Diabetes Epidemic Will Hit Half of U.S. by 2020

Researchers Say Weight Loss and Physical Activity Are Keys to Prevention of Prediabetes and Diabetes

More than half of all Americans may develop diabetes or prediabetes by 2020, unless prevention strategies aimed at weight loss and increased physical activity are widely implemented, according to a new analysis.
These efforts could in theory also save about $250 billion in health care costs in the next 10 years, suggests the analysis published by UnitedHealth Center for Health Reform & Modernization, a specialized center within UnitedHealth that focuses on health care reform issues.
"We need a sense of urgency. There is a lot of money and human suffering at stake," says Deneen Vojta, MD, senior vice president of the UnitedHealth Center for Health Reform and Modernization, which is based in Minneapolis. "The good news is that we know what works, and if we work together in a concerted national way, we can win."

Weight Loss and Exercise

For example, programs such as the UnitedHealth Group Diabetes Prevention Program, which is done in conjunction with the Y, can help make a dent in this burgeoning epidemic. This program is based on the U.S. Diabetes Prevention Program, which shows that modest weight loss through dietary changes and increased physical activity could prevent prediabetes from progressing to diabetes.
Prediabetes refers to blood sugar (glucose) levels between 100 to 125 milligrams per deciliter of blood (mg/dL). Ideal fasting blood levels should be less than 100 mg/dL.
Now, Vojta says, "If I do diagnose you with prediabetes, I can say that there is a program in your community that can add years to your life."
"As stunning as these projections are, there is hope that we can slow and reverse this epidemic with proven interventions," says Tom Beauregard, an executive vice president of UnitedHealth Group and the executive director of the UnitedHealth Center for Health Reform & Modernization.

Early Diabetes Diagnosis

Diagnosing diabetes or prediabetes earlier is a key part of the prevention strategy, Beauregard says. As it stands now, a majority of people with prediabetes and many with diabetes do not even know they have it, he says.
"On a technical level, we can identify prediabetes and diabetes and we have proven evidence-based intervention," he says. "What it comes down to is well-organized public awareness campaigns and incentives, and we need to reimburse community-based prevention programs."
Once people are diagnosed, efforts are needed to help improve management of diabetes by boosting adherence with medications, the new report suggests. Improved adherence will stave off diabetes-related complications. This will also help curb costs because the cost of caring for a person with diabetes increases exponentially in the presence of complications.
Leonid Poretsky, MD, director of the Friedman Diabetes Institute at Beth Israel Medical Center in New York City, thinks it is time for all insurers to cover the costs of diabetes prevention programs.
"Prevention of diabetes means weight reduction, including nutrition counseling and exercise, and most payers don't cover these," he says.
"These are often covered once you have diabetes, but it is much better to prevent it from occurring in the first place," he says. "Insurers need to cover screens for diabetes and prevention treatments widely for the entire population, not just certain programs in certain communities.