Prediabetes: Address the risks, or pay the price later

Large employers may be excited about recent research which looked at National Health Interview Survey data and found a near-term decline in new cases of diabetes as well as a plateau in existing U.S. cases. While the news that new cases of diabetes may be declining does sound promising, benefit managers should resist the urge to break out the champagne.

Although, it’s understandable why they would want to celebrate. More than half of Americans under age 65 — roughly 158 million people — have health insurance through an employer, and chronic conditions like diabetes are major drivers in the year-over-year increases in employee health benefit costs.

Two key points in the study stand out. First, researchers suggested education and prevention programs may have played a role in the decline and urged “continued emphasis on multilevel, multidisciplinary prevention to reduce both Type 2 diabetes and diabetes complications.” In other words, stakeholders must double-down, rather than let up, on interventions to prevent diabetes. Second, because the NHIS data includes only diagnosed cases of diabetes, researchers didn’t explore the rate of prediabetes.

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Why is prediabetes important, and why should benefit managers care? Two words: prevalence and cost.

The Centers for Disease Control and Prevention estimate that while 30.3 million Americans have diabetes, more than twice as many — an estimated 84.1 million adults, or 33.9% of the U.S. adult population — have prediabetes. Furthermore, an estimated 5-10% of individuals with prediabetes — roughly four to eight million people — will progress to Type 2 diabetes every year. This means almost one-quarter of individuals with prediabetes will have Type 2 diabetes within five years.

The financial impact of that progression is staggering. The American Diabetes Association estimates the total cost of diagnosed diabetes in 2017 was $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity.

Benefits managers can do the math: from a cost-benefit standpoint (as well as caring about employee health and well-being), employers should identify and help at-risk individuals, especially those with prediabetes, at the earliest point to turn that risk around. If risk for diabetes in an employee population is not treated as a pressing mandate, then the cost is almost certainly going to go up.

Unfortunately for both individuals and employers, there is currently no magic pill to treat prediabetes. Although the ADA suggests consideration of metformin therapy for people with prediabetes to prevent diabetes — and there was hope that other new medications may also offer promise — major new research presented at the ADA 79th Scientific Sessions and published in June in Diabetes Care found any benefit after 12 months of treatment with a variety of these drugs, including metformin, disappeared after three months.

See also: To check or not to check: Managing blood sugar in diabetic employees

What does work: a well-designed health and wellness benefit that screens for risk of diabetes and includes a National Diabetes Prevention Program, to help individuals make lifestyle changes to prevent and/or delay diabetes onset. Most importantly, the program should be delivered digitally to employees and dependents. As consumers increasingly use their devices for all sorts of engagement, new research suggests digital programs that combine online coaching with human interaction produce measurable long-term results.

A recent Quest Diagnostics study, found that individuals at risk of developing Type 2 diabetes who take part in an employer-sponsored wellness program that couples laboratory screening with digital interventions reduced their risk of developing the chronic disease for up to eight years. Levels for all biometric markers in the risk model, including fasting glucose, improved across all study cohorts and 62% of participants lost weight after the program, with 31% losing 5% or more body weight.

While return on investment in employer disease prevention programs should always be viewed from a holistic perspective, considering both direct cost and indirect cost reductions, these digital programs also demonstrate a clear ROI. For the Omada Health digital pre-chronic disease program, the provider for the Quest study, several independent analyses have identified positive employer ROI within six-24 months. The cost of ignoring risk is the inverse; a 2012 study assessed prediabetes medical costs at $510 annually per person, while the annual cost rose to $10,970 for individuals with diagnosed diabetes.

Finally, while every human resource and benefits professional is charged with developing benefits packages and reducing care costs, the employee — who may feel vulnerable and powerless about their health status — is at the center of every decision. Diabetes is the seventh leading cause of death in the U.S. Offering workplace interventions to empower employees to prevent prediabetes from progressing does more than reduce costs; it also saves lives.