The recent report from the National Center for Health Statistics on declining U.S. life expectancy painted a bleak picture, fueled in large part by the impact of Covid-19, but not exclusively. Many of the contributing factors are deeply systemic – poverty and health disparities among them — but other longstanding health issues, including high rates of obesity and Type 2 diabetes, are contributing factors.
More than 34 million people – one in 10 Americans – have the disease, and 96 million have prediabetes. Taken together, that is nearly half of the country — and rates are going up. It doesn’t have to be this way. Research suggests that prediabetes and diabetes can be stopped or reversed, or at least their progression slowed. But most patients aren’t aware of this, and even if they are, they have no idea how to make the changes needed to have an impact.
As physicians, some of the disconnect is on us. As with many lifestyle-driven conditions, our focus is almost exclusively on treatment. Of course, effective treatment and management are crucial, but prevention is often ignored, and when it is included in our discussions, we often urge patients to change their diet and increase their exercise — with no plan. This strategy isn’t working.
We need to give patients specifics – what to eat, how much, how to exercise, and other lifestyle changes around stress, sleep, and other factors. We need to use every tool available in the clinical armamentarium, including the latest digital tools, and shift our approach so that patients are aware of these technologies and understand how to use them.
Patients can now use an app to determine the nutritional quality of their meals. A device that fits in a pocket can analyze breath and reveal whether a person is metabolizing carbohydrates or fat. When patients know that the difference in fat content between a hamburger and a salmon salad is a click away, they may begin to make better food choices. Monitors can assess blood sugar levels throughout the day and send the reading via Bluetooth to a health care professional to personalize diet and exercise planning.
Most insurers do not pay for these digital tools for people with prediabetes or Type 2 diabetes. It’s now time to reconsider that approach. Coverage could start at the cost of the device and as well as a three- to six-month subscription. Pilot programs could be launched for people with certain criteria, such as those who are overweight with high blood pressure or another risk factor, and then be fine-tuned to coverage policies.
This is particularly needed for patients from disadvantaged backgrounds; otherwise, the current existing disparities will worsen. Patients should not have to wait until they have a diagnosis before insurance plans cover a continuous glucose monitor. We need to get these devices and tools to patients much sooner before they progress to needing more intensive therapy.
But, until then, we as physicians need to extend our focus beyond treatment to include preventive measures that are clear, practical, and measurable. Some patients may not adhere, but with a clear plan, others will. The issues impacting the health of Americans are complex and multi-factorial. Preventative tactics can’t solve them all. But if we include prevention as a core of patient management of a disease that is highly prevalent — and largely preventable — we will have an impact.
John Whyte is an internal medicine physician.
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