is so far advanced that serious vision- and circulation-related consequences of the full-blown disease (aggravations of chronic illness) cannot be reversed.
Diabetes is classified, along with such other chronic ailments as heart disease, arthritis, mental retardation, and high blood pressure, as a 1996 study of chronic illnesses reports. Major chronic conditions as a class afflict some 99 million patients and cost
$470 billion a year in direct health costs, according to the study, the first comprehensive survey of the issue in 30 years. Indirectly, they cost $234 billion in lost productivity from those who are disabled or die prematurely.
According to Dancer, et al., medical care for diabetes mellitus costs more than $100 billion annually, $10 billion for insulin-dependent diabetes mellitus patients alone. "Those with chronic ailments," writes Rosenblatt, "represent 46% of the patients seeking medical care each year but account for 76% of the nation's health care budget." Side effects of untreated or uncontrolled diabetes include circulatory complications such as stroke, amputation of limbs, and clogged arteries.
Nor is the cost measured solely in financial, institutional, or indeed physical terms, for chronic conditions are perforce ongoing conditions that do not necessarily respond to the remedies associated with heroic interventions in acute-disease diagnoses. This fact makes the structure of health-care delivery problematic for diabetes patie
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