


    Even as Morte, Hohman and other medical
professionals volunteer in Lawrence to help pre-diabetics, Morte said
until pre-diabetics nationwide receive the support they need to change
their lifestyles from insurance companies, the government or more
volunteers, the rise in diabetes in the U.S. will only continue.

    "I hate to be pessimistic," Morte said.  "As
long as we have a society where we don't get any exercise, it's going
to be a tremendous problem."