Another Public Health Crisis in America: Diabetes

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In December 2020, a year after the COVID-19 pandemic began, Dr. Andrew Boulton, president of the International Diabetes Federation, called diabetes another “pandemic of unprecedented magnitude spiraling out of control.” Post-COVID, it’s past time we turned our attention to other diseases that also have a massive, though less visible, impact on public health. Fortunately, for many of these conditions, we don’t need breakthrough vaccines, masking, and social distancing to bring them under control. We can make a big difference with nutritious food and healthy lifestyle changes.

About one in ten Americans, or 37.3 million people, have diabetes, and 20% of them are unaware of their condition. An additional 96 million American adults (or one in three) are prediabetic but 80% of them are unaware of the danger that’s coming. If current trends continue, the number of Americans with diabetes will double or even triple by 2050.

Diabetes comes in several forms, but the most prevalent are Type 1 and Type 2. Genetic conditions or viruses cause Type 1 diabetes and currently, it cannot be prevented or cured. . People with Type 1 diabetes can’t produce the insulin necessary for breaking down sugar to turn food into energy. Their condition can be managed through regular doses of synthetic insulin, the breakthrough therapy of a century ago.

In Type 2 diabetes, which is far more common, the body also doesn’t produce enough insulin. However, the causes are due to genetic predisposition, health, and lifestyle factors, including obesity, poor diet, stress, and insufficient physical activity. Diet, exercise, and lifestyle changes can help people manage and reduce the severity of their disease. .

With prediabetes, blood sugar levels are higher than normal but not yet high enough to be diagnosed as Type 2 diabetes. Around one in five American youths ages 12 to 19 years have prediabetes. Over the past 20 years, rates of prediabetes in American youths have more than doubled. Likewise, Type 2 diabetes, which used to be called adult-onset diabetes, is also increasing in children and youths.

Diabetes was the seventh leading cause of death in the U.S. in 2019, and accounted for $237 billion in direct medical costs in 2017 with an additional $90 billion in productivity losses. Doubling or tripling those losses over the next few decades will have a devastating impact on life spans, quality of life, community health, and healthcare spending. So, what measures can we take to reverse that trend and help over 100 million people lead longer healthier lives?

Going to the Source

Historically, U.S. healthcare has turned to drug therapies and medical interventions to treat diabetes. Not only is this a more expensive path to treatment, but it also occurs later in the disease progression.

Measures that are preventive or applied earlier mitigate symptoms and reduce costs. To that end, the best option is to address the root cause of Type 2 diabetes which is poor diet. According to a new global study at Tufts University published in Nature Medicine, approximately 70% of Type 2 diabetes is linked to poor diet. As co-author Dr. Dariush Mozaffarian notes, “These new findings reveal critical areas for national and global focus to improve nutrition and reduce devastating burdens of diabetes.” The challenge is leveraging this knowledge to direct meaningful actions that counter those burdens.

A diet filled with fiber rich fruits and vegetables, whole grains, lean proteins, and healthy fats is essential for managing blood sugar, and reducing the weight and high blood pressure that can lead to heart disease, chronic kidney disease, and diabetic neuropathy. A diabetes friendly diet in conjunction with regular exercise is an ideal mechanism through which to prevent and inhibit the continued surge of this disease. In fact, programs that encourage nutrient-dense diets and regular exercise such as the CDC’s National Diabetes Prevention Program (National DPP), can cut the risk of Type 2 diabetes in half. In West Virginia, where 15% of the adult population is diabetic (second highest in the nation) the National DPP added 4.4 quality-adjusted life years to each overweight participant while reducing their total cost of care.

But simply getting people to eat better and exercise more is not easy. For many, a poor diet and diabetes go hand-in-hand with food insecurity and other social determinants of health, including financial security, poor access to care, and transportation challenges.

Adults who are food insecure are two to three times more likely to develop diabetes, and they also must devote more of their financial resources to their healthcare than people without diabetes. Complicating matters, a chronic illness like diabetes can make it more difficult to find or keep steady work which further impacts financial security. To cut back, they’re more likely to buy cheaper, less nutritious food or even skip meals (which can increase the risk of hypoglycemia). And they’re also less able to afford diabetes medications or consistent blood sugar tests. This vicious circle leads to poorer health and an increased risk of diabetes-related complications.

The NourishedRx Approach

The challenge is in bringing effective and personalized nutrition and lifestyle programs to scale.

Our company, NourishedRx, is a digital health and nutrition solution that helps people live healthier lives. Partnering with healthcare organizations on diabetes care programs, we deliver highly personalized, culturally relevant meals and groceries to members, along with wrap-around whole health support and nutrition education. When we engage with people and communities, we relay actionable insights and coordinate care with healthcare organizations to help address the underlying health equity and care gap challenges that exacerbate chronic illnesses like diabetes.

Our goal is to educate, motivate, and empower people to control their own health. One member, a 54-year-old woman with Type 2 diabetes, saw her A1C blood sugar measure drop from 11.5 to 6.8 while losing 39 pounds. Her cholesterol and lipid levels also fell to a normal, healthy range. She enjoyed using our mobile app and getting access to a variety of vegetables. At first, she found the transition from prepared meals to groceries a struggle, but she now feels confident developing a meal plan, shopping for groceries, and understanding nutrition labels and ingredients. As her health improved, she felt even more motivated to eat well and incorporate physical activity. She’s now off one of her diabetic medications and feeling positive and optimistic about food and her life.

A 69-year-old woman struggling with diabetes for the past 25 years (along with congestive heart and chronic kidney disease) joined the program because she was tired of multiple insulin shots every day. She was excited to receive her first meal kits because the food was tasty, and the calories were low. She learned to reduce the amount of meat in her diet and balance it with vegetables and grains, and she now has the ability to read food labels and determine which foods in the grocery store are better for her. As she began to feel healthier and more energetic, she increasingly looked forward to preparing meals every day that she knew would taste good. Looking back on her progress, she says, “This program really was the best thing that happened to me.”

Such changes have a significant impact on health, well-being, quality of life, and medical costs. It’s not an instant solution, as one 65-year-old member who lost 55 pounds points out. It’s a work in progress that has a lasting and deeper effect.

Expanding the Circle

The impact of such work goes beyond the individual. We find that clients are eager to share their learnings and enthusiasm with family members, friends, and people they know in the community. As clients change their approach to and traditions around cooking, they also have a generational impact on improving the health and well-being of their children and grandchildren.

Once, viruses, infections, and communicable diseases were the biggest causes of avoidable illness and death. Today, diseases of lifestyle, environment, and nutrition, like congestive heart disease, chronic kidney disease, and diabetes are the major causes of diminished life quality and lifespan. They’re expensive, absorbing most of our healthcare spending; and yet, they are highly treatable.

Simply put, “The cure for diabetes is not medicine, it’s food,” according to nutritionist and functional medicine thought leader, Dr. Mark Hyman.

Even as we put programs in place to improve nutrition and address health equity challenges, it’s time for the healthcare industry and policymakers to think bigger about care and to take measures that fundamentally improve health. Why should we wait for disease to get worse when we can help millions of people recover and lead their best lives now?