State Of Illinois Diabetes Commission Presentation


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Diabetes Awareness, Prevention, Screening and Cost Savings Proposal to State of Illinois

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State Of Illinois Diabetes Commission Presentation

  1. 1. Proposal to the State of Illinois Diabetes Commission An investment in health through the Diabetes Risk Assessment (DRA) Test KitSynopsisIntroduction of the Diabetes Risk Assessment (DRA) to State of Illinois residents at risk for type-2diabetes based on the primary factors of:  ethnicity  family history  socio-economic level  medical history  age  sedentary lifestyle Distribute through various social and public touch points: schools, healthcare and dental clinics, health-related events, faith-based groups, etc. Success is contingent on a four-stage process:  raising awareness of the existence, access and availability of DRA testing to State of Illinois residents.  education on the features, benefits and value of DRA testing (namely identifying pre- diabetics).  Diabetes screening utilizing the DRA kit.  Completing a call to action (i.e. identification of a person with pre-diabetes or diabetes through the confirmatory DRA lab report and integrating a healthcare practitioner in order to review results and recommend a course of lifestyle changes. Distribution of DRA kits Suggested points-of-care for the DRA kit: School children: Implementing a state-wide Diabetes screening initiative based on a diabetes risk factor survey which will be administered if the student has two or more of the following: a) student belongs to an ethnicity b) family member with diabetes c) BMI calculation above normal levels. Ethnicities at risk: Diabetes screening drives offered following faith-based services. Goal to connect and cater to various populations and serve as a social and betterment network.Glycemion Proposal to The State of Illinois Diabetes Commission Page 1 February 12, 2009
  2. 2. Residents over age 45: Incorporating the DRA within the Illinois Department on Aging aspart of Illinois Cares RX programme.Lower socio-economic residents: offer the DRA at State of Illinois Medicaid clinics whenthere is suspicion of diabetes based on classic signs, symptoms or inherent risks:excessive thirst, excessive urination, elevated LDL cholesterol or high triglycerides, highblood pressure).Product HistoryThe DRA Test Kit is unique in that it is the only commercially available product that combinestwo FDA-Approved technologies in a single fingernick blood collection to determine glucose in afasting state as well as provide a retrospective look back at the previous 90 days of glucosecontrol using HbA1c. The concept of the DRA arose from the premise that for those who arebeing screened for diabetes, a single determination of blood glucose at a single point on timemay fail to detect glucose intolerance in those who will have increased glucose in a non-fastingstate. While an administered oral glucose tolerance test would increase the likelihood ofidentifying diabetes in such individuals, impracticality and cost prohibit such initiatives.RediClinics of Richmond, Virginia completed a 30-day program in summer of 2008, wherebyschool-age children presenting to RediClinics for back-to-school examinations could have freediabetes screening using the DRA. Of the 246 children who were screened through thisprogram, 27% were shown to be at increased risk for diabetes, and 2 were ultimately confirmedas having type 2 diabetes. The findings support the hypothesis that there are children who areat risk for diabetes, whose parents who were not aware, and that an in-store clinic screeningprogram is a beneficial tool for all stakeholders.OpportunityDiabetes has become an epidemic in our society and is even regarded as a national securitythreat. Having proven the utility of the DRA in retail, corporate wellness and the healthcaresectors, the intent is to administer the DRA to those who are at the highest risk: ethnicities,school children and an aging population.The DRA is an accurate, cost-effective and easy to use (self-administered) way to identify pre-diabetics. This FDA-Approved screening test combines an instant glucose self-test (results inthree minutes) with a confirmatory hemoglobin A1c laboratory test (if required). Both tests arecompleted by using a sterile safety lancet to draw just a single drop of blood that is placed on aGlycemion Proposal to The State of Illinois Diabetes Commission Page 2 February 12, 2009
  3. 3. specially treated collection card. The values used to determine pre-diabetics and diabetics arein accordance to the American Diabetes criteria. Specifically, fasting glucose above 100 mg/dLand less than 126 mg/dL indicates pre-diabetes, while fasting glucose levels above 126 mg/dLindicates diabetes. Similarly, using the calculation for estimated average glucose (eAG), [eAG(mg/dL) = 28.7 X HbA1c -46.7], an HbA1c greater than 6.0% and less than 6.5% would indicatepre-diabetes, and an HbA1c above 6.5% would indicate diabetes. (J Clin Endocrinol Metab2008;93:2447-2453).The instant portion of the test gives a result which can rule out the disease. For thoseparticipants whose instant result value does not exceed the cut-off threshold value, they aredeemed to be within the normal range and no further testing is required. Those participantswhose instant portion of the test exceeds the cut-off threshold value though will be asked tosend in the collection card whereby the confirmatory hemoglobin A1c value will be determined.Results are communicated through an illustrative laboratory report, which provides numericalresults of the two tests with a corresponding easy to follow assessment of diabetes risk. By thenintervening with lifestyle modifications, such as dietary changes and exercise, the otherwisecertain progression to diabetes can be altered. An estimated 2 million Illinois residents havepre-diabetes and are unaware of the risk. A significant portion of those people will developType 2 diabetes within 10 years if not screened or treated.Application to Illinois Diabetes CommissionApply the DRA in a campaign for identifying cases of pre-diabetes in order to stress inexpensivelifestyle changes versus costly treatment later on. Individuals identified with pre-diabetes whoreceive intervention and commit to a healthy diet and regular exercise regimen may avoid theonset of diabetes and its debilitating complications. It is through awareness, education,detection and a committed call to action that this early intervention initiative will succeed inreducing the costly, lifelong morbidities of diabetes for the residents of Illinois.Benefits to Illinois Diabetes Commission  Cost savings in treating diabetes and its related medical complications  Savings in lost work hours for people with diabetes as well as the caregiver(s)  Recognition as pioneers in implementing a statewide diabetes initiative to stabilize and reverse this trend of diabetesGlycemion Proposal to The State of Illinois Diabetes Commission Page 3 February 12, 2009
  4. 4. Future costs of not identifying newly diagnosed pre-diabeticsWithout diabetes screenings, present day undiagnosed pre-diabetics will develop type 2diabetes and delay necessary medical attention. As a result, damage will occur to themicrovasculature and over time, can result in stroke, blindness, kidney failure and even death.According to the American Diabetes Association, in 2007, each person with diagnosed diabetesincurs an average expenditure of $11,744 per year in primary treatment. These expenditures donot include advanced care such as ER visits, kidney dialysis and transplant, cardiovasculartreatments, eye care, amputations, etc. Indirect costs include increased absenteeism, reducedproductivity, unemployment from disease-related disability and less productive capacity due toearly mortality. Secondary and indirect costs of diabetes per individual per year exceed $75,000– this represents more than 6 times the primary cost of disease management itself.Statistical SupportAccording to the US Centers for Disease Control and Prevention, the average national rate ofdiabetes growth is up 90% in the last decade. The annual direct and indirect costs of diabetesexceed $132 billion nationally, and $7.5 billion in Illinois according to an IDPH 2004 report.Combine the obesity epidemic, the aging population, with the current recessionary times andthe number of new cases of type 2 diabetes among our population is certain to escalate.InvestmentUnder a state-wide screening initiative, the instant glucose test can be offered at a costof $8. From this instant test, healthy individuals will be identified and no further testingon these individuals is needed. Contingent on the results of the instant test, if needed,the Hba1c portion of the DRA will be offered for an additional cost of $12 (inclusive ofshipping, lab processing and reporting).Assuming the availability of 1 million DRA screening kits to Illinois residents with theexpected positivity detection rate for pre-diabetes of ~ 20%, would mean that 200,000pre-diabetics would be identified. Using the above data as it relates to Illinois, byidentifying and counseling 200,000 newly diagnosed pre-diabetics, a budgeted amountof $10.4 million would save Illinois $2.3 billion per year in diabetes treatment alone, orover $15 billion in direct and indirect costs. Sponsorship through alliances among theGlycemion Proposal to The State of Illinois Diabetes Commission Page 4 February 12, 2009
  5. 5. pharmaceutical and healthcare industry for such an initiative would help to offset thecosts of promoting the program and providing the kits and testing.Cost Comparisons  The original research article Cost-Effectiveness of Screening for Pre-Diabetes Among Overweight and Obese U.S. Adults (Diabetes Care30:2874-2879, 2007) concluded that screening for pre-diabetes followed by lifestyle intervention has a relatively cost- effectiveness ratio. Of particular note is that the published cost per diagnostic test totaled $42.92  The 2009 Medicare Fee Schedule lists the reimbursement rates for the two parts of the DRA as follows:CPT Code Test Name 2009 Medicare ReimbursementQW-82947 Glucose, Blood (CLIA Waived) $5.7383036 HbA1c/Glycosylated Hb $14.14The total reimbursement is $19.90 and in line with the cost per DRA kit.Proposed timeline for roll-out of DRA programmeBy November 2009 to coincide with Diabetes Awareness MonthContact Information+847.236.0943Konstantine HaralampopoulosGlycemion Proposal to The State of Illinois Diabetes Commission Page 5 February 12, 2009