- The Centers for Disease Control released some unusual news this week. The number of new cases of Type 2 diabetes is starting to exhibit definite signs of a downward trend, even as population health management programs become more and more prevalent in primary care providers across the nation.
Peaking in 2009 with 1.7 million diagnoses a year, the number of new patients suffering from the disease decreased to 1.5 million in 2011 and 1.4 million in 2014.
"After so many years of seeing increases, it is surprising," said Edward Gregg, a Centers for Disease Control and Prevention diabetes researcher.
While the disease is still nearly three times more prevalent than it was in 1980, the dip in new cases may represent a significant victory for the hard work of providers engaged in population health management efforts, which started to pick up steam just around the time that the numbers began to drop.
The CDC’s raw data does not offer any direct interpretation of what may be spurring the progress, but it seems clear that a broader awareness of unhealthy lifestyle choices among patients, and a greater stress on education and chronic disease management among providers and payers may have something to do with the gains.
“It’s not yet time to have a parade,” said Dr. David M. Nathan, the director of the Diabetes Center and Clinical Research Center at Massachusetts General Hospital to the New York Times.
“[But] it has finally entered into the consciousness of our population that the sedentary lifestyle is a real problem, that increased body weight is a real problem.”
But the news isn’t universally positive. Despite the fact that many patients are becoming more aware of their risks and the contributing factors that lead to diabetes, a shocking number of patients may already be living with the condition unawares.
Both the CDC and the Journal of the American Medical Association (JAMA) have recently released studies stating that close to one-third of Americans with full-blown Type 2 diabetes have not been officially diagnosed and are not receiving treatment for their issues.
“These new numbers are alarming and underscore the need for an increased focus on reducing the burden of diabetes in our country,” said Ann Albright, PhD, RD, director of CDC’s Division of Diabetes Translation in 2014. “Diabetes is costly in both human and economic terms. It’s urgent that we take swift action to effectively treat and prevent this serious disease.”
In addition, racial and other socioeconomic disparities in the rate of diabetes development persist, with black and Hispanic patients diagnosed at consistently higher rates than white patients.
Educational level also appears to have an influence on a patient's likelihood of receiving a diabetes diagnosis. Patients with less than a high school education are more than twice as likely as those with high school diplomas or higher educational achievements to be diagnosed with diabetes, the latest data shows. The data does not include pediatric patients.
Healthcare providers have been pouring millions of dollars and man hours into reducing these disparities by utilizing population health management technology tools and community strategies. Educational programs, chronic disease support groups, care managers, and patient engagement projects have been instrumental in keeping patients connected with the resources they need to cope with their needs.
Earlier this year, the American Medical Association (AMA) and the CDC launched a joint diabetes prevention effort, which hopes to specifically address the number of undiagnosed diabetics that may not be included in the most recent CDC data on new cases.
“Here, in one of the most medically advanced countries in the world, more than 86 million Americans are living with pre-diabetes, the precursor to Type 2 diabetes,” said past AMA President Robert M. Wah, MD. “And yet nearly 90 percent of them don’t even know they have it.”
“Think about that for a moment. That’s one in every three people. This isn’t just a concern. It’s a crisis. And it’s not just taking a physical and emotional toll on people living with pre-diabetes. It’s also taking an economic toll on our country. More than $245 billion each year in healthcare spending and reduced productivity is directly linked to diabetes.”
The “Prevent Diabetes STAT” program is just one of the tools available to healthcare providers attempting to address the epidemic levels of the metabolic disease. Big data analytics, home monitoring and mHealth tools, and EHR adoption have been instrumental in developing improved risk stratification and predictive capabilities that help identify vulnerable patients, maintain appropriate care schedules, and prevent long-term complications.
It seems reasonable to assume that the combination of these efforts is paying off as providers shift to patient-centered approaches to chronic disease management and prevention, and it is encouraging that the nation has been able to sustain a modest decline in new cases over the past several years. But much remains to be done in order to keep the numbers trending downward while ensuring that patients already living with diabetes continue to have access to optimal chronic disease care.