According to the ADA, the diagnosed cost of diabetes in the United States is estimated to be $412.9 billion in 2022, including both direct medical costs and indirect costs like lost productivity. As the prevalence of diabetes continues to rise, costs will climb higher and higher, placing an unsustainable and unnecessary burden on our health system and economy. It points to a stark, uncomfortable realization that the biggest cost burden on the American taxpayer isn’t drugs (11 percent of the total national health spend); it is the cost of manageable disease run amuck.

While the White House and Congress rightly tout their success in lowering the cost of insulin for Americans in need, the policy victory speaks to the persistent problem—akin to closing the barn door after the horse has escaped—that more and more people are being diagnosed with or unaware of their diabetes risks. The bigger “hairy audacious goal” is to reduce the number of people with diabetes in the first place.

A Tale of Two Americas

The Type 2 diabetes epidemic is not an equal opportunity offender. It disproportionately affects racial and ethnic minorities, as well as those with lower educational attainment and socioeconomic status. This is not a coincidence; it results from systemic inequalities plaguing our health-delivery system. It speaks to the long overdue need to use PK-12 education to inform young people about healthy diets.

Black Americans, Hispanic/Latino Americans, and Native Americans bear a heavier burden of this disease because of deeply rooted social determinants of health. Access to quality healthcare, education, and economic opportunities are crucial in determining who develops Type 2 diabetes and who doesn’t.

According to the ADA: “The poorer you are in America, the less likely you are to have a grocery store within walking distance of your home. Diabetes rates are inversely related to income level, and nutrition is critical to diabetes prevention and management. Every American with diabetes and prediabetes must have access to affordable, culturally relevant food and the information they require to eat healthfully.”

At the heart of this crisis lies a fundamental issue raised for years: our relationship with food and education. The lack of basic nutritional literacy in many communities is not just unfortunate; it’s a tipping point for heart disease and diabetes. Many Americans, particularly in underserved communities, make food choices that harm their health because of strained household economics or lack of information. The food label on packaged goods is helpful to those who can translate the percentages listed into actionable decisions. Still, desperation often makes those decisions for people regardless of what the label says.

In urban and rural areas with limited access to fresh, nutritious food, food deserts are not just inconveniences but public health hazards. When the only food options available are processed, high-calorie, or convenient and tasty fast foods, we set up communities for a lifetime of health struggles.

Innovation and Public Policy: Islands of Hope

Traditional approaches are proving inadequate in the face of this growing threat. The health system needs to embrace innovative, policy- and technology-driven solutions that can reach people where they are and provide personalized support.

More than 41 million people participate in the Supplemental Nutrition Assistance Program (SNAP) and receive an average monthly benefit of $191 per person, or a little over $2 per meal. ​Roughly four out of 10 SNAP participants (42%) are children under age 18; 16% are people 60 and older, and about 12% are people with disabilities. The results are dramatic!

Children receiving SNAP benefits have better health status than youngsters who are not SNAP participants, and their households are less likely to sacrifice health care to pay for other necessary expenses. Older SNAP participants are less likely to be admitted to a nursing home or hospital than their counterparts who do not participate. It seems like common sense. Caring for the chronically ill costs taxpayers more.

Telemedicine and remote monitoring technologies offer potential avenues for diabetes management. These tools can provide real-time data to healthcare providers, allowing for more timely interventions and personalized care plans. AI-powered nutritional guidance apps have the potential to democratize access to customized meal plans, accounting for an individual’s health status, cultural preferences, and economic constraints. These tech tools can only be used as preventive and interventional extensions of the doctor’s office if third-party payers – private and public – ensure it is in the health providers’ interests. 

On the pharmaceutical side of innovation are the GLP-1 receptors – that can help millions of people struggling with obesity – among the key catalysts for the surge in pre- and Type 2 diabetes. GLP-1 receptor agonists mimic the hormone’s action, crucial in regulating blood sugar levels. But here’s the kicker: these drugs don’t just lower blood glucose; they’re a Swiss Army knife of metabolic health. However, private payers often place obstacles in the path of access. Obesity is a complex – tipping point – disease leading to diabetes, mental health challenges, heart disease, and more. Payers often will not authorize GLP-1 use for people who are overweight and have prediabetes – waiting till people (their beneficiaries) graduate to Type 2, citing cost.

The Obesity Society spokesperson Katherine H. Saunders, MD, of Weill Cornell Medicine, New York City, in an interview with Medscape, comments: “What is more expensive than Wegovy (a GLP-1 class drug)? A day in the hospital. This is a particularly important finding for health plans, employers, and any group covering the total cost of care — many of whom are concerned about the cost of Wegovy. Hopefully, this data will encourage more decision makers to recognize not only the significant health benefits associated with Wegovy but also potential cost savings.” Dr. Saunders is among the nation’s top thinkers in the field of obesity and associated conditions, and as an entrepreneur, co-founded FlyteHealth, a community of health providers who specialize in helping people manage their weight.

Health- or Sick-Care – We Must Choose a Path

The economic impact of Type 2 diabetes is staggering. The time for half-measures and incremental change is long past. We need a coordinated, multisectoral response—the health sector, industry, government, and private philanthropy—working together to address the epidemic’s foundational causes.

Five suggestions include:

1. Investing in education at the primary school level and ensuring children understand healthy food choices and have access to in-school meals.
2. Addressing social determinants of health through Federal and state policies that promote economic equity and access to quality health and education
3. Leveraging well-proven approaches in remote patient monitoring to improve diabetes intervention, detection, and management
4. Strengthening the use of Federal and state programs such as SNAP and the Child and Adult Care Food Program (CACFP)
5. Fostering collaboration between health providers, community organizations, national professional health organizations and tech companies to deploy proven solutions.

The Future We Must Embrace

Current efforts to address Type 2 and prediabetes prevention are insufficient. By acknowledging the complex relationship among social, educational, economic, and environmental factors contributing to this chronic illness epidemic, the United States private and public health system must examine drug costs; however, it can develop more effective policies and campaigns for diabetes intervention and management. 

It’s time for a mindset shift in approaching this preventable condition. We must recognize that we have, to date, given lip service and window dressing to address disparities and support the needs of children growing up without sufficient knowledge about food choices or, in the case of cash-strapped families, access to a healthy meal that reinforces what they are learning in school. Half measures were never good enough and are no longer acceptable.

Every step toward managing Type 2 diabetes – or better yet, preventing it entirely – is a step toward a healthier, more equitable society. The challenge is immense, but the ability to make a difference is possible.  There are proven delivery methods for insulin, vastly improved ways to monitor blood glucose and policies that could be tweaked to meet people’s needs.  Together, we can turn the tide on this epidemic and create a future where Type 2 diabetes is no longer a looming threat but a manageable condition.

Pay now or pay later. It’s a decision payers and policymakers must make.

The post The Diabetes Epidemic: A Pressing Public Health Catastrophe appeared first on Medika Life.

More than 1.6 million New Yorkers are diagnosed with diabetes, and some 11 percent of the State’s almost 20 million residents may already have prediabetes. Diagnosis and intervention are complicated by the fact that only 20 percent of the population is aware that without a lifestyle change and medical oversight, they will “graduate” to a Type 2 diagnosis.

This crisis is hidden in plain sight, waiting to overwhelm the health system.

Diabetes and New York, Imperfect Together

Prediabetes is among the more worrisome health comorbidities. Consider that:

• Diabetes disproportionately affects racial/ethnic minority populations. Compared with white adults, the risk of having a diabetes diagnosis is 77 percent higher among African Americans, 66 percent higher among Latinos/Hispanics, and 18 percent higher among Asian Americans. New York’s diverse population positions the State as an epicenter for diabetes risks.

• Diabetes prevalence is approximately 17% higher in rural areas than in urban areas, with studies showing that adults in rural America were more likely to report a diagnosis of diabetes than their urban counterparts. Approximately 21.5 percent of New Yorkers live in rural regions, with about 4.2 million residents.

• Type 2 diabetes is a pressing public health concern in New York State, affecting individuals of all ages and backgrounds. According to the New York State Department of Health, approximately 10.3% of adults in the State have been diagnosed with diabetes, with Type 2 accounting for most cases. This prevalence translates to over 1.6 million adults living with diabetes, a figure that continues to rise.

• There are 5,228,000 people in New York, 33.5% of the adult population, who have prediabetes. Their blood glucose levels are higher than usual but not yet high enough for them to be diagnosed with diabetes.

• Some 33% of adults aged 65 or older have Type 2 or prediabetes. This age group is at higher risk than younger people of developing diabetes-related complications such as nerve damage, kidney failure, or heart disease. In New York, nearly one in six people are 65 and older, and this population is growing faster than in any other State.

Raising awareness of prediabetes is one challenge; preventing diabetes is another. Addressing the urgent needs of people unable to afford essential treatment is yet another.

Without consistent treatment, blood sugar levels in individuals with diabetes fluctuate uncontrollably, risking hyperglycemia or hypoglycemia, both life-threatening conditions. Prolonged neglect escalates health complications, including cardiovascular diseases, kidney failure, blindness, and nerve damage, significantly reducing life expectancy. The emotional toll of diabetes is also profound; diabetes burnout is real, resulting from the stress and anxiety of constant monitoring every day, all year long, which often leads to depression.

Tackling Access to Care Saves Costs and Lives

The already considerable healthcare costs of diabetes also continue to mount, causing intensifying economic strain as emergency treatment, hospitalizations and repeat hospitalizations climb due to the disease. According to the National Institutes of Health, care for people with diabetes accounts for 1 in 4 healthcare dollars in the U.S. On average, people with diabetes shoulder annual medical expenditures of $19,736, of which approximately $12,022 is specific to diabetes management.

When people require insulin, the price can be a significant obstacle, and failure to access therapy has downstream costs. According to the American Diabetes Association (ADA), people with diabetes have medical expenses that are 2.3 times higher than people who do not have diabetes, and the impact is even more significant for communities of color, which face disproportionately high diagnosis rates.

To fight the disease and its costs in reduced health and mental well-being, as well as runaway treatment and hospitalization costs, addressing the barriers to accessing insulin is paramount. For decades, data has demonstrated that tighter control of insulin blood glucose levels corresponds to fewer medical complications, keeping people out of the hospital and helping to prevent amputations.

People with Medicare Part B and D have a one-month supply of each Part D- and Part B-covered insulin, capped at $35, and do not pay a deductible. However, for the economically challenged, the cost of insulin often means that they are skipping or limiting doses. The impact on their long-term health can be disastrous.

New York State’s Governor Tackles Insulin Access

Governor Kathy Hochul has proposed eliminating insulin cost-sharing through legislation to tackle this public health challenge. The policy would cap an insured person’s cost at $100 out-of-pocket for each 30-day prescription supply.

This public policy effort is the most expansive stopgap against insulin cost-sharing in the nation, providing financial relief to New Yorkers and improving adherence to a life-saving medication that can prevent severe kidney disease that can even cascade to necessary dialysis. This proposal is estimated to save New Yorkers $14 million in 2025 alone.

By removing cost barriers, the program empowers individuals to manage their diabetes effectively. It tackles a key social determinant of health – the cost barrier to access medicine – potentially improving health outcomes. Since the insulin cap proposal was introduced in New York, other States have seen Governor Hochul’s program as a model to address their patient-care challenges.

“Access to affordable insulin is an essential need for those who require this life saving medication,” states Dr. Leon Igel, an endocrinologist and obesity medicine specialist at Weill Cornell and Chief Medical Officer for Intellihealth. Dr. Igel will be honored in May 2024 by the New York Metro Region of the American Diabetes Association for his equal commitment to patient care and research.

Insulin dependency and consistent access to diabetes care is a New York State priority.  Through public health Initiatives such as the Governor’s insulin program, progress is being made in addressing this escalating crisis. Addressing social determinants of health and ensuring that people can affordably access healthy food will also help reduce risks – these steps can address obesity, a critical preventive measure.

Relationship Between Obesity and Health Inequities

Obesity is among the primary risk factors for Type 2 diabetes, and its prevalence in New York reflects the national trend. The Centers for Disease Control and Prevention (CDC) reports that nearly 30% of adults in New York have obesity, with specific communities showing disproportionate risk. Minority populations, low-income individuals, and those residing in underserved neighborhoods are particularly vulnerable to obesity. Limited access to nutritious foods, inadequate healthcare services, and socioeconomic disparities contribute to the heightened risk faced by these groups.

Obesity also leads to prediabetes, a stepping-stone to Type 2 diabetes. Alarmingly, more than 35% of adults in New York have prediabetes, placing them at an increased risk of developing the full-blown disease if left unchecked. State health officials note that 15-30 percent of people with prediabetes without intervention will develop Type 2 diabetes within five years, leaving them vulnerable to heart disease and stroke.

The trajectory from prediabetes to Type 2 diabetes underscores the importance of early detection and comprehensive management strategies – including, if necessary – access to insulin. Moreover, addressing the underlying factors driving prediabetes, such as obesity and health inequities, is essential in stemming the tide of diabetes-related complications.

 “Treating obesity to prevent progression to Type 2 diabetes is critical” according to Dr. Katherine Saunders, an obesity medicine expert at Weill Cornell Medicine in New York City and co-founder of Intellihealth. “Once individuals develop Type 2 diabetes, it can be harder to treat their obesity and the other weight-related comorbidities they likely have as well.”

Government Action Can Save Lives

With access programs like the Governor suggests, New York State is taking bold, preemptive steps toward a future where diabetes no longer casts a dark shadow on the health and well-being of its citizens. Being insulin-dependent and having consistent access reduces a pivotal barrier to care.  As patients, care providers and insurers struggle to navigate the complexities of diabetes management, Governor Hochul’s policy efforts are paramount in shaping a healthier tomorrow for Empire State residents. This proposed legislation, if passed, may encourage other States to follow her lead.

Now, if States also recognize that preventive care – addressing access to healthy food and keeping waistlines down is a public health priority issue, our healthcare system might begin to shift from sick care to well-care.  That would be a significant cost- and life-saving advance.

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Dr. Igel’s distinguished career spans both academia and clinical practice. As a Clinical Assistant Professor of Medicine in the Division of Endocrinology, Diabetes, and Metabolism at Weill Cornell Medicine, and an Attending Endocrinologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, Dr. Igel has demonstrated unparalleled expertise in the management of a wide range of endocrine disorders, with a specific focus on weight management, post-bariatric surgery care, type 2 diabetes, and other related conditions.

His commitment to advancing diabetes care is evident in his innovative approach, particularly in addressing the often-overlooked connection between diabetes and obesity. Dr. Igel emphasizes a weight-centric approach to diabetes treatment, advocating for medications that are either weight-neutral or lead to weight loss. This approach challenges the status quo in healthcare, where the impact of certain diabetes medications on weight gain is often disregarded.

“The link between diabetes and obesity is complex, and addressing it requires a comprehensive approach,” says Dr. Igel. “We know that over 11% of Americans have diabetes, and a large percentage are actually undiagnosed. Many individuals are in a progression towards diabetes, and much of that progression is closely tied to weight gain that occurs throughout someone’s lifetime. This is why we are committed to continuing our work to improve diabetes care and raise awareness of the critical connection between obesity and diabetes.”

“It is a privilege to recognize Dr. Leon Igel as the Medical Honoree of the Year,” said ADA’s Research Dinner Executive Committee Chair Gil Bashe, Finn Partners. “Obesity is a common, chronic, and progressive disease that is linked to a significant number of diabetes cases every year, and Dr. Igel’s dedication to reshaping diabetes care through his groundbreaking work in obesity management will help improve the lives of many people. His innovative approach and unwavering commitment are invaluable contributions to the field.”

As part of the Intellihealth team, Dr. Igel’s contributions extend beyond clinical practice. Intellihealth is at the forefront of leveraging innovative solutions to improve patient outcomes. Dr. Igel’s work with Intellihealth underscores the company’s dedication to advancing healthcare through research, technology, and patient-centered approaches.

For more information, sponsorships, and tickets, please go to www.diabetes.org/researchdinner2024.

About Intellihealth
Intellihealth is changing the perception of obesity and redefining how it is treated. We offer evidence-based medical obesity treatment that is three times more effective than lifestyle intervention alone. Our product, Evolve^™, enables health care providers to offer effective medical obesity treatment both via telehealth and in person. Our clinical services affiliate, Flyte^™ Medical, provides businesses and healthcare systems the services of experienced clinicians who are passionate about obesity medicine, including physicians, nurse practitioners and registered dietitians. More about Intellihealth, Evolve and Flyte Medical may be found at www.intellihealth.co.

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Among those with the most significant risk are older Americans with chronic conditions. From the earliest stages of the pandemic until now, COVID hospitalizations have been six times higher and deaths 12 times higher for people with underlying medical (i.e., non-communicable diseases – NCDs) conditions such as diabetes, heart disease, or chronic lung disease. Currently, 81% of COVID deaths occur in people over age 65. The number of deaths among people over age 65 is 97 times higher than that among people ages 18-29. It’s a dangerous situation that we can overcome if we prepare before the next pandemic wave.

COVID + Diabetes = Serious Risk

For example, consider the brutal truth about one of the deadliest comorbidities in COVID at-risk communities: diabetes.

• Diabetes disproportionately affects racial/ethnic minority populations. Compared with white adults, the risk of having a diabetes diagnosis is 77% higher among African Americans, 66% higher among Latinos/Hispanics, and 18% higher among Asian Americans
• Diabetes prevalence is approximately 17% higher in rural areas than in urban areas, with studies showing that rural adults were more likely to report a diagnosis of diabetes than urban counterparts
• Some 33% of adults aged 65 or older have pre- or Type 2 diabetes. This age group is more at risk of developing diabetes-related complications like low blood sugar, kidney failure, and heart disease than younger people.

The scale of this patient challenge is immense. Approximately 84 million adults — more than 1 in 3 Americans — have prediabetes. According to the Centers for Disease Control (CDC), 90% of people with prediabetes do not know they have it; neither do they know that if left unchecked, it may lead to Type 2 diabetes.

Though its symptoms are subtle, prediabetes is insidious, and as with elevated blood pressure and high cholesterol, it can quickly become deadly. Add another pandemic into the mix, and we know where our subsequent waves of hospitalizations and deaths will come from: seniors, people of color, and rural Americans. We are not prepared, but if we recognize the risk and mobilize health professionals now, we will save lives later.

Further complicating our ability to address this threat is our disregard for prediabetes. For many people, prediabetes means, “Whew! I don’t have diabetes.” But prediabetes requires critical intervention and requires patients to change their behavior. Public health leaders must organize payers, patient groups, and providers – especially pharmacists and long-term care pharmacists – and that must happen before the next pandemic hits. We must get smarter and faster and not wait until the coffins pile up.

Primary Care Has A Change of Address

While this pressing public health threat becomes more urgent, our front-line defense, primary care, undergoes retreat in some cases and fundamentally changes to a retail pharmacy setting in others. These changes may presage increased access to care for some. Conversely, it could allow older patients to fall through the cracks in the face of the growing threat of non-communicable illnesses such as diabetes.

Historically, primary care providers diagnosed, treated, and engaged these consumers. Can walk-in services alleviate people’s ongoing care burden and be ready for the next pandemic?  Corporate and clinical leaders of the mega-chains and community retail pharmacies retail must rally these sites to be front-line communicators regarding non-communicable illnesses, especially prediabetes. Pharmacies are no longer just locations where you can grab a jab – an immunization, vaccine, or booster. Pharmacists will need greater input and support as we go forward and face emerging pandemics.

The ability to walk into a CVS MinuteClinic, Walgreen Health Corner, or Walmart Health for primary care is a win for access to manage pressing health needs. But will ongoing, long-term preventive care — featuring a plan for wellness care instead of sick care — be addressed at these sites? People “shop around” for medical convenience and not necessarily for provider relationships, another reason retail clinics need to be part of the preventive care solution.

Today, fewer and fewer people have a long-term family physician who tracks their needs and feels responsible for their longevity. The single-practitioner office is now being absorbed into larger practice groups and private practices are vanishing. Without the diagnostic oversight a trusted healthcare provider offers, we are missing an essential link between urgent and specialty care,  prevention and illness,  and prediabetes and diabetes.

Weathering the Storm

It is a perfect storm. Poorer diet, higher sugar intake, and increasingly sedentary lifestyle lead to prediabetes, which isn’t straightforward to diagnose and is often not taken seriously by patients. And, as we have seen, the essential player in defense against the condition — the primary care physician — is beginning to step off the stage.

To meet the challenges posed by diabetes/prediabetes epidemic, the lack of primary care patient support, and the persistent threats posed by COVID and other pandemics which will emerge, we need to consider the following actions:

1. Easy-Access Diagnostics Technologies – Retail pharmacies must ally with point-of-care and home-testing companies such as Babson Diagnostics and ixlayer. Consumers at risk must be empowered to take greater responsibility for their well-being. Give people with NCDs easily accessible tools to be full partners in preventive care.

• Find a Digital Connection – Netflix pings us about movies and TV shows that might attract our interest. Political parties use texts and email to rally the faithful. It’s time health insurance companies and the CDC find creative ways to enter the game using AI and digital health to establish closer relationships with consumers, helping people with diabetes to become aware of and purchase products to address their healthy lifestyle needs. Keeping people alive and well is a mutual interest of insurers and the CDC.
• Deputize Pharmacists:Pharmacists were always able to do much more than give shots, and now primary care nurses and assistants have found a home in retail pharmacies.  CDC and physician associations need to recognize that seniors and people with diabetes increasingly see pharmacy as a go-to for questions, easily accessible solutions, and vaccinations.  The American Pharmacists Association is raising the bar on public health resources.

• Start Talking to People: There is “no one-size fits all” effective way to communicate about COVID-19. The 65+ community faces different risks than the 15-and-under crowd.  People with diabetes and heart disease face heightened risks from COVID.  People of color are often at particular risk for these illnesses, compounded by COVID. The CDC needs to address people’s specific needs and risks better. People are tired of hearing about COVID. They are less worn out from hearing about what matters to their particular interests.

CDC is the target of many critiques right now. More than 80 years ago, British Wartime Prime Minister Winston Churchill told the New Statesman: “Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things.”  For people in science, failure does not mean the end – it’s the rocket fuel of future success. The CDC will learn from the COVID chapter and return ready for the next viral confrontation.  Our lives depend on its success.

The post Taking On Prediabetes Could be America’s Best Defense Against COVID-19 appeared first on Medika Life.