Diabetes: The Next Healthcare Tsunami

A tsunami is about to hit the United States. Eighty-six million people are at high risk, and many will be injured without early warning and action. Many more will eventually be injured and die from the complications as a result of the tsunami.

Alarmed? You should be. A tsunami is defined as “an arrival or occurrence of something in overwhelming quantities or amounts.”

The next tsunami to hit healthcare is the drastic increase in the number of Americans who will develop type 2 diabetes.

Diabetes: The Next Healthcare Tsunami

An estimated 86 million US adults have prediabetes. Without prevention, 15% to 30% of those at high risk will develop type 2 diabetes within 5 years. If left unchecked, 1 in 5 US adults will have type 2 diabetes by 2025, 1 in 3 by 2050. In a recent study published by the Journal of the American Medical Association, 50% of US adults have diabetes or prediabetes, and very few know it. This trend is not sustainable.

According to the CDC's 2014 National Diabetes Report, 29 million Americans have diabetes, which costs $245 billion in direct and indirect costs. A recent UCLA Center for Health Policy Research article reports that 1 in 3 California hospitalizations are related to diabetes.

If this were a real tsunami, there would be a coordinated system to identify and warn people of their impending risk: physical, financial, and emotional. Local and national groups would work together to identify those at high risk and guide them to appropriate resources. The discussion would focus on action and prevention among a wide variety of stakeholders. The discussion would not focus on documenting the short-term return on investment (ROI) to justify action to prevent the looming catastrophe.

There Is a Solution

There is a proven lifestyle change program that can help prevent or delay getting type 2 diabetes—the National Diabetes Prevention Program (National DPP). The CDC National DPP is a lifestyle change program that is helping people with prediabetes prevent or delay the onset of type 2 diabetes. Research studies have shown that such programs can reduce the risk of type 2 diabetes by 58% in people at high risk for developing the disease. The evidence for the effectiveness of the National DPP is strong—these programs work. Both randomized clinical trials and real-world implementation studies have proven that structured lifestyle change programs can help prevent or delay type 2 diabetes by 60% in people with prediabetes.

The CDC has taken the lead to build capacity for community-based organizations, and more recently digital or virtual providers, to deliver the National DPP in their communities as an adjunct to primary care. Over 700 organizations currently have pending or full recognition by the CDC to deliver the program and meet the CDC quality standards.

The Problem

One of the limitations to broad adoption and referral to the National DPP is the lack of health plan reimbursement. Despite the recognized need for diabetes prevention, it is typically not a covered health benefit. It is difficult to establish a short-term ROI for prevention, despite the evidence that it leads to long-term cost savings.

The doctor’s office remains the number 1 place where people who are at risk for diabetes can be referred to the evidence-based National DPP but there is one problem: doctors hesitate to refer patients to programs that are not covered by insurance. Given the number and type of National DPP providers, it is difficult for doctors to know where to refer their patients. Once the National DPP is a covered preventive benefit and available to patients at no charge, doctors are more likely to refer patients at high risk to the program. This is a first step toward winning the race against diabetes.

There Is Good News

The CDC and the American Medical Association (AMA) have partnered to raise awareness of the incidence of prediabetes and encourage physicians to refer their patients to the National DPP. Together, they have launched the Prevent Diabetes STAT program, which includes a variety of information and toolkits. UnitedHealth Group and the YMCA of the USA were early adopters and partnered to scale the Diabetes Prevention Program in 2010. More recently, Anthem BCBS of Colorado and other health plans have partnered with Viridian Health Solutions to deliver the National DPP through a national integrated network of community and digital providers.

What Can You Do?

• If you are a healthcare provider, screen your adult patients for prediabetes. Educate them about the risk factors for diabetes, and if they are at high risk, refer them to a National DPP provider or train your staff to deliver the program.

• Create awareness of prediabetes. Infographics, flyers and technical guides are available from the CDC and AMA to identify qualified patients and share information. Use and distribute the simple online quiz that will indicate whether someone is at high risk for developing type 2 diabetes. You can also download and print a copy of the Prediabetes Screening Test [PDF-758 KB] or Cuestionario para la detección de la prediabetes [PDF-455 KB] to share with others.

• Support reimbursement for the National DPP as a covered preventive health benefit.

The time to act is now. Prevent the healthcare tsunami.