For almost 1 million New York City residents living with type 2 diabetes, the silence from public officials as they fail to confront this epidemic with proven, highly effective strategies must end and it must end now. In the many neighborhoods where 25% or more of residents now have diabetes, normal life is broken. Even for those who are well, watching so many family members and friends in a constant battle for health is overwhelming.
But what’s worse it doesn’t have to be this way. The state and city Health Departments alike have completely failed to put in place clear strategies to control diabetes; they won’t even launch the kind of community-delivered self-care education, which has proven so effective for public health battles from HIV prevention to improving mental health — and which in diabetes can be spectacularly successful, reducing blood sugar, complications and costs.
That is why a Bronx Diabetes Action Summit, called by Bronx Borough President Vanessa Gibson, pushed the city Board of Health to declare diabetes an emergency. Some 60,000 more New Yorkers are diagnosed with diabetes every year, adding to the one in nine already in its grip. The rate is twice as high among Black, Latino and Asian residents.
New York’s horrific level of complications, which have given the state the highest diabetes costs in the U.S., is as publicly bankrupting as it is humanly unacceptable. Some 220,000 people in the greater New York area have diagnosed kidney disease — for which diabetes is the main cause; nearly all will, in the foreseeable future, have to go on dialysis or have a transplant.
With diabetes as the major cause of adult blindness, New York’s large caseload has left it with 493,200 residents who are blind or have serious vision loss. The state and city’s diabetes-related amputations rate climbed a stunning 100% between 2009 and 2020 and the continuing post-COVID climb has been especially devastating in the Bronx. where amputations are close to 60% higher than the city at large.
Both the New York State and City health departments have made no move whatsoever to bring down these amputations which even the American Diabetes Association says are 90% preventable.
A citywide emergency is possibly the only way we can get the action that is desperately needed. These amputations have lifetime costs of $500, 000 or more (surgeon, anesthesia, prosthetics, pain management, etc.)
Because all we’ve seen for years is that diabetes gets worse and worse, many people have come to think that nothing can be done. To the contrary, diabetes presents the greatest opportunity of any major disease to save outright billions of public dollars while helping millions lead healthier lives.
It is amazing what even small reductions in blood sugar accomplish. A 10% decrease in a diabetic’s A1C, a standard blood sugar measure, reaps a 35% reduction in eye damage. The Diabetes Self-Management Program, a six-session course, is perhaps the best evaluated American diabetes education. A year after participating, people with type 2 diabetes see a 90% decrease in new cases of kidney disease — a better outcome in controlling kidney disease than that claimed for the expensive GLP-1 medications.
For Vanessa, this issue is also personal. Her mother died last year from end-stage renal failure, a result of poorly treated diabetes. “We know our parents have to die but I feel very sure with what I know now that if my mother had the help of effective self-care education she would not have died, as so many of our mothers and fathers do, in the terrible distress of three times weekly dialysis sessions.”
As New York ignores clear routes to both huge savings and widely better health, it has the highest per patient diabetes costs in the nation. Diabetes alone consumes almost 30% of its $103 billion Medicaid budget.
“This neglect is a public health crime,” says Chris. “The wonderful thing about good diabetes education is that you can train local peer educators to facilitate it and build new community skills and hope for overcoming diabetes.”
There are many more things we can do to confront this tragedy — obvious things. The state should support safety-net hospitals to become diabetes centers of excellence — as the summit host, BronxCare, has managed to do.
We should have empowering public messaging. Do you see any public service ads from New York State or New York City encouraging their huge at-risk populations, for instance, just to read every label and learn to detect the many forms of sugar hidden in their food?
No. There’s nothing. Declare an emergency.
Gibson is the Bronx borough president. Norwood is founding executive director of Health People in the Bronx and the community co-chair of the New York City Diabetes Working Group.
