Diabetes stats are soaring across the US. While no State is immune to this public health risk, New York State, with its rising obesity rates, vast rural regions with limited access to care, and health inequity challenges, faces heightened risk as instances of this non-communicable condition continue to escalate.

More than 1.6 million New Yorkers are diagnosed with diabetes, and some 11 percent of the State’s almost 20 million residents may already have prediabetes. Diagnosis and intervention are complicated by the fact that only 20 percent of the population is aware that without a lifestyle change and medical oversight, they will “graduate” to a Type 2 diagnosis.

This crisis is hidden in plain sight, waiting to overwhelm the health system.

Diabetes and New York, Imperfect Together

Prediabetes is among the more worrisome health comorbidities. Consider that:

• Diabetes disproportionately affects racial/ethnic minority populations. Compared with white adults, the risk of having a diabetes diagnosis is 77 percent higher among African Americans, 66 percent higher among Latinos/Hispanics, and 18 percent higher among Asian Americans. New York’s diverse population positions the State as an epicenter for diabetes risks.

• Diabetes prevalence is approximately 17% higher in rural areas than in urban areas, with studies showing that adults in rural America were more likely to report a diagnosis of diabetes than their urban counterparts. Approximately 21.5 percent of New Yorkers live in rural regions, with about 4.2 million residents.

• Type 2 diabetes is a pressing public health concern in New York State, affecting individuals of all ages and backgrounds. According to the New York State Department of Health, approximately 10.3% of adults in the State have been diagnosed with diabetes, with Type 2 accounting for most cases. This prevalence translates to over 1.6 million adults living with diabetes, a figure that continues to rise.

• There are 5,228,000 people in New York, 33.5% of the adult population, who have prediabetes. Their blood glucose levels are higher than usual but not yet high enough for them to be diagnosed with diabetes.

• Some 33% of adults aged 65 or older have Type 2 or prediabetes. This age group is at higher risk than younger people of developing diabetes-related complications such as nerve damage, kidney failure, or heart disease. In New York, nearly one in six people are 65 and older, and this population is growing faster than in any other State.

Raising awareness of prediabetes is one challenge; preventing diabetes is another. Addressing the urgent needs of people unable to afford essential treatment is yet another.

Without consistent treatment, blood sugar levels in individuals with diabetes fluctuate uncontrollably, risking hyperglycemia or hypoglycemia, both life-threatening conditions. Prolonged neglect escalates health complications, including cardiovascular diseases, kidney failure, blindness, and nerve damage, significantly reducing life expectancy. The emotional toll of diabetes is also profound; diabetes burnout is real, resulting from the stress and anxiety of constant monitoring every day, all year long, which often leads to depression.

Tackling Access to Care Saves Costs and Lives

The already considerable healthcare costs of diabetes also continue to mount, causing intensifying economic strain as emergency treatment, hospitalizations and repeat hospitalizations climb due to the disease. According to the National Institutes of Health, care for people with diabetes accounts for 1 in 4 healthcare dollars in the U.S. On average, people with diabetes shoulder annual medical expenditures of $19,736, of which approximately $12,022 is specific to diabetes management.

When people require insulin, the price can be a significant obstacle, and failure to access therapy has downstream costs. According to the American Diabetes Association (ADA), people with diabetes have medical expenses that are 2.3 times higher than people who do not have diabetes, and the impact is even more significant for communities of color, which face disproportionately high diagnosis rates.

To fight the disease and its costs in reduced health and mental well-being, as well as runaway treatment and hospitalization costs, addressing the barriers to accessing insulin is paramount. For decades, data has demonstrated that tighter control of insulin blood glucose levels corresponds to fewer medical complications, keeping people out of the hospital and helping to prevent amputations.

People with Medicare Part B and D have a one-month supply of each Part D- and Part B-covered insulin, capped at $35, and do not pay a deductible. However, for the economically challenged, the cost of insulin often means that they are skipping or limiting doses. The impact on their long-term health can be disastrous.

New York State’s Governor Tackles Insulin Access

Governor Kathy Hochul has proposed eliminating insulin cost-sharing through legislation to tackle this public health challenge. The policy would cap an insured person’s cost at $100 out-of-pocket for each 30-day prescription supply.

This public policy effort is the most expansive stopgap against insulin cost-sharing in the nation, providing financial relief to New Yorkers and improving adherence to a life-saving medication that can prevent severe kidney disease that can even cascade to necessary dialysis. This proposal is estimated to save New Yorkers $14 million in 2025 alone.

By removing cost barriers, the program empowers individuals to manage their diabetes effectively. It tackles a key social determinant of health – the cost barrier to access medicine – potentially improving health outcomes. Since the insulin cap proposal was introduced in New York, other States have seen Governor Hochul’s program as a model to address their patient-care challenges.

“Access to affordable insulin is an essential need for those who require this life saving medication,” states Dr. Leon Igel, an endocrinologist and obesity medicine specialist at Weill Cornell and Chief Medical Officer for Intellihealth. Dr. Igel will be honored in May 2024 by the New York Metro Region of the American Diabetes Association for his equal commitment to patient care and research.

Insulin dependency and consistent access to diabetes care is a New York State priority.  Through public health Initiatives such as the Governor’s insulin program, progress is being made in addressing this escalating crisis. Addressing social determinants of health and ensuring that people can affordably access healthy food will also help reduce risks – these steps can address obesity, a critical preventive measure.

Relationship Between Obesity and Health Inequities

Obesity is among the primary risk factors for Type 2 diabetes, and its prevalence in New York reflects the national trend. The Centers for Disease Control and Prevention (CDC) reports that nearly 30% of adults in New York have obesity, with specific communities showing disproportionate risk. Minority populations, low-income individuals, and those residing in underserved neighborhoods are particularly vulnerable to obesity. Limited access to nutritious foods, inadequate healthcare services, and socioeconomic disparities contribute to the heightened risk faced by these groups.

Obesity also leads to prediabetes, a stepping-stone to Type 2 diabetes. Alarmingly, more than 35% of adults in New York have prediabetes, placing them at an increased risk of developing the full-blown disease if left unchecked. State health officials note that 15-30 percent of people with prediabetes without intervention will develop Type 2 diabetes within five years, leaving them vulnerable to heart disease and stroke.

The trajectory from prediabetes to Type 2 diabetes underscores the importance of early detection and comprehensive management strategies – including, if necessary – access to insulin. Moreover, addressing the underlying factors driving prediabetes, such as obesity and health inequities, is essential in stemming the tide of diabetes-related complications.

 “Treating obesity to prevent progression to Type 2 diabetes is critical” according to Dr. Katherine Saunders, an obesity medicine expert at Weill Cornell Medicine in New York City and co-founder of Intellihealth. “Once individuals develop Type 2 diabetes, it can be harder to treat their obesity and the other weight-related comorbidities they likely have as well.”

Government Action Can Save Lives

With access programs like the Governor suggests, New York State is taking bold, preemptive steps toward a future where diabetes no longer casts a dark shadow on the health and well-being of its citizens. Being insulin-dependent and having consistent access reduces a pivotal barrier to care.  As patients, care providers and insurers struggle to navigate the complexities of diabetes management, Governor Hochul’s policy efforts are paramount in shaping a healthier tomorrow for Empire State residents. This proposed legislation, if passed, may encourage other States to follow her lead.

Now, if States also recognize that preventive care – addressing access to healthy food and keeping waistlines down is a public health priority issue, our healthcare system might begin to shift from sick care to well-care.  That would be a significant cost- and life-saving advance.