There's been a lot of buzz lately about the increase in diabetes; new findings published in The Lancet show that, over the last three decades, the rate of diabetes has doubled worldwide and nearly tripled in the United States. Earlier research indicates that diabetes prevalence in New York State has doubled since 1994, according to the State Health Department.
If we want to get serious about turning the tide on diabetes, we need to get smart about spreading effective prevention strategies.
We are seeing some momentum. For example, a Diabetes Prevention Program (DPP), based on a major federally-funded research study, shows promise for people with pre-diabetes (those who are at a high risk, but who have not yet developed the disease). The program, which focuses on modest weight loss and regular physical activity, has been found to reduce the risk of developing the disease by 58 percent. The program is also cost-effective. Over a three-year period, the program costs just less than $500 per participant and reduces medical costs by just more than $900.
YMCAs and other community organizations across New York State have begun offering the program (I should note that we at the New York State Health Foundation were among the early funders of the initiative), and health insurers in New York State -- including UnitedHealth Group, Independent Health and BlueCross BlueShield of Western New York -- are beginning to reimburse for the program so that it can be sustained. A big push from the Centers for Disease Control and Prevention is also helping to replicate the program.
A colleague recently asked me why there aren't more prevention programs in place, why more insurers aren't supporting these kinds of interventions; why aren't we seeing creative ideas bubbling up all over the place?
The fact is, there are ideas popping up everywhere, but not all of them have what it takes to attract sustainable funding from insurers. I think that the DPP model has taken root for a two key reasons:
First, there's good evidence the program is effective. Many other ideas that might work have not been carefully tested. We should be supporting innovative and creative solutions at all levels -- local, state and federal interventions targeting individuals, schools, workplaces and communities. But for those programs to be brought to scale, and for private insurers -- or any funder -- to invest in their replication, objective, rigorous evidence regarding the programs' impact is essential. Enthusiasm among people trying to mount prevention programs is useful, but enthusiasm does not convince funders; hard evidence does.
Second, there's a fairly quick return on investment associated with the DPP model. Many other interventions are effective at preventing illness and disease but they often are expensive relative to their impact, especially in the short term. When an intervention saves health care costs only in the long run by preventing the onset of disease or reducing complications, private insurers are generally unwilling to take this long view, because so many people change insurers from year to year. A program that yields improved health outcomes and is cost-effective in the short run is probably the best candidate for sustained funding through private insurers. For efforts that achieve results over a longer period of time, funding from the public sector -- which should take a long-run perspective -- is likely the only possible funding source.
We all have a role to play. Foundations like my own should be seeding pilot and demonstration programs that can help build the evidence about what works and what doesn't, and to build the business case for effective interventions. Government, too, has a role to play in encouraging innovation and spreading effective models; the Prevention and Public Health Fund, established as part of the Federal health reform law, is a good example. Community-based organizations, schools, workplaces and health care providers all are fantastic places for conceiving and testing these models, and individuals must take responsibility for their own health and take advantage of available resources.
That's what it will take to turn the tide on diabetes: smart ideas, solid evidence and shared commitment. We have the tools to get the epidemic under control, but we need to marshal our resources and act swiftly to make meaningful progress.