Diabetes in 2024: Let’s Keep Making Progress – Especially with Nutrition
November is Diabetes Awareness Month. Could 2024 be a turning point in the prevention, treatment, and management of this avoidable disease? There are reasons to think so if we take advantage of progress being made across multiple fronts.
There’s no question that diabetes is a massive health crisis that deserves attention, resources, and compassion. According to the CDC, 38 million people in the US have diabetes and an additional 98 million people in the US are prediabetic. If rates continue to increase, the number of people with preventable type 2 diabetes could increase 700% by 2060. The rising rate of prediabetes in young people is particularly troubling.
As the eighth leading cause of death in the US, not only does diabetes impact quality and length of life; it also absorbs one out of every four healthcare dollars. Turning the tide on this disease is in everyone’s best interest. Fortunately, new technologies, new policies, and new interventions are making headway – but the biggest, most effective, and most sustainable gains can still be made by improving the quality of food we eat.
Multi-pronged Efforts at Management and Prevention
On the policy front, the outgoing Biden Administration has taken some impactful actions. For example, the cost of insulin has been capped at $35 for Medicare beneficiaries, and CMS expanded Medicare coverage for diabetes screening and A1C tests. In addition, CMS extended the Medicare Diabetes Prevention Program (DPP) through the end of 2027. The DPP focuses on lifestyle and eating changes and has cut the risk of diabetes in half.
Many states have also utilized the Medicaid 1115 waiver to implement diabetes management programs that expand coverage, test new delivery and payment models, fund community-based interventions, tailor programs to meet specific population needs, and integrate services with physical health, behavioral health, and social care. These are all crucial for better diabetes management.
In terms of medical advances in prevention, management, and treatment, GLP-1’s have shown themselves to be effective at weight loss and blood glucose management. For adults with overweight or obesity, GLP-1s have demonstrated a 94% reduction in the risk of progression to type 2 diabetes. A new treatment developed by the Mayo Clinic and now in clinical trial called endoscopic re-cellularization via electroporation therapy (ReCET) also shows significant promise in improving the function of the digestive system to enhance insulin sensitivity.
Continuous glucose monitors (CGMs) have long been available via prescription for people with diabetes. They track glucose levels continually without drawing blood and can enable retrospective analysis by a physician. They’ve also proven to be a powerful tool for behavior change, giving wearers real-time feedback on eating habits and activity patterns. In 2024, they were approved by the FDA for over-the-counter purchase which will likely expand their use dramatically, paving the way for enhanced prevention in addition to diabetes management.
No doubt, other advances and access to treatment are on the horizon—but the most impactful intervention remains the simplest.
Food as Medicine with Lasting Benefit
A landmark study at the Friedman School of Nutrition Science and Policy at Tufts University estimated the impact of a nationwide food-as-medicine program on 40 to 79-year-olds living with diabetes who are also food insecure. Even knowing that 70% of type 2 diabetes is linked to poor diet and food insecure adults are two to three times more likely to develop diabetes, the researchers were surprised by the extent of the potential impact which they projected could prevent 296,000 cases of cardiovascular disease while adding 260,000 quality-adjusted life years, while saving $39.6 billion healthcare spending and $4.8 billion in lost productivity.
As the study's lead author, Dariush Mozaffarian, noted, “These innovative treatments are exciting because they can not only improve health and reduce health care spending, but also reduce disparities by reaching those patients who are most in need.”
As a leader in food-based interventions for chronic conditions, NourishedRx has seen similar results through its own real-world programs. Our tailored food and nutrition program for individuals living with type 2 diabetes in Marion County, IN showed a $254k net lifetime cost savings per member with a 1.3% average reduction in HbA1c at the end of the program, and a 10.5% decrease in average fasting glucose.
The program was run in collaboration with a large health system in the Midwest with its own Medicare Advantage plan. They determined that 20% of its members with uncontrolled type 2 diabetes also faced significant social barriers to health. This health system enlisted NourishedRx to design a program to deliver nutritious food and nutrition-related education to those members.
The 14-week program improved weight loss, blood pressure, cholesterol, and A1C scores by the end of the program. On average, participants continued to reduce their A1C levels for 12 months afterward, with an average reduction of 2.2% compared to a case-mix-adjusted control group! They also reported improved health, quality of life, mental health, and self-confidence in sustaining their healthy lifestyles.
Making a Breakthrough
Technological and pharmacological innovations are important and show promise but do not necessarily address the most significant root cause of type 2 diabetes, which is diet and lifestyle. As the Tufts study shows and our own programs prove, expanding food-as-medicine programs to people with diabetes who face social barriers to health is a cost-effective and sustainable way to promote lasting health improvements that reduce the effect of this terrible disease.
Everyone should have easier access to nutritious, affordable food. It's also our hope that programs and initiatives such as Diabetes Awareness Month continue to deepen our understanding of the influence of nutritious food on health and chronic illness in general. Helping people manage their diabetes effectively, prevent its onset, and live healthier lives should be among the most important objectives of our healthcare system.
At NourishedRx, we envision a future where poor diet is no longer the top driver of death, disease, and disparities. If you’re interested in partnering with us to provide innovative food care delivery models, we’d love to hear from you.
