There’s a single mom out there who left her job to homeschool her children when the COVID-19 pandemic closed classrooms. Dinner is whatever can be found at the corner store or the drive-through because it’s what her family can afford on a single income.
On top of these challenges, this woman is diabetic. Multiple times a day she must manually tell her body to turn food into energy. If she doesn’t, the long-term health implications could be dire: She could become physically weak, suffer a stroke, go blind or lose a foot to amputation.
Diabetes takes a larger toll. One in 10 Americans, 34.2 million people, is diabetic. Another 88 million Americans, one-third of the adult U.S. population, are pre-diabetic. If left unchecked, diabetes will remain one of the top 10 causes of death globally, killing more than 4 million people every year.
Diabetes cost the U.S. $327 billion in health costs and lost productivity in 2017, a jump of 26% in just five years. In the Type II form that is most prevalent, Diabetes is expected to become a $67.7 billion global market by 2022, up from $28.1 billion in 2012.
Despite a lot of noise about “market opportunity” and “optimizing outcomes,” the U.S. is failing to address this ongoing crisis, and COVID-19 is making it worse: 40% of people who died from COVID-19 from February through May 2020 had diabetes, and for those under age 65, it was 50%.
This winter will bring an uncomfortable reckoning: It is harder to manage this very personal disease — one that literally saps energy, and that comes with a higher risk of depression — in the dark, cold, lonely months. That’s in a normal year.
Part of what makes diabetes so hard to treat is how personal it is. Type II diabetes, which represents 95% of diabetes cases and develops due to poor nutrition and lack of exercise, as well as familial factors unrelated to lifestyle, can progress until it permanently alters the body’s ability to process energy. Even if someone corrects the lifestyle issues that led to the disorder, the damage in many cases is irreversible.
Correcting lifestyle issues is a challenge: 80% of New Year’s resolutions fail. Imagine 34.2 million people trying to keep a New Year’s resolution to exercise regularly and eat better — every day, every year.
So how do we help diabetics when getting a doctor’s appointment requires a wait time far greater than usual? (It can take three- to six months to get an endocrinologist appointment in New York City — and rural areas face even more dramatic access issues.)
New telehealth initiatives and apps hold great potential, and the market is rightly recognizing their value. But we’re not even close to scratching the surface of scaling remote support for people living with diabetes and other chronic conditions.
The hyper-individualized nature of diabetes means one-to-one support must be scaled in an extraordinary way. At Cecelia Health, for example, in more than 1 million engagements with people with diabetes we’ve seen the combination of human- plus digital outreach lead to an average reduction in HbA1C level, a proxy for blood glucose level, of a highly significant 1.5 points in previously unmanaged patients.
Research suggests that reducing this metric by about a point can drop the risk of cardiovascular disease and death by 40%, and reducing the level below nine points overall can lower healthcare costs by 24% in the first year. Health insurers we work with see an average annual healthcare cost reduction of $2,675 per employee.
One-to-one support works when it includes trusted relationship with a human being, combined with clinical guidance. Innovative telehealth resources for diabetics, providing remote access to coaches and clinicians, can be a breakthrough for a healthcare crisis that is hurting millions of Americans, reaching people quickly, wherever they are.
Arnold Saperstein, M.D., is chief medical officer at Cecelia Health, a provider of virtual diabetes and chronic disease management.