Los Angeles clinic shows flaws in diabetes care

By Lisa Baertlein

LOS ANGELES (Reuters) - Two years ago, Mike Metcalfe awoke from a five-day coma to discover he was diabetic, a new statistic in a disease that has reached epidemic proportions in the United States and other rich countries.

But unlike some other sufferers of diabetes, which cost the United States an estimated $132 billion per year, Metcalfe has his condition under control and hasn't darkened a hospital door in the intervening two years.

That is thanks to a program designed at the University of Southern California's School of Pharmacy that puts pharmacists into community clinics serving the poor.

In addition to filling prescriptions, they give check-ups, order tests and help high-risk patients manage the complex drug regimens that come with diabetes, high cholesterol and heart disease.

Such intervention helps rein in the costs of treating chronic diseases, which are taking an ever-increasing chunk out of U.S. health care spending, by paring unneeded drugs and tapping programs that provide common, or even the latest, medicines free of charge or at steep discounts.

"If you give the right medicines, you will save in the long run," said Steven Chen, the program's pharmacist supervisor, who oversees five pharmacists and five residents working at seven Los Angeles safety-net clinics and a mobile asthma van in Orange County.

Metcalfe, 53, takes his medicine religiously, has adopted a healthy diet, and has moved on from his tiny room on Los Angeles' Skid Row -- one of the poorest areas of Los Angeles and a home to many indigent people.

"Dr. Chen saved my life," said Metcalfe, who still attends the same clinic in Skid Row.

"I do not want to live a nightmare," said Metcalfe, who saw diabetes ravage a relative's health and is determined to stay clear of its expensive and devastating consequences, which can include heart disease, kidney failure, amputation and blindness.

TAKE TWO PILLS, SEE ME IN THE MORNING

A new study from the Milken Institute found that common chronic diseases -- including cancer, diabetes, heart disease, stroke, lung problems and mental illness -- cost the United States at least $277 billion in medical treatment and more than $1.05 trillion in lost productivity in 2003.

It goes on to suggest that the bill for chronic illness could hit $6 trillion by the middle of the century, and emphasizes that much of that additional cost is avoidable.

Public health officials are particularly concerned with the fast rise in diabetes, which affects at least 194 million people worldwide and is expected to top 300 million people by 2025, according to the World Health Organization.

It cost the United States $92 billion in medical costs and $40 billion in indirect costs in 2002, according to the Centers for Disease Control.

"Diabetes is like an accelerant" for other health problems, said Dr. Alan Marcus, medical affairs director at device maker Medtronic Inc.