Diabetes care needs to support lifestyle changes – not pharmaceutical intervention – first

by Bailey Amber
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The outsized impact of type 2 diabetes on the health system in the United States is well established – millions of Americans experience declining health and higher healthcare costs each year because of this epidemic and chronic condition. According to the CDC, diabetes costs $327 billion each year and the total cost rose 60% from 2007 to 2017. Most of these are direct medical fees from either pharmaceutical treatments or care for symptoms of the disease.

What is frustrating to those who focus on diabetes care is that this is not a mysterious, misunderstood disease. The risk factors behind diabetes, the link between the disease and diet and activity level, and ways to mitigate its progression through lifestyle choices are well known and backed by decades of research. But despite this, the way we treat diabetes does not match up with what we know about what causes it.

More often than not, the primary form of therapy offered to diabetes patients is pharmacological. And while we have incredibly innovative and effective drugs that can mitigate the symptoms of diabetes, they end there, failing to address the underlying causes of the disease. This means that, without those accompanying life-style changes, patients are inevitably on the path of their disease progressing, causing more adverse events, increased medication usage and higher healthcare costs.

This pattern is at odds with what we know about how best to treat type 2 diabetes and is failing patients and leaving providers without the tools needed. In fact, the issue is so critical that the American Diabetes Association has recommended new standards of care, calling for the use of mobile apps and digital solutions for therapies like behavioral counseling and lifestyle changes as the first line of treatment. So why is this not the experience for so many of the millions of people with this condition?

In short, it’s been a challenge of scale. Lifestyle changes are hard under the best circumstances, much less while dealing with a chronic illness. People need support to change long-standing diet and exercise habits and, with so many patients suffering from diabetes and a host of other cardiometabolic conditions, it’s no shock that providing one-on-one support has not often been possible, especially in a model where primary care physicians are the most likely to oversee diabetes care.

But the good news is that there may be another option – tapping into technology to scale up the delivery of behavioral therapies to type 2 diabetes patients. Prescription digital therapeutics can and should be considered as part of type 2 diabetes therapies because they can help provide that first line of defense that the current standard of care calls for. Backed by clinical research and regulated by the FDA, these can be prescribed by a physician as easily as any pharmaceutical treatment and require only the smartphones that so many of us use daily to deliver always-on, tailored support rooted in proven therapies like Cognitive Behavioral Therapy (CBT).

CBT has been used in psychological practice for decades to treat conditions ranging from anxiety and depression to addiction – as well as helping with nutritional and activity changes. Based around the concept of helping patients interrogate and understand the subconscious underpinnings of habitual behaviors, CBT has been shown to be an effective way to help people make healthier eating choices, achieve glycemic control and minimize the progression of cardiometabolic diseases.

A growing number of prescription digital therapeutics for a host of conditions – including cardiometabolic diseases – will soon hit the market and clinical trial data has shown that they are truly effective. Organizations like the American Diabetes Association have made moves to update guidelines to include the use of these validated digital tools. While pharmaceuticals are a critical piece of the treatment landscape for type 2 diabetes, they have been the exclusive and de-facto first-line treatment for too long. And while they provide relief to patients, when used alone they are also part of a cycle of increasing costs and lower health outcomes. Patients, doctors, payers and the health system at large deserve better and prescription digital therapeutics that can help patients take control of their own cardiometabolic health may be part of the solution.

Photo: MURAT GOCMEN, Getty Images

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