Diabetes Debate : Diabetes Symptoms and Cost

In the bitter debate about health care, here's one thing many people agree on: The U.S. spends too much on health care, and much of it could be avoided.

Diabetes is one of the big examples.

About 20 percent of health care spending goes to people with diabetes. The number of people with diabetes nearly doubled from 1995 to 2006. About 8 percent of Pennsylvania residents have the disease. About half of people with diabetes receive taxpayer-funded health care through programs including Medicare.

In theory, it might seem easy to slash the diabetes-related expense. The disease is often the result of lifestyle. People exercise too little and eat too much. They become obese and then diabetic. In reality, that's hard to change. American culture tends to encourage minimal activity and overeating. Despite the alarm about obesity, rates of obesity and diabetes are rising.

Pennsylvania is mounting an effort to improve the health of diabetics and reduce the expense. The effort, backed by the Rendell administration, is called the Pennsylvania Diabetes Action Plan. So far, it involves about 100 medical practices, and the goal is to make the approach standard among family doctors.

The effort involves promoting a team approach to caring for diabetes patients and making sure they get tests and other support needed to control the disease. Health insurers are involved.

A goal is to adjust the payment system to encourage medical practices to provide the best care for diabetics and reward good results.

Dr. Robert Gabbay heads the diabetes clinic at Penn State Milton S. Hershey Medical Center, where he has worked for 11 years. Gabbay, 51, is one of the leaders of the diabetes plan.

He recently discussed diabetes and the plan. (Gabbay's responses have been summarized.)

Why do so many people have diabetes, and why is it rising?

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