Cost of Preventing Diabetes is Less Than Treating It 

By Bryant Stamford |  Special to The Courier-Journal

The chronic diseases that kill us are largely preventable. Also, the risks associated with heart disease, stroke, various forms of cancer (colon, breast, prostate) or diabetes can be reduced substantially through lifestyle changes.

This is not news. Even so, we still haven't taken the first step as a society and formally endorsed preventive measures. There are several obstacles, but two stand out.

The first obstacle is overemphasis on the power of heredity. This is embraced by the majority of Americans who would rather not assume responsibility for their health. The best way to rationalize non-action is to surrender completely to our heredity.

"It's all in the genes" is the perfect cop-out, because if you believe your risk is tied mostly, if not entirely, to how well you chose your parents, then all lifestyle modifications are pointless.

The first obstacle feeds the second: denial. Our denial helps health-insurance companies justify their resistance to pay for preventive interventions.

Why? Health insurers are in a business, and if their customers are not clamoring for preventive health services, they are unlikely to take the initiative.

Thankfully, we have at least arrived at a point where most insurers will pay for so-called secondary preventive tests geared toward early detection, such as mammography, PSA tests for early detection of prostate cancer, etc.

But early detection, while important, is quite different from primary preventive interventions that involve lifestyle changes. The ones I'm always harping on are healthful diets, physical activity, stress management -- the ones that prevent chronic diseases from gaining a foothold in the first place.

Ideally, primary and secondary prevention approaches would go hand in hand. Follow a healthy lifestyle, but, just in case, also submit to tests that detect a disease early, before major medical intervention is required. The need for data

A logical argument in favor of preventive measures that emphasize healthful lifestyle changes is easy to make. However, health-insurance companies aren't swayed by mere logic. They require overwhelming scientific proof that lifestyle changes will, in fact, create desired outcomes.

Moreover, because health insurers are accustomed to paying for medications, proof must be forthcoming that a healthy lifestyle is not only productive, but is at least as productive as taking medications.

And, lifestyle interventions must be shown to be cheaper than medications -- perhaps the most important aspect. All in all, that's a pretty steep slope to climb. Thankfully, progress is being made.

The latest results from the three-year Diabetes Prevention Program are positive and timely.

In this study, a comparison was made between two approaches, each attempting to reduce the risk of type 2 diabetes (maturity onset diabetes, closely associated with obesity) in individuals at high risk for the disease.

One group of patients received standard drug therapy. A second group participated in a healthy-lifestyle intervention program that included dietary changes and regular moderate physical activity. A third group served as a control, with no intervention.

After three years, when comparisons were made with the control group, the incidence of type 2 diabetes was reduced 58 percent by making healthful lifestyle changes versus a 31 percent reduction when employing typical medications.

This kind of data is truly encouraging and makes the case that healthful preventive measures are effective in curbing the incidence of type 2 diabetes, a chronic disease that is disabling and killing us at an alarming rate and, worse, is gaining momentum as our society gets fatter and fatter.

But more important for health-insurance companies, the cost of administering the lifestyle prevention program was only a fraction of the cost of paying for medications. This combination of effectiveness and lower cost is hard to beat.

An interesting additional finding is that while both interventions were successful, medications were not effective in patients age 65 and older, while the preventive health program was effective across all ages. The bottom line

The preventive health program was highly effective in reducing the risk of type 2 diabetes -- a horrible disease that in the advanced stages causes blindness and amputations.

The preventive health program required only a 30-minute brisk walk five days a week, and a modest change in diet (a reduction in calories with emphasis on reducing dietary fat). This approach is within the reach of busy overweight Americans.

All we need now is an insurance company to step up to the plate and lead the way in formally acknowledging and acting upon what has been obvious for so long.

Until this happens, individuals can take matters into their own hands and easily implement the kind of program employed in the diabetes study.

Just start walking and get some advice on improving your diet from a registered dietitian. Your body will thank you in more ways than you can imagine.

"The Body Shop" runs Thursdays. Bryant Stamford is professor and chairman of the department of exercise science at Hanover College and co-host of "HealthWorks" on WFPL radio. If you have questions or suggestions, go to his Web site at DrBryantStamford.com. Or address questions to "The Body Shop," The Courier-Journal, P.O. Box 740031, Louisville, KY 40201-7431.