Life is not a matter of holding good cards, but of playing a poor hand well - Robert Louis Stevenson
image by: Nutrición clínica y bariatría 1.0
About two years ago, my friend Tony lost three toes. The cause of this tragedy was type 2 diabetes, even though the disease is manageable and often preventable.
Tony then fought a host of complications. Small wounds would not heal and became life-threatening. Another amputation was necessary, and more were a looming threat. Comorbidities, including infection, high blood pressure and heart disease, waylaid him.
Tony was challenged on many other fronts. He was in and out of doctors’ offices, emergency rooms, hospitals and rehabilitation centers. He was financially stretched. He used up his short-term disability. He struggled to continue working in order to maintain his health insurance. Some days, he would work from home even when he didn't have the strength to get out of bed. His cousin Carl moved in to care for him. He became bedridden. He only left home for doctors’ visits–and was only able to do that after calling 911 to get paramedics to carry him down the stairs of his second-floor flat.
Tony was not alone: according to the U.S. Centers for Disease Control and Prevention (CDC), 30.3 million Americans suffer from diabetes, 7.2 million of whom are undiagnosed. All are at risk for amputated limbs, stroke, blindness, heart disease and other serious complications.
Diabetes sufferers are sometimes stereotyped as relatively poor, uninsured, uneducated individuals who know little about health. Tony, by contrast, was a well-educated, well-insured, technology professional who spent most of his career in healthcare.
When he was in his 20s and 30s, Tony enjoyed life too much. He had an overwhelming handshake, a playful laugh and a loving stubbornness that, sometimes, did not serve him well. His habits were erratic. His weight was too high. A physician told him he had prediabetes, i.e., at high risk for developing type 2 diabetes, but offered no clear prescription or follow-up. Tony tried to shift his habits, but with little success.
Tony was diagnosed with diabetes in his 40s. He episodically managed his condition with better diet, exercise and medications. But life—demanding jobs, travel, dinners out and no time for exercise—got in the way. It all caught up with him. His diabetes worsened and led to other complications, including cardiovascular disease.
Several weeks ago, Tony suffered a massive, life-ending heart attack. He was 56.
You could argue that Tony failed himself. He was the first to admit he was paying for his undisciplined lifestyle choices. But the world is full of people making similar choices. Left unaided, many millions will suffer similar outcomes.
The CDC estimates that 84 million adults in the U.S.—one-third of all adults—have prediabetes, and nine out of ten of them don't know it. It further estimates that about 1.9 million will develop diabetes each year, with 90-95% of those new cases being type 2 diabetes. In time, 30 to 70% of those with prediabetes worsen to have full-blown type 2 diabetes. If current trends continue, diabetes prevalence is projected to increase two to threefold by 2050.
In other words, someone in your close circle of family and friends is at risk to suffer Tony's fate and, most likely, doesn't even know it. That person might even be you.
On top of the personal suffering, diabetes adds hundreds of billions of dollars a year to the cost of healthcare. Tony’s care cost him and his self-insured employer more than $200,000. The American Diabetes Association estimates that the total cost of diabetes in 2017 in the U.S. was $327 billion, made up of $237 billion in direct medical costs and $90 billion in decreased productivity. Medical expenditures for people with diabetes are 2.3 times higher than for people without it.
Globally, the news is even more bleak. More than 420 million have diabetes, reports the World Health Organization. If current trends continue, over 700 million adults worldwide will be afflicted by 2025.In China alone, according to the WHO, almost 10% of all adults—about 110 million people—currently suffer from diabetes. The WHO estimates that “almost half of all adults in China—close to 500 million people—have prediabetes.” The global cost of diabetes reached $1.3 trillion in 2015 and is projected to rise as high as $2.5 trillion by 2030. It is possible to avoid much of this human and economic suffering.
Rather than "just" spending hundreds of billions of dollars in the U.S. and more than a trillion dollars globally to care for those afflicted with diabetes, we can think bigger. We need to fashion an urgent, all-out effort to prevent as many new cases of diabetes as possible. We need a moonshot for diabetes prevention.
When I say moonshot I am talking about an ambitious project aimed at an audacious goal enabled by innovative technology. Much in the way President Kennedy rallied and focused the U.S. space program by setting the goal of sending a man to the moon and President Obama tasked Vice President Joe Biden with spearheading a “cancer moonshot” to accelerate development and deployment of cancer therapies, we need to mobilize our ingenuity and resources to accelerate programs aimed at saving millions from diabetes.
Unlike going to the moon or curing cancer, however, no scientific or medical breakthroughs are needed to prevent millions of new cases of diabetes. Instead, as I will lay out in parts two and three of this series, we have all the ingredients necessary to reconfigure our healthcare system to do so.
Source: Chunka Mui, We Need A Moonshot For Diabetes Prevention, Part One: The Case For Action, Forbes, January 9, 2019.