Hurtling Forward

Hurtling Toward 100 Million Americans with Diabetes

America is heading at a breakneck pace toward an awesome milestone – 100 million Americans with diabetes. According to a new CDC report, 30 million have it already. Another 84 million are well on their way. They have prediabetes – elevated blood sugar that makes it very likely for a person to develop full-blown type 2 diabetes.

Among people with prediabetes, roughly 74% will progress to diabetes, according to this study.  In 2015 alone, 1.5 million more Americans developed diabetes. Dynamic modeling suggests that 25-28% of the Americans will have diabetes in 2050. That will mean 110 million Americans with diabetes. Under some scenarios, the number might be higher – hitting one in three Americans

Excess Weight and Obesity: 88% of People with Diabetes

One of the best documented ways to prevent diabetes is evidence-based obesity care. That’s because untreated obesity is one of the key risk factors for type 2 diabetes. Among people with type 2 diabetes, 88% also have excess weight or obesity.

The Diabetes Prevention Program (DPP) uses intensive behavioral therapy to help people lose a little bit of weight (typically 5-10%). The result? The number of people progressing to have diabetes comes down by more than half. In people over 60, the reduction was 70%.

Likewise, for people with diabetes and obesity, bariatric surgery does a far better job of controlling diabetes than even the best medical therapy for diabetes can deliver. In a recent randomized, controlled study, 29% of surgery patients achieved remission. That compares to only 5% of medically managed patients.

Can We Avoid a Healthcare Disaster?

Caring for more than 100 million Americans with diabetes will carry an incredibly high cost. We already have some tools to reduce that burden – evidence-based obesity care – but we are barely using them. In Medicare, less than 1% of the patients who could benefit from the DPP are getting it. Fortunately, CMS is moving to expand access to the DPP in Medicare. Finally.

New obesity drugs can prevent diabetes as well. Earlier this year, a double-blind RCT showed a 66% reduction in risk for diabetes with liraglutide 3 mg versus placebo.

The challenge is to use the tools we have now, before the burden grows to crush our healthcare system. It is not enough to simply advise patients to lose weight. That’s been studied and it has no effect. Intensive, structured help is necessary to have an effect. Medical therapy can have an effect. And for the right patients, surgery can have a dramatic effect.

But only if we put these tools to use. Otherwise we can pay the bill later for more than 100 million Americans with diabetes.

Click here for the CDC report and here for more perspective from the LA Times.

Hurtling Forward, photograph © Rolf Brecher / flickr

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July 19, 2017

2 Responses to “Hurtling Toward 100 Million Americans with Diabetes”

  1. July 29, 2017 at 4:05 pm, Allen Browne said:

    There needs to be a continuum of care – life style changes then pharmacotherapy if needed, then devices if needed, the combinations of devices and medications if needed, then bariatric surgery if needed, then medications or devices or medications and devices if needed. Whatever it takes to help the patient get healthier.

  2. July 29, 2017 at 4:46 pm, Ted said:

    Thanks, Allen! I agree with you.