Hospitalist Jeffrey Schnipper, MD, MPH, FHM, estimated last year that a full third of his current patient census was either diabetic or hypoglycemic, a figure that might seem out of place for someone who isn’t a diabetologist.
Last week, Dr. Schnipper's estimation made perfect sense with the release of a new report from the Centers for Disease Control and Prevention (CDC) that forecasts a near-doubling of diabetic incidences in the next 40 years.
"I won't be surprised when there's a day where half of my patients have diabetes or hypoglycemia," says Dr. Schnipper, director of clinical research and associate physician in the general medicine division at Brigham and Women's Hospitalist Service in Boston. "We all have to become experts in how to comanage these patients."
The CDC data, published in Population Health Metrics on Oct. 22, state that "annual diagnosed diabetes incidence [new cases] will increase from about 8 cases per 1,000 in 2008 to about 15 in 2050" (doi: 10.1186/1478-7954-8-29). The authors note that intervention can reduce that prevalence, but won't eliminate it.
Dr. Schnipper says the exponential growth of diabetes incidence will not directly correlate to growth in patient counts, as many diabetics will be able to control their disease without admission to the hospital. However, he says, a large percentage of new cases are likely to end up as hospitalized patients heaped on HM groups' already full plates.
He suggests one response to the looming surge in diabetics might be to administer an A1c test to nearly all of your admitted patients to determine blood-glucose levels, or develop new protocols for how, who, and when to screen for diabetes.
One obvious patient group to be concerned about is the obese population, which Dr. Schnipper says is a direct cause of the diabetic incidence increase. "What we're seeing is an epidemic of obesity causing an epidemic of diabetes," he adds. "We already need to know how to manage these patients."