And saves money. Apparently an ounce of prevention is still worth a
pouond of cure.
one of themore hopeful diabetes stories in quite a while, from today's
NY Times:

December 30, 2006
New Job Title for Druggists: Diabetes Coach
By IAN URBINA

ASHEVILLE, N.C. - In an office behind the Hershey's candy rack at a
Kerr Drug here, Stuart Rohrbaugh shifts in his chair as his pharmacist
stares at a dangerously high blood sugar reading from last month.

"I think that was the day a buddy of mine brought over his home-brew
beer," stammers Mr. Rohrbaugh, whose diabetes was diagnosed six years
ago.

Silently, the pharmacist lifts her eyes, sending Mr. Rohrbaugh's gaze
to the floor.

"I know, I know," he says.

Mr. Rohrbaugh, 37, learned relatively late in life that he had Type 1
diabetes, a malfunction of the immune system that usually surfaces in
childhood. There are hundreds in Asheville with that type, and even
more with the more prevalent Type 2, which often hits as a consequence
of obesity or age.

And so in this town of 75,000, where people like to use sugar in their
coffee and in their iced tea, and as a term of endearment, Mr.
Rohrbaugh and the others face the formidable challenge of either
managing their diabetes or suffering its potential ravages: blindness,
organ failure, stroke.

In trying to meet that challenge, the kind of polite browbeating that
Mr. Rohrbaugh faced at his local pharmacy seems to be paying off.

For the past 10 years, the city of Asheville has given free diabetes
medicines and supplies to municipal workers who have the disease if
they agree to monthly counseling from specially trained pharmacists.
The results, city officials say, have been dramatic: Within months of
enrolling in the program, almost twice as many have their blood sugar
levels under control. In addition, the city's health plan has saved
more than $2,000 in medical costs per patient each year.

There are at least 21 million diabetics in the United States, and
health officials have begun to despair of combating the disease because
it involves getting people to do something much more difficult than
taking their medicine or having surgery: altering their daily behavior,
like their eating and exercise habits.

But amid this gloom, Asheville's public health experiment is
something of a ray of hope, an example, however modest, of the kind of
house-to-house, block-to-block battle that can win results and save
lives in the face of a disease that has resisted quick-fix solutions.

Indeed, in recent years, about 40 other employers across the country
- private companies or municipalities - have adopted versions of
the program.

"We get a four-to-one return on investment," said Barry Bunting,
pharmacy director at Mission Hospitals, which runs the program in
Asheville for about 450 city and hospital employees. For every dollar
spent on medicines or counseling about diet, exercise and lifestyle, he
said, the city saves $4 by preventing emergency room visits, dialysis,
amputations or other common complications of diabetes.

During the first five years of the program, participants took an
average of six sick days from work a year, half the number of previous
years. Within three years of enrolling in the program, patients had
halved their chances of going blind or needing dialysis or an
amputation, a founder of the program said.

"When you have to answer to someone each month, you think twice
before eating what you shouldn't," said George Ledford, 69, who
joined the program five years ago.

The fifth deadliest disease in the nation, diabetes costs more than
$130 billion per year in medical expenses and lost productivity in the
workplace. While there is no cure, patients can delay or prevent
complications by using medications properly and adjusting their diet
and exercise routines.

But the efforts to help people change their lifestyles are complicated
by a health care system in which insurers typically do not reimburse
doctors for the kinds of counseling and monitoring that might keep
patients on track.

So the Asheville experiment has enlisted pharmacists in its model. They
serve as coach, clinician and cheerleader for patients, and they earn a
fee for each session.

"Once you have a sense of what motivates them, you set little goals
each visit and then build on them," said Dana K. Arrington, a
clinical pharmacist at Kerr Drug who sees at least one diabetes patient
a day.

"This month, get on the treadmill once a week for 15 minutes. Next
month, we write down each time you take your pills. Then switch from
whole to skim milk. It's a slow process if you want it to stick."

While diabetics have often shown significant improvements in
controlling their blood sugar soon after taking diabetes education
classes, they typically relapse within three months, according to a
study released in March 2003 by the Journal of the American
Pharmaceutical Association. The report was co-written by Carole W.
Cranor, a pharmacoeconomist who was then at the University of North
Carolina, Chapel Hill.

What makes the Asheville Project unusual, the study found, is that at
the end of the first year of the program, half the participants had
their blood sugar under control. That number increased to two-thirds of
the original group at the end of the program's third year.

"Asheville had unusually long-term successes because of the distinct
role played by pharmacists, who have at least five years of academic
training and who are more rooted and accessible in communities than
doctors," said Ms. Cranor, who is now a clinical pharmacist at
Dorothea Dix Hospital in Raleigh, N.C.

Aside from Asheville's successes, the popularity of the program is
being driven by pharmaceutical companies.

GlaxoSmithKline and Sanofi-Aventis, which make diabetes drugs, have
jointly given about a million dollars in the past five years to the
American Pharmacists Association Foundation, a nonprofit research
group, to help promote and replicate the program, said Dan Garrett, one
of the founders of the Asheville Project and a director at the
foundation.

Diabetics frequently fail to take their medications consistently,
studies show, so these drugmakers stand to profit from better patient
compliance. None of the employers or cities that adopt the program are
obligated to buy from these companies, though.

The frequency of consultations is the reason the Asheville Project has
shown such long-term benefits, Mr. Garrett said.

For patients struggling to adjust their daily habits, it is the little
questions - those too small and too numerous to justify an
appointment with a doctor-that make the disease so difficult to
manage and pharmacists' involvement so invaluable, patients said.

When Mr. Ledford kept getting sores on his feet, a common diabetes
complication, his pharmacist ventured into the aisles to help him find
a lotion that worked. When Mr. Ledford's blood sugar levels spiked
mysteriously, the pharmacist questioned him about any changes in his
routine. "The new cup I was using for my cornflakes was the wrong
size," recounted Mr. Ledford, explaining that this mistake in
figuring his carbohydrate consumption was throwing off his insulin
dosage calculations.

Despite his occasional lapses, Mr. Rohrbaugh said that without frequent
feedback from his pharmacist and the program's nutritionist, he would
never have been able to learn how to count his carbohydrates, drop the
necessary 20 pounds and administer his insulin. "I also was
struggling to afford it all," said Mr. Rohrbaugh, a worker in city
planning who was paying more than $300 per month for medicines and
supplies before joining the program two years ago.

John Miall, one of the founders of the Asheville program, who recently
retired as the city's director of risk management, said that within
its first year the average annual health care cost for diabetic
employees dropped to $3,554 from $6,127.

"Do the math," he said. "If just one employee is kept off
dialysis, that is a $100,000 net savings for the year. That pays for a
heck of a lot of preventative medicine and supplies."