New York Times series highlights funding challenges for diabetes

This week the New York Times ran a two part series on research funding aspects of diabetes.  The first part, Rising Diabetes Threat Meets a Falling Budget , focused on federal research funding.  The second part, Cost and Effect: Beyond 'I'm a Diabetic,' Little Common Ground, described the differences in type 1 and type 2 diabetes as a disease and how these differences have impacted private fundraising for research.  These articles held the 7 th and 8th respectively most emailed article position. We applaud the continued effort by the New York Times to report on the problems diabetes – both type 1 and type 2 – pose for us as a country.  While each article approaches the issue differently, the overarching theme of scarce funding dollars and choices made is an important one to continue revisiting.  The first article describes the current federal funding situation as fairly bleak, especially juxtaposed against the wildly increasing population of type 2 diabetics.  Heading into 2007, the NIH budget allocates $1.2 million less for diabetes; the CDC allocates $700,000 less.  It's true that NIH and CDC funding is declining across the board.  No chronic desease is left unscathed; in absolute and relative terms, research dollars allocated for cancer and heart disease are declining even more than diabetes.  But given the outpaced growth of type 2 diabetes, it's hard not to be alarmed by anything other than increased effort and focus by everyone. The New York Times offers a few examples of just the kinds of consequences that frighten us most, at least for the population of type 2s.  (A group which is likely to add 500,000 or more people to its roster each year for the forseeable future.)  Programs heavy on prevention are at risk in light of the funding constraints:  reduction or elimination of classes for type 2 diabetics on how to avoid foot amputations; slower than needed implementation of church-based programs in poorer communities to teach the benefits of diet and exercise; elimination of other grass roots efforts to prevent type 2 diabetes and its complications. Our healthcare system is tragically geared towards expensive treatments and interventions rather than inexpensive investments in prevention.  We see ample evidence – and have written on the topic before – of our system's perverse logic in caring for complications associated with type 2 diabetics in particular.  Payors (and we most certainly include Medicare in that lot) regularly swallow camels and choke on gnats.  Willing to spend $30,000 on amputating a diseased foot, payors do so not long after balking at spending $150 on podiatry care that would have negated the need for such extreme surgery.  The kinds of programs mentioned above aren't nice extras; we see them as essential components in managing the ticking time bomb of expensive and deadly complications associated with type 2 diabetics. The second part of the series considers the stark differences between type 1 and type 2 diabetics – both from the fundamental nature of the disease as well as the attendant demographics of each group.  In some ways, the only common ground between the two types is the fact that both involve elevated blood sugar levels.  The roughly 1 million type 1 diabetics first experience the disease as children; type 1 crosses all socioeconomic boundaries and strikes without warning.  The 20 million type 2 diabetecs tend to be older adults, frequently in poorer demographic groups and sometimes obese.  What also differs dramatically, is the success respective advocacy groups have had galvanizing financial support.  The Juvenile Diabetes Research Foundation (JDRF), which focuses its efforts on funding research to cure type 1 diabetes, has experienced phenomenal success in terms of organization and execution.  The Times reports that last year JDRF raised $183 million – over half of which goes towards research for a cure.  This rivals the $209 million raised by the much larger American Diabetes Association (ADA) – an organization usually associated with focusing on type 2 diabetes.   And, of all public and private funds raised, approximately 30% is earmarked for type 1, 40% for type 2, and 30% for both.  The Times almost successfully resists the temptation to pit the two disease types against each other in terms of equitable funding patterns and levels.  Clearly that line of thinking isn't productive.  For type 2 in particular, we would argue that the measure of appropriateness isn't relative to type 1 support levels, but to the enormity of the problems ahead given the growth prospects we are facing.   Without delving into the complexities of the relationship between the two groups and their respective missions, it does seem that type 2s have lessons to learn from the success of the JDRF in constructing an effective message capable of attracting resources and garnering influence.  To be sure, the diseases are so very different, but it is reasonable to hope that successes for one will benefit the other. The one important commonality for both types is that addressing the pressing issues posed by diabetes will require continued significant financial investments -- by government, by industry, and by individuals.  To that end, we want to see more scary articles, keeping diabetes in the forefront of public imagination as well as in its pocketbook. Reference: Rising Diabetes Threat Meets a Falling Budget; Ian Urbina; New York Times, May 16, 2006 Cost and Effect:  Beyond 'I'm a Diabetic,' Little Common Ground; Richard Perez-Pena; May 17, 2006