Guest blogger Linda Ridell is back this week, and she’s decided to take it easy with this post — considering the firestorm of comments that accompanied her last one. Enjoy and of course, share your comments for Linda below. —KMB


Undeniably, putting a dent in the cost of diabetes would be good, as medical costs for the disease annually reach into the billions.

As we’re all aware, disease management programs seek to reduce the costs associated with diabetes by getting patients to better control their blood glucose, blood pressure and cholesterol. Everyone who has diabetes faces the same challenges, potential complications and treatment options. So logically, everyone who has diabetes would benefit from disease management.

However, it’s a case where science defies logic. 

Countless studies have shown that people with less education have more complications from diabetes. Less-educated patients are more likely to switch treatment, which can lead to worse health results. One study of diabetes patients found that those patients with less education had two to three times greater incidence of end-stage renal disease and coronary artery disease. Researchers concluded that patients with lower education and social-economic status had weaker self-management skills, leading to the complications. 

The education connection holds for the likelihood of dying from diabetes, too. Studies show that diabetes patients who have less than a high-school education have twice the death rate as patients with a college degree.  This was true even when other factors were taken into account, such as obesity, age, gender and race. 

Disease management will make the biggest impact on members who need it most — those who have higher risk for complications. Disease management programs will have the highest return-on-investment for groups that have lots of high-risk members. It will have lower return for groups that have more college educated people. This is not to say that a white-collar group would derive no benefit, but it would be a markedly smaller benefit since their group will have fewer complications with or without a disease management program.

What is true for diabetes is also true for many other illnesses: people who have less education, less income, lower socio-economic status have more challenges. For example, HIV patients who have more education are more likely to follow their treatment plan and therefore have better results; individuals of lower socio-economic status who smoke have higher nicotine dependence and need more intensive support to quit. 

Disease management guided by science targets the people who need it most, rather than rely on the faulty assumption that all patients with a particular disease are equal. 

Guest blogger Linda K. Riddell is a principal at Health Economy, LLC, where she works with clients on gaining practical tools to comply with health care reform, and to maximize the new opportunities that health reform offers. She can be contacted at

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