The Case for Diabetes Preventative Care and Earlier Intervention

An August 2nd article in Medical News Today, "How does weight loss fix type 2 diabetes?"asserts that losing weight could very well contribute to remission for type 2 patients who have been recently diagnosed. In this piece, writer Maria Cohut cites the results of a recent Diabetes Remission Clinical Trial (DIRECT) that were published in The Lancet, in which almost half of the participants experienced a reversal of their condition upon following a weight loss regimen.

While many of us in the field know that there is a direct relationship between effective weight management and normalized blood sugar levels, this study also suggests that the pancreatic beta cells which produce, store, and release insulin were revitalized in patients who 1) had achieved substantial weight loss, and 2) had only been living with type 2 diabetes for less than two years.

It is important to note that this DIRECT trial had a small sampling size of only 64 patients. However, I did find two other studies that support the possibility that beta cell re-genesis could very well be possible, especially for newly diagnosed patients.[i]

AdobeStock_9337690 scale and tape measure-804694-editedWeight Loss to Reverse Trends
The findings of these studies should be broadcast to the medical community as a rallying cry for us to actively engage pre-diabetic patients and those who have been recently diagnosed with type 2 diabetes with a "code red" sense of urgency. Early intervention to encourage these patients to get very serious, very quickly to make the necessary changes can save lives and save millions in health care costs.

In addition to avoiding the risks and tedious care management routines of typical type 2 diabetes patients, the fact that the patients who did not experience a reversal in their condition upon losing weight had been living with diabetes for a more extended period should also be a big scare tactic. There has been a long-held belief that a type 2 diagnosis meant that the insulin-producing beta cells had been killed and that the condition was irreversible. An early intervention, immediate response with a diet-driven weight loss program for the recently diagnosed as well as for those with a pre-diabetic condition could be the answer for reversing the trends in this growing pandemic. A 2011 study concluded that regular telephone contact with patients by care team members provided ongoing encouragement for them to stay on track.[ii]

iStock-647392168 diabetes kitNational Diabetes Prevention Program (DPP)
The findings of these studies have led to the creation of the National Diabetes Prevention Program (DPP) and pre-diabetes programs that the CDC is certifying. While these developments are encouraging, I regret to report that there are a limited number of diabetes centers that are participating in these programs since there are more reimbursement dollars in the traditional self-management programs.

In Pennsylvania, for example, there are only a few centers certified by the CDC that offer this program AND get Medicare reimbursement. This is because the Medicare reimbursement is minimal compared to the amount of time spent on data collection for this program.

The Impact of Diabetes on Employer Benefit Costs 
Notwithstanding, diabetes prevention programs are a viable option for employer-sponsored health plans, and the impact on the overall health of our nation could be significant. Studies on employee health have shown that pre-diabetes programs have decreased benefits costs for employers.

Companies with 100 employees could save almost $9,000 over three years while those with 2,600 could save nearly $100,000 over the same period.[iii]

iStock-175399084 healthcare costsThese savings are significant when you consider that annual medical expenditures for those who are newly diagnosed with type 2 diabetes are almost one-third higher compared to those who do not transition from pre-diabetes to diabetes.[iv] Furthermore, diabetes cost the nation more than $327 billion in 2017, including an estimated $92 billion in reduced productivity – a figure that hits the average employer’s bottom line pretty hard.[v]

In this spirit, I strongly encourage organizational stakeholders (especially in Accounting and HR) to use the CDC’s Diabetes Impact Employer Toolkit to see how a prevention program can affect positive outcomes for their business.

Promoting employer-sponsored prevention programs could be the impetus for mobilizing more support for greater participation in the DPP.  A truly comprehensive national program in which higher numbers of those at risk are engaging in lifestyle prevention initiatives could generate a 42% return on investment in just a 3-year period.[vi]

In closing, and perhaps more to the larger point, the potential for beta cell rejuvenation for those recently diagnosed as revealed in the DIRECT trials and similar studies should be an even bigger rallying cry for more extensive research involving larger sampling sizes, especially with the inclusion of those from higher risk demographics. An overwhelming number of participants in DIRECT were mostly white,[vii] so we need to create a critical sense of urgency in more studies and more engagement with the recently diagnosed and those with a pre-diabetic condition before it’s too late.

More About Diabetes

[i] “Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol,” E. L. Lim & K. G. Hollingsworth & B. S. Aribisala & M. J. Chen & J. C. Mathers & R. Taylor Received: 22 March 2011 / Accepted: 5 May 2011 / Published online: 9 June 2011 # The Author(s) 2011. This article is published with open access at; “Pathogenesis of type 2 diabetes: tracing the reverse route from cure to cause,” R. Taylor.  Received: 6 May 2008 / Accepted: 7 July 2008 / Published online: 26 August 2008.  # The Author(s) 2008
[ii] “Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol,” E. L. Lim & K. G. Hollingsworth & B. S. Aribisala & M. J. Chen & J. C. Mathers & R. Taylor Received: 22 March 2011 / Accepted: 5 May 2011 / Published online: 9 June 2011
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Marianne McAndrew, DNP, RN, CDE

Marianne McAndrew, DNP, RN, CDE

Marianne McAndrew holds a Doctor of Nursing Practice, is a Registered Nurse, Certified Diabetes Educator, and a CCS Medical Insulin Pump Specialist.

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