Be Well: Diabetes Education Considered Critical,Ohio Lacks Coverage Rules

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by Sarah Jane Tribble

Lisa Bradford was diagnosed with Type 2 diabetes just before Thanksgiving last year.

“I was very upset, very emotional. I was very depressed," Bradford says. 

Years ago, she had watched her grandfather struggle with the disease, eventually having his leg amputated from complications.

“I knew that it was going to be a challenge and I knew it was going to be some work," she says. "And I knew that I had to stay focused and dedicated.”

But she didn’t know exactly what to focus on and how to dedicate herself. Diabetes is a complicated disease, requiring people to eat properly and track their blood sugar levels daily with pricks and pokes.

Research has shown that education is a critical element of care for people with diabetes. But it’s not always easy to get the education needed, says Leslie Kolb, a vice president for the advocacy group American Association of Diabetes Educators. 

While most states require insurers cover some diabetes education, Ohio doesn’t, according to a survey by the National Conference of State Legislatures. This leaves Ohioans struggling to figure out whether its covered and, if not, how to pay for it, Kolb says.

“Reimbursement for this service is really confusing,” Kolb says. 

Government programs, such as Medicare, Medicaid and any individual plan bought on the exchange have mandated some coverage of what’s called self-management training. But it’s not always comprehensive and can include co-pays and other costs.

And, because of Ohio's lacking state law, it can be even more confusing for people insured through and employer.

“Sometimes they cover it, sometimes they don’t. Sometimes they only cover it in certain areas, and sometimes they cover it for certain providers," Kolb says. "So a person with diabetes going through investigating where they can receive this kind of service, it can be so overwhelming.”

Ohio has a higher rate of diabetes than the national average, with nearly12 percent of people in the state suffering from the disease.  It’s estimated that the cost of that care is $1.3 billion dollars statewide. And, as with many chronic conditions, those costs can be lowered if patients take care of themselves.

Still, more than one in four Ohioans diagnosed with diabetes are considered to be in poor control of the disease, according to Ohio’s 2014 plan to reduce chronic diseases.

Leslie Andrews is a registered dietician at St. Vincent Charity Medical Center in downtown Cleveland and organizes patient education classes there.

"Diabetes is one of the very few diseases that necessitates such self-management at home. You are figuring out your insulin doses at home, you’re checking your blood sugar at home, you’re figuring out what you can eat and what makes your sugars go up and down," Andrews says.

Diabetes occurs when the body can’t control the amount of sugar in the blood. Education classes help people learn how high blood sugar can cause damage to the heart and blood vessels, nerves, kidneys, eyes and feet, among other things

Nurse Mariellen DeSmit details these risks as she leads a diabetes education class at St. Vincent.

“Not meant to scare you but just meant to teach you," she says to the class of about five people with diabetes and their caregivers. 

The group studies a large plastic map on the table showing the stages of diabetes. Each class members has a thick binder of worksheets and information.

“So on page 21, we’re going to talk about exercise and diabetes," DeSmit says, pointing down. 

For Cleveland resident Lisa Bradford, insurance didn’t cover classes like these. Even though the cost was more than $100 a session, she thought it was worth it.

Her grandfather’s amputated leg is a strong reminder of the power of the disease.



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