Did anybody catch the first ever YouTube democratic debate last week? It was cosponsored by CNN and the cool thing about it was this: all the questions came in from Americans like you and me. Turns out two of the candidates spoke out on behalf of diabetes. Here's what they had to say...

Governor Richardson mentioned the fact that 33% of Medicare is wrapped up in diabetes costs. He suggests, "Let's have major prevention programs, and also ways that we can ensure that we find a cure." He still has not announced a plan to ensure a cure. But if he does - I'm willing to bet all of his campaign funding from Big Pharma might mysteriously disappear.

The other candidate addressing diabetes was Senator Chris Dodd of Connecticut. Dodd's promise came after from a woman's question about stem cell research. Somehow the senator was able to plug an endeavor to "deal with diabetes". However, much like Governor Richardson - he has yet to announce a plan to cure. Politics as usual. Stay tuned for the LIVE Republican Debate on September 17th.

In 2005, insulin cost state Medicaid programs $500 million. The diabetes epidemic is causing the government to question one of the big-ticket items on the shopping list - insulin. Insulin was developed over 20 years ago and many of these original forms are now off patent. This is a screaming opportunity for generic drug makers to prosper and government programs to save.

Two of the largest insulin makers, Novo Nordisk and Eli Lily, say they are opposed to any F.D.A. action that would approve generic insulin without clinical studies. Why the concern? The combined sales in the United States for Humulin and Novolin is about $1 billion. No wonder.

A drug maker needs to prove the generic version contains the same active ingredients, purity and quality, and provides equivalent delivery over time as the brand-name version. However the makers of generic drugs agree that the approval process for generic biologics, like insulin, would be more complex than the current shortened process for other generic drugs. Anybody have a guess as to what the hold up is for this much needed and overdue generic insulin explosion?

If the US wants to slow the spread of diabetes, it should think about coming up with a diabetes prevention program, say researchers who have been assessing the likely benefits of that approach. They predict that such a prevention program, provided to American adults with prediabetes at age fifty cold significantly reduce the diabetes problem.

A successful prevention program would provide "lifestyle interventions" (yikes, would not want to be on the receiving end of that) to push weight loss and exercise.

It makes financial sense, says Tom Hoerger, a health economics researcher. The cost of such a program would greatly reduce the money spent by insurance companies and Medicare on diabetes treatment. And, of course, it would greatly reduce human suffering also.

The results of the study that evaluated this approach was published in Diabetes Care (June 2006). In that article, the researchers predict that diabetes prevention, if made available to Americans with prediabetes at age fifty, could in theory reduce diabetes onset by age sixty-five by thirty-seven percent.

Ask the experts about diabetes and you'll hear one word over and over and over: prevention. The view is that money spent on prevention is always money well spent. Add to the chorus, this view just put forth by researchers from Indiana University: It would be more cost effective for Medicare to allow diabetes prevention coverage beginning at age fifty, rather than age sixty-five, as is now the case. Waiting until people hit sixty-five, they say, makes no sense because by then many individuals have already developed diabetes. Better to start when people are younger and there is a great chance to nip it in the bud, so to speak.

Note, they are not talking just about patient care here. It's not just about touchy-feely subjects such as quality of life, although that is always a concern. No, simply in terms of money this would make sense. Gives you an idea of how much money the country currently spends on diabetes treatment for seniors, huh?

Do you have coverage under Medicare? Do you have diabetes? If so, you should be aware that one of Medicare's benefits for diabetics involves free shoes of the type that help prevent irrevocable damage to the feet. If you have diabetes, you should not need me to tell you that diabetics are at a high risk for lower limb amputation resulting from extreme nerve damage to the feet and debilitating foot ulcers. Medicare will pay for the cost of one pair of shoes and three pairs of custom-molded insoles per year if you have diabetes and have been diagnosed with diabetes-related foot problems (nerve damage or ulcers). You can find out more by visiting the government's Medicare website.