Type 2 Diabetes and Preventive Cardiology
"Sixty five percent of people with diabetes in the US die from heart attacks or strokes. Unfortunately, most of them are not aware of the link between diabetes and heart disease and the things they can do to reduce their risks....Just walking 30-minutes a day, reducing your weight by 10-15 pounds, can reduce the incidence of diabetes by 58%."


Tommy Thompson
Secretary of Health and Human Services


"Dear Dr...........:
Your request for authorization of a program of care for your patient.............has been denied. The reason for this decision is that the proposed care plan is not a covered benefit. Should the patient wish to appeal this decision etc. etc. etc."


Standard letter to a physician from a Health Maintenance Organization or Preferred Provider Organization


Diabetes mellitus is a chronic debilitating illness that affects 3.5-4 million Americans. The estimates of its prevalence for 2000 based on the National Health Interview Survey (1997-1999) and the National Health and Nutrition Examination Survey (NHANES) (1988-1994) illustrate the staggering extent of the problem. Prevalence of diabetes among people aged 20 years or older is 8.6%, i.e., 16.9 million of all people in this age group have diabetes. In those 65 years or older, the prevalence is as high as 20.1% accounting for 7.0 million individuals. Overall, the incidence of diabetes is slightly higher in women compared with men (8.9% vs. 8.3%). Its complications affect the cardiovascular system, kidneys, and the nervous system and it is one of the leading causes of blindness. In 1997, the American Diabetes Association estimated that the direct annual medical costs attributable to this disease were $44 billion and the indirect cost resulting from disability, work loss, and premature death was an additional $54 billion.