To mark National Diabetes Month this year, the White House issued a proclamation noting the scale and severity of the disease, and calling for the nation to make treatment more affordable, improve care, and finally find a cure.
The White House proclamation, in line with the Administration’s larger health equity goals, focuses primarily on the cost of insulin and the challenges of affordable access to care while acknowledging that diet has a considerable impact also.
At NourishedRx, we believe diet and nutrition should be a top priority in promoting diabetes prevention and care – because access to quality food is the most effective way to avoid or limit the impact of diabetes and a doorway to better health and lifestyle change.
Facing the Facts
The scale of our national diabetes challenge is almost inconceivable. 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. 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. If current trends continue, the number of Americans with diabetes will double or even triple by 2050.
Diabetes was the seventh leading cause of death in the U.S. in 2019. In 2017, it accounted for $237 billion in direct medical costs 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.
In our struggle to turn those numbers around, it's time to question whether we’re focusing on the right problems.
The Impact of Better Nutrition
Type 1 diabetes is caused by genetic conditions or viruses and cannot currently be prevented or cured. But the more-common Type 2 diabetes is likely caused by some combination of genetic predisposition, health, and lifestyle factors, including obesity, poor diet, stress, and insufficient physical activity.
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, often after acute symptoms arise. Unchecked diabetes can become life debilitating, reducing activity, life quality, and physical capacity. Out of the 200,000 people in America who require amputations each year, about 130,000 have diabetes.
Our best strategy for reducing the impact of diabetes is to focus on prevention and early treatment. According to a recent global study at Tufts University published in Nature Medicine, around 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.”
Nutritionist and functional medicine thought leader, Dr. Mark Hyman, puts it succinctly: “The cure for diabetes is not medicine, it’s food.” A healthy diet rich in nutrients and low in fats, sugar, and calories is essential for controlling blood sugar and reducing the weight and high blood pressure that can lead to heart disease, chronic kidney disease, and diabetic neuropathy.
Combining such a diet with regular physical activity is even better. Programs that encourage lifestyle change, 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) a diabetes prevention program added 4.4 quality-adjusted life years to each overweight participant while reducing their total cost of care.
And yet we all know there’s nothing simple about adopting changes to diet and lifestyle. Other challenges must also be addressed.
Diabetes is also a Social Problem
For too many people, poor diet and diabetes go hand-in-hand with food insecurity and other health equity issues, including financial insecurity, lack of access to care, and proximity to environmental toxins.
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. To cut back, economically vulnerable people are 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 increased risk of diabetes-related complications. Health equity is a complex set of challenges that require integrated solutions. But nutrition and lifestyle programs do an incredibly effective job addressing multiple barriers to health in a targeted way.
Targeted Food Programs Work
National produce prescription programs can make a profound difference. Organizations have been experimenting with variations of produce prescription programs for several years, and evidence of their effectiveness is mounting. A patient with a diet-related health condition can visit a participating healthcare provider to receive vouchers or cards redeemable for free or discounted fruits and vegetables that can be delivered to the home, picked up from a grocery store or farmer’s market, or healthcare food pharmacy.
The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University researchers reported a new study in the JAHA — Journal of the American Heart Association. The researchers analyzed surveys and medical records from over 1,800 children and 2,000 adults identified as low-income and at risk for cardiometabolic diseases, enrolled in produce-prescription programs operating across 22 sites in 12 U.S. states from 2014 to 2020. The results should be eye-opening.
Providing free fruits and vegetables had measurable health and food security benefits and the potential to save at least $40 billion in medical costs. Their modeled implementation of a nationwide program—which would provide free or discounted fruits and vegetables to eligible Americans living with diabetes, also projected extensive reductions in national rates of cardiovascular disease and associated healthcare costs.
Produce prescriptions have long shown definable benefits for health—such as improving blood sugar control, body weight, and blood pressure levels. But long-term national impacts had not previously been investigated. The study estimated that a national produce prescription program for 40- to 79-year-olds with diabetes and food insecurity could prevent 296,000 cases of cardiovascular disease (for example, heart attacks and strokes) and gain 260,000 quality-adjusted life years (As years lived with good health) over the lifetime of current patients.
This study shows why we must embrace a paradigm shift. A future where produce prescriptions is the norm and quality food serves as medicine is within our grasp.
The NourishedRx Approach
NourishedRx, aims to improve health outcomes and reduce the burden of cardiometabolic disease by providing access to healthy food and fresh produce. We have witnessed the transformative power of nutritious food on overall well-being.
To that end, we’ve built a digital health and nutrition solution that helps people live healthier lives. Partnering with payers, we deliver highly personalized, culturally relevant meals, produce, and groceries to individuals, along with wrap-around whole health support and nutrition education. When we engage with people and communities in need, we identify actionable insights that can 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 enable their own health. Across patient populations, individual stories illustrate the power of the approach.
One client, a 54-year-old woman with Type 2 diabetes, lost 39 pounds and saw her A1C blood sugar measure drop from 11.5 to 6.8 while receiving our delicious, nutritious meal deliveries. Her cholesterol and lipid levels also fell to a normal, healthy range. When she transitioned from prepared meals to groceries, she struggled at first but with support 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 her diabetic medication and feeling positive and optimistic about food and her life.
Another 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, wellbeing, quality of life, and medical costs. They require a combination of personal engagement and technological support, but they have proven to have a sustained impact on lives and communities.
On this World Diabetes Day and Diabetes month, let’s take our national goal to transform diabetes care to another level. If we want to truly overcome our growing diabetes challenge, it’s time to bring diet and nutrition solutions to scale for the millions of people who need them most.