There’s an epidemic of prediabetes in the United States: 84 million Americans have this condition but most don’t know it. Prediabetes puts an individual on track for developing full-blown diabetes in five years. Although simple strategies can derail that train, one of them — nutrition counseling — is missing.
I worry that without preventive efforts like counseling about nutrition and other lifestyle choices, many people will unnecessarily make the journey from prediabetes to diabetes. And that would be a shame.
Here’s the issue: While most insurance plans cover nutrition counseling for people with diabetes, it isn’t covered for those with prediabetes. That flies in the face of research documenting that lifestyle counseling is an effective way to halt the steady progression of prediabetes to diabetes and reduce the long-term costs associated with treating the complications like heart attacks and limb amputations that diabetes inflicts.
Here’s the solution: The U.S. House and Senate have recently introduced the bipartisan Preventing Diabetes in Medicare Act. It would cover medical nutrition therapy counseling for Medicare recipients with prediabetes. If passed, the law would likely force private health insurance providers to also cover the cost of counseling for those with prediabetes.
The damage of diabetes
Diabetes is one of the top seven leading causes of death among Americans. That may be a bit of an underestimate, since having it confers a double whammy: individuals with diabetes are also at risk for heart disease, the No. 1 killer of Americans. In shopping terms, this is a BOGO sale — buy one, get one free — gone very, very wrong.
Here’s the science behind the disease: Your body depends on a particular type of sugar, glucose, that it extracts from the foods you eat or regenerates from starch stored in the liver. In fact, your brain, nervous system, and red blood cells depend heavily on glucose to function properly.
Normally, the body relies on the hormone known as insulin to usher glucose out of the bloodstream and into cells. But when cells lose the ability to respond to insulin’s “open up for glucose” signal, or the production of insulin falters, glucose builds up in the bloodstream. Too much blood sugar is the hallmark of prediabetes and diabetes. Over time, a high level of blood glucose can damage:
- the nervous system, causing chronic pain, tingling, and the loss of feeling in the feet and lower legs.
- the eyes. Diabetes-related eye disease is the leading cause of impaired vision and blindness among adults.
- the kidneys, often leading to kidney failure and the need for dialysis.
- the heart and arteries. Diabetes is a significant risk factor for heart attack, stroke, peripheral artery disease, and other cardiovascular problems.
People with prediabetes have higher-than-normal levels of blood sugar, but not high enough to be classified as diabetes. Being overweight increases the risk of developing prediabetes, as do eating an unhealthy diet and physical inactivity. The hazard of prediabetes isn’t just that it might lead to diabetes. Individuals with it are also at a higher risk of developing heart disease and stroke, even if they don’t yet have full-fledged diabetes.
Prevention is key
The good news is that diabetes-related health complications can be minimized — and even prevented — by adopting a healthy, well-balanced diet and participating in regular physical activity that maintains your blood glucose level in a normal or close-to-normal range.
The landmark Diabetes Prevention Program demonstrated that losing a minimum of 7 percent body weight, coupled with 2 ½ hours of brisk walking or other similar type of physical activity a week, could reverse prediabetes or at least delay the onset of diabetes. The folks in that study received personalized counseling about their diet, physical activity, and lifestyle behaviors to achieve these weight loss and activity goals. Follow-up research confirmed that this type of personalized counseling was more cost-effective over the long haul than just dispensing medication to lower blood sugar without making these lifestyle changes. In other words, taking a pill isn’t going to cut it. What’s needed are positive changes in diet and lifestyle.
The American Diabetes Association recommends that individuals with diabetes receive individualized medical nutrition therapy, preferably by a registered dietitian knowledgeable in this area, to help them clean up their diets and get off the couch. Luckily, this type of personalized nutrition counseling is covered by most health insurance plans. The association also supports the same approach, and insurance coverage, for those with prediabetes.
While the Preventing Diabetes in Medicare Act is a no-brainer, it may not be passed without public support. Consider contacting your representatives in the House of Representatives and the Senate and telling them you support this bill. Americans could be a co-pay away from getting a handle on diabetes by taking care of prediabetes.
Joan Salge Blake is a clinical associate professor in the nutrition program at Boston University. She has received funds from General Mills and Mars for conference travel and for providing an educational webinar for nutrition and fitness professionals.