Beyond Diabetes Awareness
By Kostas Trakas
Merrill Goozner doesn’t sugarcoat bad news. In his latest editorial in Modern Healthcare, he seizes upon some of the most recent data showing the disastrous state of the United State’s fight against diabetes. His grade for the overall effort is an unqualified “F” – and he’s right.
By most measures, the diabetes epidemic is growing. The latest CDC data indicates that more than 1 in 10 Americans have diagnosed or undiagnosed diabetes. Fully one third (33.9%) of Americans are estimated to have prediabetes. If the risk of kidney disease, blindness, amputations and death isn’t bad enough, the annual cost of diabetes is estimated at $245 billion.
So what accounts for the failure to stem the tide? Money has been spent on awareness campaigns and treatments. The price of treatments is often pointed to as a key impediment to treatment adherence. The problem is that adherence is more than just access to medicines or the affordability of those medicines. Adherence requires that a patient understands their disease. They also need a trusting, long-term relationship with their care team. Considering that the highest prevalence of diabetes occurs in the most economically depressed counties within the US, patients need to know that precarious employment will not disqualify them from health insurance coverage. Lastly, diabetes is a disease of our modern age. Its increase in incidence has been catalyzed by our ability to consume far too many calories for our metabolic needs, whilst introducing the common use of a myriad of nutrient-dense additives to our processed foods.
This is all bad news, but it gets worse. Earlier this summer, a BlueCross, BlueShieldanalysis of their covered lives found that the fastest growth in new cases of diabetes is occurring in millennials (adults aged 18-34). Since obesity is a primary contributor to the development of diabetes, this shouldn’t be surprising considering that the rates of teenage obesity have risen by more than 30% from 2001 to 2015, according to the CDC. With all the tools at their disposal, millennials believe they are better informed about diabetes than comparable older cohorts, but they seem reticent to take the steps to prevent the disease or manage it effectively once diagnosed. While this runs counter to the common preconception of millennials as overly health-conscious, they seem to be progressing along the same health outcome trajectory as their parents.
At the end of the day, it’s not about adherence or shaming healthcare providers and pharma. It’s about improving outcomes. So, where do we start? Education paired with coaching is already known to be one of the most successful strategies for changing behaviours in patients with diabetes. Providers such as Omada Health and Glooko have already added a digital component to this strategy. Considering the constraint in healthcare resources, both human and financial, digital platforms will have to be utilized to scale-up traditional high-touch programs. This will be particularly critical in reaching tech-savvy millennials and in helping them change their health outcomes trajectory.
The gravity of diabetes’ impact on our health and economic future demands that Mr. Goozner’s “F” stands for more than “failure”. During this November’s Diabetes Month, an honest self-assessment of our progress against diabetes needs to be accompanied by a rededication to continue the “fight”.