San Joaquin Valley hospitals filled with diabetes patients

The Fresno BeeMay 15, 2014 

A file photo of a dialysis machine used on diabetes patients.


More than one in three patients in San Joaquin Valley hospitals has diabetes, according to a study released Thursday.

Health professionals in the Valley said the study by the UCLA Center for Health Policy Research confirms what they already know: Diabetes is epidemic here and in the state.

"When I do admissions at the hospital, I would say virtually every other patient has diabetes," said Dr. Kirnan Reddy, a Fresno internist.

The study used 2011 hospital discharge data from the Office of Statewide Health Planning and Development to look at hospital patients with diabetes and costs to the health care system. Diabetes may not have been the reason for the hospital admissions, but was listed as a diagnosis.

Six of the 10 counties with the highest percentages of patients with diabetes were in the Valley. Merced, where 35.7% of hospital patients had diabetes, led the Valley.

Statewide, only Imperial County, which had 40.1%, and Solano County, with 36.2%, had higher rates. Yuba County matched Merced's 35.7% rate. Fresno County, at 35.1% of patients with diabetes, came next. California's rate was 31%.

And diabetes is costly: On average, it cost $2,200 to treat hospital patients with the disease than those without, the study said. Statewide, diabetes accounted for an additional $1.6 billion every year in hospitalization costs.

The study did not specify why costs went up for patients with diabetes. One possibility: It takes people with diabetes longer to heal from illness.

Patients with diabetes added $42.2 million to hospital costs in Fresno County. Additional costs for other counties: $20.5 million in Tulare, $11.6 million in Merced, $6.3 million in Madera and $2.7 million in Kings.

"These numbers really highlight not only the cost for the hospitalization, but because they're so high, they highlight the impact this condition really has on the people who have this condition and their families," said Sue Babey, senior research scientist at the health policy research center at the University of California at Los Angeles.

The study says three-quarters of the care for the patients with diabetes was paid through two government insurance programs -- Medicare and Medi-Cal.

The Valley has among the highest rates of diabetes in California. In Tulare County, approximately 15 people out of every 100 are believed to have diabetes, according to the latest state estimates for 2011-12. In Madera, it's 14 out of 100 and in Merced, almost 12 people out of 100 have the disease. Fresno's rate (8.5) is close to the state rate of 8.4 per 100.

Diabetes is a chronic condition, but one that can be managed with diet, exercise and medications. Complications from uncontrolled diabetes, however, often send people to hospitals.

"We're going to see more and more people with these chronic complications and more and more hospitalizations as a result of these complications unless we start aggressively screening and following up on these patients and making sure they understand this disease and how to manage it," Reddy said.

Genetics plays role

The causes of diabetes are complex, but revolve around genetics, obesity and poverty.

Minorities are up to two times as likely as whites to die from diabetes and its complications. Less educated residents and the poor, regardless of ethnic background, are more likely to get the disease than other Valley residents.

The UCLA study on diabetes found disparities in hospitalizations by race and ethnicity. Of all Hispanics hospitalized in California, 43.2% had diabetes. For American Indians and Alaskan natives, 40.3% of the patients had diabetes; blacks 39.3% and Asian American and Pacific Islanders 38.7%. Of all whites hospitalized, 27.5% had diabetes.

Reddy said she is concerned because she is seeing more Hispanics developing Type 2 diabetes in their early 20s.

Awareness about diabetes and how healthy eating and regular exercise can help prevent development of the disease should be introduced to children in elementary school, she said.

Obesity challenge

Preventing obesity is key to reducing diabetes in the Valley, said Genoveva Islas-Hooker, who directs the Central California Regional Obesity Prevention Program. "When we work at obesity prevention, we can help prevent a lot of chronic disease," she said.

Adult obesity rates in the Valley are among the highest in the state, ranging from 44.3% in Kings County to 31.8% in Fresno. Statewide, 27.7% of people ages 35 and older are obese, according to the 2011-12 California Health Interview Survey.

The Valley has to get a handle on obesity, said Dr. Saber Ghiassi, a Fresno bariatric surgeon. "It has to be attacked from multiple fronts. Government, private enterprise, health care, community, civic groups -- we all have to be addressing this issue, otherwise it's only going to get worse."

The UCLA study on diabetes and hospitalizations was done with support from the California Center for Public Health Advocacy, a nonprofit focused on solving obesity and diabetes problems in California. Funding for the study was from The California Endowment, a private statewide health foundation.

Among the study's recommendations: reducing the consumption of added sugars and sugary drinks. Such beverages are a contributor to obesity and diabetes, said Harold Goldstein, executive director of the California Center for Public Health Advocacy.

But legislation to require warning labels on sugary drinks could be a hard sell. A bill to require such a label by Sen. Bill Monning, D-Carmel, was heard April 28, but was placed in the suspense file where bills go to be analyzed.

Health professionals in the Valley had not seen the UCLA diabetes study, but said reducing consumption of sugary drinks is only one answer.

No access to care

A lack of access to care and resources contribute to many patients with diabetes filling hospital beds in the Valley, said Dr. Robert Streeter, vice president for medical affairs at Mercy Medical Center in Merced.

By Mercy's calculations, 22% of the hospital patients in April had a diabetes diagnosis.

Mercy has had patients admitted to intensive care because they ran out of insulin and couldn't afford to refill the prescription, Streeter said. The hospitalizations for some patients "could have been avoided had they been able to access care earlier," he said.

And education for patients at risk of diabetes as well as ongoing support for those diagnosed with diabetes too often is missing, Streeter said.

Hospitals, such as Mercy, offer free diabetes education classes to try and prevent hospitalizations, but hospitals have to look to community partners to help keep patients healthy, he said.

Poverty can be a barrier to getting help, said Maria Guzmán, a health educator at Clinica Sierra Vista in Fresno.

Guzmán teaches a "Diabetes 101" class to explain the disease and how to manage it. Her two-hour classes are available on a sliding-fee scale based on a patient's income. Clinica has had patients pay as little as $9 for a two-hour class, but some say: 'I can only come to one class per month,' " Guzmán said.

Requiring health insurers to cover early screening and detection and management programs for diabetes is among the UCLA study's recommendations.

"It's really important to support testing and screening so that diabetes can be identified early and especially pre-diabetes can be identified," said Babey, the lead scientist.

Education key

Diabetes education has made a difference for Dustin Oaks, 46, of Prather.

Last year, Oaks, a laboratory manager, was diagnosed with pre-diabetes, which could progress into diabetes without attention. He made an appointment with Chuck Newcomb, a dietitian consultant based in Madera. "He helped me get things under control," Oaks said.

A "meat and potatoes" man, Oaks, 46, said he's cut back on both foods and added vegetables to his diet. He gave up a daily two-can soda habit. And he takes three 10-minute walks a day. The lifestyle changes are paying off: His blood-sugar levels have improved and he's lost about nine pounds in the past three months. Said Oaks: "I had to put another hole in my belt."

The California Center for Public Health Advocacy supported the UCLA diabetes study because diabetes is a growing epidemic that affects every population in the state, Goldstein said. And 90% of diabetes is preventable with diet, exercise and regular screening, he said.

"There's a lot we can do and need to do about the impact of diabetes on our families, on our communities and on our health care system," he said. "It's time that we make prevention and early detection of diabetes a priority in California."

Diabetes explained

People with diabetes have too much glucose, or blood sugar, that builds up in their bodies. The hormone insulin regulates blood sugar and in Type 1 diabetes -- the most common type among children -- the body's immune system destroys pancreatic cells that make insulin.

But about 90% to 95% of diabetics have Type 2, in which the body becomes resistant to insulin produced in the pancreas, and gradually the organ stops making the hormone, allowing blood-sugar levels to rise out of control.

Left uncontrolled, diabetes can attack organs, nerves and blood vessels anywhere in the body. It can lead to blindness, amputations, kidney failure, heart disease, and stroke.

Links to the study

UCLA Center for Health Policy Research

California Center for Public Health Advocacy

The reporter can be reached at (559) 441-6310, or @beehealthwriter on Twitter.

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