More than 29 million Americans have diabetes, and the disease ranks as the seventh leading cause of death in the United States. About 86 million adults in the U.S. have prediabetes, but structured lifestyle-change programs have been shown to help prevent or delay type 2 diabetes by 60%. Although encouraging, the task of preventing complications in patients diagnosed with type 2 diabetes can be challenging because these individuals often do not qualify for enrollment into diabetes prevention programs.
With type 2 diabetes, several types of complications can occur over time, including coronary heart disease, cerebrovascular disease, retinopathy, nephropathy, and neuropathy, among others. Many of these complications produce no symptoms during the early stages of diabetes, but most can be prevented or minimized with a combination of regular medical care and blood sugar monitoring. “Even after patients are diagnosed with type 2 diabetes, clinicians should make efforts to ensure that other prevention strategies are initiated and used throughout follow-up,” says John B. Buse, MD, PhD.
Guide Patients to Interventions
It is critically important that physicians recommend lifestyle interventions to patients who are diagnosed with type 2 diabetes, according to Dr. Buse. The American Diabetes Association has released toolkits for clinicians that are intended for use with their patients, including segments on optimizing care of the disease (Table 1) and preventing cardiovascular complications (Table 2), among several others. Dr. Buse says these resources and others can be especially helpful when having discussions with patients about what they will need to do to prevent diabetes-related complications.
Clinical guidelines recommend screening patients for prediabetes early in order to prevent progression to type 2 diabetes. If the disease progresses, Dr. Buse suggests that physicians guide their patients toward evidence-based lifestyle programs, most notably weight-loss programs. “A physician’s recommendation or referral to a weight-loss program can significantly impact whether or not they take action,” Dr. Buse says. “Lifestyle changes like losing weight, exercising, eating healthy, and quitting smoking are paramount in diabetes management. Patients with an early diabetes diagnosis may also benefit from metformin, an approach that has been shown to be cost-effective.”
One of the most important aspects of managing type 2 diabetes is the need for patients to be actively engaged in their care, according to Dr. Buse. “We should not take a ‘business as usual’ approach to managing patients with diabetes because what works for some people may not work for others,” he says. “Patients who are actively engaged in their care and share in decisions to participate in specific interventions are more likely to stick with them.” They are also more likely to have better long-term results and can further reduce their risk for long-term diabetes-related complications.
Involve the Team
Moderate weight loss and increased physical activity can stave off many diabetes complications, but Dr. Buse says that coordinated, organized, and unified efforts will be necessary. “It’s important to have a collaborative multidisciplinary team get involved in patient care,” he says. “This can include physicians and nurses as well as clinical life coaches, diabetes self-management educators, dieticians, and others who have the common goal of helping patients achieve and sustain weight loss. At the same time, it’s vital that patients understand that they are the captain of their own diabetes care team.”
Making improvements to the physical environment, such as increasing the availability of healthy food choices and creating opportunities for physical activity, can facilitate efforts by patients to sustain weight loss with lifestyle interventions. “The key is to ensure that patients understand why they need to participate in ongoing prevention programs,” Dr. Buse says. “The next step is for clinicians to discuss what patients believe will work and find out if they’re willing to take the necessary actions. It’s critical that patients buy into why they’re participating in prevention programs so that they adhere to them for the long haul.”
The total costs for diabetes are estimated at about $245 billion per year in the U.S., and that figure will likely rise as the obesity and diabetes epidemics grow larger. “Prevention programs are typically cost-effective, but many insurers have been spotty when it comes to reimbursement for such programs, especially those intended for people who have been diagnosed with type 2 diabetes,” says Dr. Buse. “Clinicians should keep this in mind and be sure to talk to patients about financial considerations. We should find out what patients can afford and what they’re willing to do when it comes to recommending preventive interventions.”
Readings & Resources (click to view)
American Diabetes Association. Reducing Cardiometabolic Risk: Patient Education Toolkit. Available at: www.diabetes.org/toolkit.
Centers for Disease Control and Prevention. Diabetes Public Health Resource. Available at: http://www.cdc.gov/diabetes/home/index.html.
Centers for Disease Control and Prevention. National Diabetes Prevention Program. Available at: http://www.cdc.gov/diabetes/prevention/index.htm.
Ali MK, Echouffo-Tcheugui J, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program? Health Aff. 2012;31:67-75.
Katula JA, Vitolins MZ, Morgan TM, et al. The Healthy Living Partnerships to Prevent Diabetes study: 2-year outcomes of a randomized controlled trial. Am J Prev Med. 2013;44(Suppl):S324-S332.
Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
Guide to Community Preventive Services. Combined diet and physical activity promotion programs to prevent type 2 diabetes among people at increased risk. 2014. Available at: www.thecommunityguide.org/.