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.

THE BENEFITS OF SLEEP are numerous. Like eating or getting physical activity, sleep is essential for optimal health. Deep sleep is the restorative phase; we need it to feel at our best each day.

Let’s briefly look at deep sleep, the benefits of deep sleep, and the signs of insufficient deep sleep. We will begin with the stages of sleep and end with an attempt to answer the question posed by the title: How much sleep do you need?

Sleep stages

Sleep Foundation offers this take: Fall asleep, and you should cycle through three non-rapid eye movement phases of sleep, followed by one rapid eye movement (REM) sleep stage. It typically takes between 90 and 120 minutes to get through all four stages. Then the cycle begins anew.

Adults usually have four to six cycles each night. We typically spend more time in non-REM sleep; as the night progresses, we dwell in more REM-type sleep.

Adults usually have four to six cycles each night. For the first half of the evening, we typically spend more time in non-REM sleep; as the night progresses we dwell in more REM-type sleep.

• Stage 1: This drowsy stage is brief and marks the transition to sleep. Your breathing and heartbeat are slowing.
• Stage 2: Your breathing and heart rate slow even more during this stage of light sleep. Stage 2 sees a temperature drop and muscle relaxation. This stage progressively increases with each cycle throughout the night. Roughly half of our total sleep is here.
• Stage 3: This slow-wave sleep stage is the deepest cycle. Brain waves are their highest in amplitude and slowest in frequency.
• Rapid eye movement (REM): Your eyes flicker bath and forth beneath your eyelids. If we looked at your brain activity, it would not look that different from the awake you. Given much of our dreaming occurs here, it makes sense that we lose muscle tone and don’t move. Nobody wants to watch you running (in real life from that tiger you spy in your dream state.

Deep sleep — benefits

With an increase in brain sugar (glucose) metabolism during deep sleep, we support short- and long-term memory and overall learning. The pituitary gland secretes vital hormones during deep sleep, including human growth hormone.

In his 2017 book Why We Sleep, my favorite sleep expert, Dr. Matthew Walker, informs us that brain imaging (magnetic resonance imaging or MRI) illustrates this:

Slow brain waves of stage 3 sleep (deep non-REM sleep) “serve as a courier service,” transporting memories from the hippocampus [memory center] to other more permanent storage sites.

Moreover, deep sleep allows for strengthening the immune system, promoting growth and repair of tissues and bones, and more blood supply to your muscles. In addition, you get cell regeneration and energy restoration.

Deep sleep deficits

Get too little deep sleep at your peril. Sleep is associated with so many functions. Cognitive function and memory? Yes. Language learning, brain development, and motor skills. Check.

Researchers believe that deep sleep plays a role in preparing the spaces (synapses) between your nerve cells for the next day’s communication. Your brain evaluates new memories, consolidating and preserving only the most relevant ones.

Short sleep is associated with sleep disorders such as sleepwalking, night terrors, and weight gain. If you don’t enough quality sleep, you are also more likely to suffer from Alzheimer’s disease, type 2 diabetes, heart disease, and stroke.

Deep sleep — How much do we need?

Do you want to know how much deep sleep you need? First, calculate how much sleep you need overall. Most of us should try to get seven to nine hours of sleep each night. That’s the recommendation of the US National Sleep Foundation.

Now the trickier calculation: Between 13 and 23 percent of your overall sleep should be in a deep sleep; this translates to about 55 to 97 minutes each night in a deep sleep.

Sleep hygiene

So, to answer the question about how much deep sleep you need? Probably about an hour to an hour and a half each night. How can you make sure you have a good shot at achieving that? Aim for seven to nine hours of overall sleep. If you have sleep apnea, treat it — you’ll get more deep sleep, even within one day.

As we age, we tend to have less deep sleep (and more stage 2 sleep). For those of us who enjoy the occasional (and glorious) nap, we get less deep sleep at night (as our nap already contributed to our day’s allotment).

That’s it. Today we looked at one of my four pillars of health — rest. In the future, we’ll turn to the other three, including movement, nutrition, and mindfulness. Thank you for joining me today.

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Six in 10 American adults have a chronic disease, and a significant percentage of these conditions could be prevented with lifestyle change. Studies suggest that up to 90% of type 2 diabetes, 80% of coronary artery disease, 70% of stroke and 70% of colon cancer are potentially preventable through a reduction in five key lifestyle risk factors: unhealthy diet, inadequate physical activity, overweight, smoking and excess alcohol consumption.

Considering the unhealthy habits many of us picked up during the pandemic (decreased exercise, increased snacking, heavier drinking), compounded by stress and loss of sleep, we can expect a further surge in chronic disease — and the associated personal and financial costs.

How are we going to address this growing problem before it overwhelms our health care system, our economy, and our ability to compete and lead the world by the power of our example?

A lack of primary prevention

Much of the problem lies in the expectation that our existing health care infrastructure is going to solve this problem. Physicians don’t have the training or time to create personalized habit-change plans and ensure that patients follow them, nor are they adequately reimbursed for practicing lifestyle medicine.

While medical education is shifting to incorporate more behavior-change best practices into curricula, most physicians — aside from the key role they play in preventive screenings and identifying patients at risk — continue to focus on sick care rather than on keeping healthy people healthy.

The lack of primary prevention and consistent support for incremental habit change for healthy people represents a massive structural hole in our health care system and our society in general. And it’s a hole that physicians cannot and should not be expected to fill on their own.

The one-on-one personal coaching needed to help individuals achieve long-term successful habit change requires greater frequency of contact than is possible with typical health provider relationships, and although behavior change clearly results in long-term cost savings, it does not fit the fee-for-service model that most providers still operate under.

An opportunity for insurers and payers

The savings do, however, represent an opportunity to introduce the needed paradigm shift via insurers and corporate payers, who currently bear a large share of the cost of managing expensive chronic conditions once they have developed.

The front line in this battle should not be when patients are in the hospital dealing with symptoms, but much earlier — before unhealthy habits have had a chance to negatively affect people’s health.

Insurers and payers certainly recognize the value of promoting a healthier workforce, and they frequently offer preventive health programs for their members and employees. However, traditional health improvement and prevention efforts tend to be one-size-fits-all curriculum-oriented programs — modeled on our learning and education system — that rely on participants’ own motivation to find what works for them and stick with it. Unfortunately, it’s human nature to look for quick-fix solutions, particularly when it comes to lifestyle change and losing weight.

Many people give up if they don’t see the results they want right away. Traditional efforts also rely heavily on willpower, which is rarely enough when it comes to the complex issue of weight loss. An effective plan must also take into account a wide range of individual circumstances and characteristics, including the person’s medical history, genetics, social determinants, personality, intrinsic goals, readiness to change, and many other factors.

Habits are by definition cultivated over time, and sustainable behavior change requires one-size-fits-one coaching and support — in the context of a trusting personal relationship — to build confidence in making small incremental changes and keep individuals engaged, motivated and accountable over the long term. Fortunately, support for habit change is a role that lends itself well to a virtual environment, with telehealth coaching sessions complemented by smart remote monitoring tools such as fitness trackers and smart scales, along with the right gaming and curated social health community. This makes participation more convenient and accessible for employees while reducing costs for payers.

A new partner in health

In short, support for habit change is a task best suited to a new and different type of health specialist that insurers and payers can partner with to overcome lifestyle-related chronic disease. Just as there are many physician and allied health subspecialties that address the diverse aspects of diagnosis and treatment of various illnesses and health conditions, we should look to embrace a new (and virtual) front line of healthy habit change providers that can address primary prevention and effective habit change — working with and alongside physicians and the existing “sick care” infrastructure.

It’s time to fill that structural gap. The health of our families, neighbors, and country is at stake

The post Treating Lifestyles . The Structural Gap in Patient Care appeared first on Medika Life.