Tuesday, March 21, 2023

NYC Must Fight Diabetes Rates: Disease Spikes COVID Risk, yet Solutions Are Available

New York City experienced a 356% increase in diabetes deaths during the first wave of the COVID-19 pandemic, the most of any urban area in the nation, and the rest of New York had the largest increase of any state. This appalling reality confirms the real price of the state’s absolute, studied refusal to confront the diabetes epidemic with evidence-based strategies that could significantly improve self-care and prevention.

By February 2020, peer-reviewed international reports had already confirmed high rates of severe COVID in people with diabetes, but stressed that while “individuals with diabetes are at risk of infections, especially influenza and pneumonia… this risk can be reduced, though not completely eliminated, by good glycemic (blood sugar) control.”

As the pandemic approached New York, it was already clear that people with diabetes — especially low-income and minority populations — would be incredibly vulnerable to COVID-19. The state had experienced a 48% increase in diabetes-related lower limb amputations since 2009, and the city a 55% increase — a sure sign of how sick this population had become.

But instead of tackling this preventable crisis head-on, by supporting cost-effective peer education programs to help the predominantly Black and brown residents in vulnerable communities, the state, and the federal government cut those funds completely. Even as the state awaits an infusion of an estimated $12.5 billion in unrestricted federal stimulus funds (and the city awaits an additional $6 billion), the state has refused to use $4.5 billion dollars in its Essential Plan which provides medical care to residents just above Medicaid income levels.

People with diabetes have become outright commodities for a vast sickness industry and its interlocking academic medical centers, huge hospital systems, influential unions, and auxiliary services. New York City has one million people with diabetes and the state has 2 million, with 896,000 state Medicaid recipients uniquely harnessed to support this industry. The state was already paying the highest excess costs in the nation for Medicaid patients with diabetes — $15,366 per year more than for people without diabetes.

This money was constantly poured into procedures, complications, and endless emergency visits and hospitalizations of people whose diabetes is out of control. Even as diabetes costs grew to constitute a major part of the huge Medicaid deficit, the state would not pay the estimated $900 per patient for the peer education programs proven to help people lower their blood sugar and quite literally turn their diabetes around.

Yet, public insurance pays $50,000 to $90,000 per patient, per year, for diabetes-related dialysis. Dialysis is a $35 billion per year business nationwide, with squads of lobbyists protecting its financial interests at the expense of the health of our most vulnerable residents.

Those appalling realities apply to other chronic diseases — heart disease, hypertension, obesity, and kidney disease — that disproportionately affect the same Black and brown and low-income communities that don’t have the lobbying muscle to convince lawmakers to help them.

As I told the joint legislative hearing in Albany on budget proposals for the next fiscal year, “Please let’s fully recognize that the terrible burden of chronic disease that so hurts our low-income communities is not necessary. People do not have to be this sick.”

Medical studies have confirmed the direct correlation between increasing A1C (a standard blood sugar measure) and higher deaths and complications when diabetics contract COVID. We now understand that excess blood sugar actually acts to increase the number of ACE 2 receptors, the portals through which the COVID virus enters cells.

We also know the steps that can start to change this, including easy availability of the programs that help diabetics drive down their A1C. We saw this when we worked with almost 2,000 South Bronx residents who could easily participate in homeless shelters, public housing, and mental health programs.

It includes tackling “food deserts” in communities where lack of access to fresh produce is a major obstacle to reversing diabetes. Teaching diabetics to read food labels and avoid processed sugar is another core element. Plant-based nutrition will slash many chronic diseases but the sole plant-based program in New York for Medicaid and uninsured patients at Bellevue Hospital has such a long waiting list it had to cut off the list.

As we enter the pandemic’s second year, inaction by New York City and state, like jurisdictions around the nation, has subjected low-income and Black and Brown communities where diabetes and other chronic diseases are rampant to needless susceptibility to more suffering and deaths from COVID — and more challenging recoveries after acute COVID-19 illness.

Will lawmakers in Albany, and Washington, finally have the wisdom and courage to set aside the interests of the “sickness industry” and serve the needs of their most vulnerable constituents? Will they invest in prevention to save countless thousands of lives and billions of public tax dollars?