The Off-Ramp: Novel Diabetes Reversal Program Bolsters Support of Nonpharmacological Disease Management

The prevalence of diabetes continues to rise and shows no signs of slowing down, according to a 2021 report from IDF that estimates 537 million people worldwide live with diabetes—approximately 10% of the global population.¹ If the reports predictions hold true, these figures could reach 643 million in the next 5 years, and surpass 780 million by 2045. At the time, diabetes led to $966 billion in health care expenditure, with IDF projections anticipating a future where the associated health care costs exceed $1.4 trillion.

In the US, CDC data indicate that nearly 12% of people (n = 38.4 million) live with diabetes and 23% of these individuals are unaware of their condition.² Furthermore, the number of high-risk individuals living with prediabetes is approaching 100 million. Overall, the national prevalence of diabetes has more than doubled since the year 2000, with the aging populace primarily driving these figures.

Over the years, patients and clinicians alike have given more attention to the prospect of nonpharmacological strategies to manage diabetes, with data in this area demonstrating the significant impact that lifestyle changes, modified diets, and physical activity have on preventing the progression and incidence of hyperglycemia in patients with prediabetes.³

Banner | Aetna, in partnership with Virta Health, a pioneer in weight loss sustainability and diabetes management, recently built upon this literature and announced 1-year outcomes from their own diabetes reversal program.⁴ Through nutritional modification, the program seeks to help individuals with diabetes return their blood sugar to normal levels, thus limiting the need—sometimes fully—for additional pharmacotherapies to manage their condition.⁵

In 2023, 6-month data showcased the program’s promise after enrolled patients experienced an average hemoglobin A_1C (HbA_1C) improvement of 1.4%.⁶ This result alone carries significant implications as the risk of long-term complications that stem from diabetes can be reduced by 40% for each 1-point drop in HbA_1C. Additionally, 50% of diabetes medications were able to be removed from participants’ treatment regimen (with the exception of metformin), with 40% of patients on insulin being able to forego insulin altogether, and insulin dosages dropping by 85% in this group. Participants also exhibited a clinically significant average weight loss of 8.2%; almost 25% of participants achieved weight loss of at least 15%.

Their newly published 1-year findings show sustained improvements for patients’ metabolic health, suggesting the long-lasting benefits of the program.⁴ Impressively, by the end of this period participants were able to do away with 66% of their diabetes medication (again, excluding metformin) and almost 60% of individuals were able to get off insulin. Weight loss outcomes also improved as participants’ average loss climbed to 11%.

The diabetes reversal program is 100% online, allowing users to access expert care when they need it, wherever they are. A specialized and evidence-based approach provides patients with personal nutrition advice and connects them to a dedicated health coach, educational resources, a supportive community of other members, and a provider-led care team to monitor their health. Additionally, real-time monitoring tools such as a digital scale, connected blood sugar meter, and ketone meter are available to help member track their progress and keep themselves accountable.

In the video above, Robert Groves, MD, executive vice president and chief medical officer, Banner | Aetna, discusses the benefits, implications, and necessary considerations for medication-free diabetes management, and gives praise to this model of continuous remote care due to the access and opportunities it provides to program members. Although new medications, such as the emergence of glucagon-like peptide 1 (GLP-1) receptor agonists, have proven to be highly effective for patients, Groves stresses how these drugs have high discontinuation rates and do not benefit everyone equally. On the other hand, implementing daily diet and exercise habits, such as a low-carbohydrate diet, as the Virta program demonstrates, can have sustained, long-term benefits for diabetes management compared with pharmaceuticals.

Groves emphasizes the importance of individualized approaches and education when it comes to patient care, highlighting additional initiatives such as the Banner | Aetna Kitchen program that can provide hands-on experiences for patients. As he describes above, individuals get to participate in a “cooking show–like environment” where they gain knowledge and receive help in real time from professional chefs and dietitians who walk them through cooking healthy meals on their own and ingredients to look out for.

“I think this is important in many respects, and one of the primary ones is it starts to address that epidemic of loneliness that seems to be associated with so many of chronic disease patients,” Groves adds. “These days, there's an epidemic of loneliness in the US. It's been addressed by many before, but we're trying to bring people together. We're investing in community.”

This communal, experiential learning, he continues, is “probably the most important thing. We're not giving a didactic lecture, which people don't retain long term. We know we're not telling them what to do. We are showing them and they actually do it themselves. That kind of learning tends to stick. And so, we're not just creating folks who can be healthier. We're creating teachers.”

Virta may be covered by one’s health plan, affording all these resources to patients at no cost. In cases where a patient does not have coverage, Virta can still be accessed for $299 per month and an initiation fee of $250. Cost of care remains an important factor to consider as multiple studies have evaluated the financial burden of diabetes management. For example, a 2023 analysis reported that 73% of its sample patients with diabetes reported an average, monthly, out-of-pocket spending of over $100 related to their condition—16% of them reported over $300 in spending, and 10% over $500.⁷ Diabetes medication and accessing healthy foods were identified as areas where patients needed the most assistance, and they were also consistently among the top factors contributing to financial stress, especially considering many patients fell below the poverty line. Participants were also managing 4 chronic conditions on average and nearly 50% reported taking at least 7 medications. Prior analyses from this team found similar results in terms of financial burden, but also had 40% of participants with diabetes reporting over $1000 per month to manage their overall health, which not only included medication and healthy food costs but also factored in insulin pumps and lost time at work.

In this same thread, a 2020 study on health care resource utilization in patients with type 1 diabetes in the US revealed, shockingly, that monthly diabetes-related costs can soar to over $700 per patient, with total all-cause monthly costs ranging between $1482 and $1522. In their database searches and evaluation of electronic medical records, administrative claims, and more, pharmacy costs stood out as the most financially burdensome for patients with diabetes.⁸

These 2 studies offer but a glimpse into the expansive literature on diabetes-related financial burden. With these figures in mind, the immense value of implementing nonpharmacological approaches to address diabetes becomes clearer, especially with the prospect of eliminating otherwise necessary medications.

While Groves explains above how this may not be the right approach for everyone, he truly believes this methodology should become a standard of care for patients with diabetes. Patient testimonials from these programs, he continues, detail the life-changing impacts of daily habits on their health. And these benefits do not just stop in patients’ HbA_1C levels or weight loss. Virta’s research also suggests a plethora of benefits these programs can have on individual liver function, blood pressure, sleep, mental health, and more, demonstrating the power implications that lifestyle modifications—without medication—can have on overall well-being.⁴

The development of GLP-1s and other medications have been life altering, Groves explains; however, “if you can have a lifestyle management strategy that will help you get there, why wouldn't you do that? Unless you're planning to take GLP-1s for the rest of your life, you need an offramp.”

References

1. Diabetes around the world in 2021. IDF Diabetes Atlas. 2021. Accessed October 7, 2024. https://diabetesatlas.org/

2. National Diabetes Statistics Report. CDC. Updated May 15, 2024. Accessed October 7, 2024. https://www.cdc.gov/diabetes/php/data-research/index.html

3. Zhou R, Cui Y, Zhang Y, et al. The long-term effects of non-pharmacological interventions on diabetes and chronic complication outcomes in patients with hyperglycemia: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2022;13:838224. doi:10.3389/fendo.2022.838224

4. Banner | Aetna members eliminate medications and see significant, sustained weight loss on its Type 2 diabetes reversal program through Virta Health. Banner | Aetna. Press release. August 28, 2024. Accessed October 7, 2024. https://www.banneraetna.com/en/about-us/news/type-2-diabetes-reversal-program-through-virta-health.html

5. How Virta works. Virtahealth.com. Accessed October 7, 2024. https://www.virtahealth.com/how-it-works

6. Banner | Aetna members eliminate half of diabetes medications after six months on Virta Health’s type 2 diabetes reversal program. Banner | Aetna. Press release. April 4, 2023. Accessed October 7, 2024. https://www.banneraetna.com/en/about-us/news/members-eliminate-half-of-diabetes-medications.html

7. Patel MR, Anthony Tolentino D, Smith A, Heisler M. Economic burden, financial stress, and cost-related coping among people with uncontrolled diabetes in the U.S. Prev Med Rep. 2023;34:102246. doi: 10.1016/j.pmedr.2023.102246

8. Simeone JC, Shah S, Ganz ML, et al. Healthcare resource utilization and cost among patients with type 1 diabetes in the United States. J Manag Care Spec Pharm. 2020;26(11):1399-1410. doi:10.18553/jmcp.2020.26.11.1399