Jay H. Shubrook, DO


August 16, 2018

Hi. I am Jay Shubrook, a family physician and professor at Touro University, California. I am here today at the 78th Scientific Sessions of American Diabetes Association in Orlando, Florida.

We all know that diabetes is a disease associated with significant costs. Currently, 1 out of 4 US healthcare dollars are spent on a person with diabetes,[1] making it one of the single largest expenses in the United States.

A recent survey by Upwell illustrated many other expenses at the personal level associated with diabetes. This online survey, conducted in 2017, included 5255 people. The investigators looked at the personal time and emotional costs of having diabetes, because we know that diabetes can present an overwhelming burden that can consume a person's life. The survey had several important results.

First of all, let's look at absenteeism and presenteeism. Absenteeism means that you have missed work because of your illness; presenteeism means that you have made it to work, but you are not fully functional. In this survey, 55% of people reported that they missed work because of their diabetes. This is a significant cost to society.

At the personal level, almost 40% of people reported that they gave up hobbies or other personal interests, and 46% said that they missed outings and other personal events due to their diabetes. This is something that is affecting their day-to-day life.

We know that sleep is incredibly important for diabetes, for health, and for regulation of glucose. In this survey, 62% of people said that their diabetes complications interrupted their sleep. Hypoglycemia seemed to be one of the most important complications that interrupted sleep, with some people reporting that they had up to 10 episodes per week. We know that if you are not sleeping well, it is going to be much harder to be functional during the day. Certainly, [this loss of sleep affects] day-to-day quality of life.

Time is another significant factor in diabetes self-care. In this survey, 30% of people said that they need 2 or more hours per week just to do extra meal prep specific to their diabetes. Most people spent 1-5 hours per day [on self-care, with many patients reporting more time than that].

This correlates well with a survey of certified diabetes educators across the country that [my colleagues and I conducted] earlier this year.[2] We asked these educators to estimate how much time was necessary to [complete all aspects of self-care] for people with diabetes. The mean time estimated was 1.5-5 hours per day to complete all self-care activities. This is not reasonable or viable. We really have to work with our patients, their families, and our communities to examine how [our patients] can better integrate these self-care behaviors into everyday life.

Going back to cost, in the Upwell survey, nearly half (45%) of patients said they went without diabetes care because they could not afford it. These could include important tests, surveillance screenings, or even medications because the cost of their disease was more than they could bear.

And finally, 37% of people in this survey said that diabetes harmed a relationship with friends, loved ones, or coworkers. This might be in part because many people do not disclose that they have diabetes. This can be a source of contention when an emergency or complication arises because [this diagnosis] has not been shared.

Fifty-five percent of people in this survey [reported that they were] worried about the future and 39% reported that they had depression related to their diabetes. There is a significant psychosocial component to diabetes.

It is important to remember that [diabetes presents] not only a financial cost to the individual but also a substantial life cost. This involves relationships, activities, and functionality at work and at home. Let us remember to work with our patients, recognize these burdens, and help them to thrive with their diabetes. Thank you.


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