We need policies to prevent diabetes — not just treat it

There has been a lot of focus lately by the federal government and insurers on the cost of insulin, including a recent bill passed by the House to cap the price. Yes, we need to make insulin more affordable. However, only focusing on affordable treatment is a shortsighted health policy. We also need a commitment to preventing Type 2 diabetes, including leveraging digital health tools. While there are a growing number of tools available to help diabetes prevention, insurers typically do not cover these tools — that should change.

Consider the fact that over 34 million people have diabetes. That’s one in 10 Americans. Another 96 million have prediabetes. If you add it together, nearly half of Americans have prediabetes or diabetes — and rates are going up. Every year, more than 1 million people are diagnosed with Type 2 diabetes, but it doesn’t have to be this way. Although many Americans have little to no idea of how they can stop the march of prediabetes to diabetes, research suggests that it is possible to reverse diabetes or at least slow its progression.

Unfortunately, as with many lifestyle-driven conditions, our focus is almost exclusively on treatment. And, while certainly a crucial element in Type 2 diabetes, it isn’t the only factor to consider. When the medical community does reflect on prevention or slowing progression, we typically urge patients to change their diet and increase their exercise — with no plan. Just one look at the growing prevalence of diabetes is evidence that this strategy isn’t working.

Yes, we certainly need to encourage a healthier diet, weight loss and daily exercise. But we also need to use every tool available in the clinical armamentarium, including the latest digital tools, and we need the health care infrastructure — physicians, health care professionals and insurers — to shift their approach so that patients are aware of these technologies, understand how to use them, and are assured they will be covered by both public or private insurers.  

The implications are potentially life changing. Instead of taking pictures of food for Instagram posts, people could use an app to determine the nutritional quality of their meal. A device that fits in a pocket can analyze breath and reveal whether a person is metabolizing carbohydrates or fat. When the impact of late-night snacking on metabolism stares out from a smartphone, and when seeing the difference in fat content between a hamburger and a salmon salad is a click away, people may be compelled to make a better choice.

Monitors that are the size of a quarter can assess blood sugar levels throughout the day, obviating the need for a daily finger jab, and they can send the reading to a smartphone via Bluetooth to support work with a health care professional to personalize diet and exercise planning on a daily basis. We know personalized feedback works, whether it’s from a device or a health professional.

Yet, most insurers do not pay for these digital tools for people with prediabetes or Type 2 diabetes. It’s now time to reconsider that approach. We certainly need more data to know exactly who benefits and under what circumstances. But to suggest these technologies don’t play an important role in addressing prediabetes and diabetes is short-sighted.

Coverage could start at the cost of the device and as well as a three- to six-month subscription. Pilot programs could be launched for people with certain criteria, such as those who are overweight with high blood pressure or another risk factor, and then be fine-tuned to coverage policies.

This type of support is particularly needed for patients from disadvantaged backgrounds; otherwise, the disparities that currently exist will get worse. It is mind-boggling that patients need to wait until they develop diabetes and need insulin injections before many insurance plans cover a continuous glucose monitor. We need to get these devices and tools to patients much sooner, before they progress to more intensive therapy.

Employers could also consider creating a new benefit. With many offices moving to hybrid models, there may no longer be a need for a corporate gym. Why not use some savings of reduced office space to give employees access to digital tools that prevent them from ever needing insulin in the first place?

Let’s start to recognize that health happens outside the doctor’s office. The COVID-19 pandemic has taught us how much patients can do at home in helping to manage their own care. Addressing the epidemic of diabetes and prediabetes through embracing and paying for technologies that allow patients to base decisions on their personalized information is the strategy we need now to avoid much higher costs in the future.

John Whyte, MD, MPH, is the chief medical officer at WebMD and previously worked as the director of professional affairs and stakeholder engagement at the Center for Drug Evaluation and Research at the U.S. Food and Drug Administration.