For the Most Part, We Behave Ourselves into Diabetes, and Our Health-Care System Doesn’t Do Much about That

Think about it. Worldwide, 347-million human beings worldwide suffer from diabetes, according to a Lancet study released earlier this week. That’s more than the entire population of the United States and Canada combined. Throughout the world, the prevalence of diabetes has doubled over the past 30 years. In the United States, the prevalence of diabetes has tripled.

In the U.S., the dramatic rise in the number of people with this disease is troubling, and for good reason. Diabetes is almost entirely preventable. In fact, until the late 20^th century, Type-2 diabetes, the most common form, was unheard of. And so, in many ways, Type 2 diabetes can be thought of as a yardstick to measure how closely human beings live in sync or out of sync with the natural-health ecosystem. Looked at this way, we can say that we have strayed off the path, and don’t seem to be heading back toward it any time soon.

Of course, diabetes also comes at a cost. The Centers for Disease Control (CDC) estimates that diabetes treatment costs amounted to $116 billion in 2007. The CDC also indicates that because of diabetes, another $58 billion was incurred in lost productivity, absenteeism, and the like. What’s more, Americans with diabetes can expect to incur medical costs that are more than double what the rest of the population will incur.

Diabetes is also often accompanied by the onset of other chronic conditions, and account for much of the morbidity patients with diabetes face. According to the Medical Expenditure Panel Survey, most adults with diabetes have at least one co-morbid chronic disease, and as many as 40 percent have at least three.

Get the picture? More than 8 percent of Americans are diabetic, and this number has tripled in the past 30 years. Those with diabetes consume health care at twice the rate of the rest of society. And diabetes is often associated with the onset of other chronic conditions. You don’t need to plot this on a graph to know that we have a real problem.

The sad news–and also the reason for hope–is that diabetes is not only preventable, but apparently reversible. In a recent experiment, Newcastle University researchers found that an extreme, eight-week diet of 600 calories a day can reverse Type 2 diabetes in people newly-diagnosed with the disease. There are other examples of individuals who, through adopting a lifestyle of regular exercise and healthy eating, have reduced or minimized their diabetic symptoms.

Diabetes, closely tied to being overweight or obese, is perhaps the most important disease for us to get our arms around. It’s also the hardest to make headway against, because its onset is almost entirely behaviorally driven.

We have a pathway for making progress against this disease. Two-thirds of the population that’s overweight or obese can control diabetes in large part by adopting healthy diets, exercising regularly, and losing weight.

I know what you’re thinking. If only it were that easy.

Although a small portion of Americans are predisposed to diabetes, for most of us, diabetes is the inevitable consequence of lifestyle choices they’ve made that have ultimately taken a toll on the body’s ability to maintain a healthy state. The problem is, our health-care system doesn’t do a very good job when it comes to affecting large-scale, behavior change. After all, how many times have each of us been told to eat less and exercise more often? In the aggregate, how’s that working for us?

Our health-care system is most confident in dealing with specific conditions for which there is a defined treatment or cure. The system is not so good at affecting the behaviors of individuals.

Progress on the diabetes front requires a larger vision–one that is societal in scope. It involves changing how we think about our modern world by asking the right questions.

Is physical convenience always progress? Especially if it means we become more sedentary?

Is providing easy access to low-cost, high-glycemic-index foods good public policy? Are we willing to accept reduced access to, and higher prices for, these choices?

Is a fee-for-service payment system in which physicians spend 12 to 15 minutes with a patient the best way to relay the consequences of poor lifestyle choices and the consequences of diabetes?

We’ve got big decisions to make, as individuals, as health-care leaders, and as a society. We also don’t have much time to waste.