100,000 More Diabetes Deaths, More of Same Policies

It is a familiar pattern, but no less disappointing because of that. A government commission issues a report and cries out for action. “Another health crisis challenges the U.S.: diabetes mellitus,” says the report issued yesterday by the National Clinical Care Commission. The report correctly identifies obesity as a key driver of rising deaths from diabetes, but buries it in the fine print. Then, the report recommends more of the same policies to prevent the rising toll of diabetes: promote better nutrition, tax sugary beverages, put restrictions on food and beverage industries.

100,000 Deaths in 2021

Provisional data from CDC indicates that deaths from diabetes exceeded 100,000 in the U.S. for the second consecutive year in 2021. In 2020, deaths were 102,188 – an increase of 17 percent. Analysis by Reuters suggests that deaths rose again in 2021, this time by 15 percent.

Indeed, this is a cause for concern. COVID has taken a big toll on people living with diabetes. What’s more, it may be adding to new cases of diabetes in children. Epidemiologist Paul Hsu explains the concern about rising mortality:

“The large number of diabetes deaths for a second year in a row is certainly a cause for alarm. Type 2 diabetes itself is relatively preventable, so it’s even more tragic that so many deaths are occurring.”

Recognizing Limits of the DPP

If there’s anything to commend in this commission’s report it is that they call out the limited implementation of the Diabetes Prevention Program. Especially within CMS, it seems like bureaucrats are afraid someone will actually use it. Telehealth is necessary to reach some of the most severely affected populations, but coverage is inadequate. Implementation within Medicare has been inadequate. Only a tiny fraction of people who need this program can get it.

But perhaps the most insane element of its implementation is a once in a lifetime limit on using this program. Dealing with obesity and preventing diabetes is not a one-and-done exercise. Obesity is a complex, chronic disease.

Tired Old Ideas

But by far, the most disappointing aspect of this report is the reliance on tired old ideas to stop obesity from fuelling a rise in the toll of diabetes on public health. It is grounded in a presumption that obesity can’t be treated, so an exclusive reliance on prevention is the answer. For that, we need to promote healthy eating and active living and, for good measure, restrict the food industry.

The systems that promote obesity do indeed need reform – and the food industry is a big part of that. But merely trying to restrict broken food systems will not solve the problem. The industry is quite adept at using flawed concepts about good and bad foods to label their stuff good and sell it in ever increasing quantities. Healthy eating and active living strategies likewise have failed us for decades now.

We need new strategies, backed by evidence that they actually work. That evidence will require research with objectivity and rigor, because right now we don’t have much evidence for any prevention strategies that work.

But most of all, because nearly half of the population is living with obesity, we can’t pretend that prevention will solve the spiraling dual problem of obesity and diabetes. We need to get better at providing evidence-based care for obesity to prevent diabetes.

Tired old ideas are not good enough.

Click here for the commission’s report and here for reporting from Reuters.

Call of Death, lithograph by Kathe Kollwitz / WikiArt

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February 1, 2022