The driving force behind increasing costs is diabetes. More than 29 million Americans have diabetes and 86 million have prediabetes, according to Dr. Ann Albright, director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC).

One-third of the population is at risk for developing diabetes. There needs to be more effective means of addressing the scope of the problem. Because everyone learns differently, there needs to be different modalities.

Type 2 diabetes—where the body doesn’t respond to insulin or doesn’t produce enough insulin—is the most prevalent and is treatable with diet, exercise and medications. Of the more than 29 million with diabetes, approximately 27 million have type 2 diabetes, according to Dr. Anne Peters, director of the USC Clinical Diabetes Program.

“This is an important opportunity for employers to support proven lifestyle interventions.”

Common risk factors for type 2 diabetes include genetic and lifestyle factors such as obesity and physical inactivity. Beginning in 2016, the U.S. Preventative Services Task Force recommends doctors refer “overweight or obese individuals with one other cardiovascular disease risk factor for “intensive behavioral counseling” focused on promoting a healthy diet and physical activity.”

Lifestyle or behavioral interventions remain the most effective means of changing unhealthy behaviors. “People need to be ready to change,” said Dr. Peters. “They have to decide to do so.”

Prevention is key

Preventative health is key to reducing healthcare costs. Diabetics often have more costly complications, including kidney disease, heart attacks and strokes, blindness and amputation. “They require more doctor visits and healthcare services,” said Dr. Albright, affecting employee productivity.

Dr. Peters said employers need to encourage employee wellbeing through lifestyle programs that encourage exercise and healthy eating. It’s important to promote diabetes awareness and the importance of prediabetes screening.
Chronic diseases don’t go away. “People need to work on health habits,” said Dr. Peters, adding it’s difficult to motive someone to lose weight or exercise.

A therapeutic solution

Digital therapeutics is a growing medical trend that offers behavioral interventions to people where they live via digital technology and will now be covered by any commercial health plan. It costs between $400 and $500 per person, depending on the program.

The benefits of digital therapeutics includes scalability, lower barriers to access and the ability to test which curriculums work best for different users. “Technology offers an important option,” said Dr. Albright, who added no one delivery method works for everyone and it’s important to have choices. “There’s not one magic answer,” she said.
Omada Health developed Prevent, a digital therapeutics program that meets the National Diabetes Prevention Program guidelines. The program utilizes digital tracking tools, an evidence-based curriculum, a personal health coach and a supportive social network to monitor prediabetic participants. According to the results of the CDC study, individuals lost between five to seven percent of their body weight through lifestyle changes, reducing their risk of developing type 2 diabetes.

“Digital therapeutics can be effective,” said Dr. Peters. Programs can be individualized to fit personalized needs. “There is literally no one way to lose weight – just what works for the person,” she said. “We need a variety of options.”

While Dr. Peters doesn’t believe one on one coaching will disappear, there is room for both. Digital therapeutics can reach large segments of the population at risk for chronic disease, can be accessed quickly and can show evidence-based results. It needs to engage the user.

Tools of the trade

Employers must offer behavioral counseling as part of their preventative benefits plan. Dr. Peters added this should be an incentive for employers to develop wellness programs, provide gym memberships and encourage healthy eating and work with employees to lessen or reduce their risk of developing diabetes.

“This is an important opportunity for employers to support proven lifestyle interventions,” said Dr. Albright.

“Toys are nice,” said Dr. Peters. “Changing behavior is the hard part.”