Scientists and clinicians like to debate—and when there is data to debate, that’s even better. It is surprising, though, how often experts can look at the same data and come to different conclusions. Debates about how best to manage diabetes are nothing new, and I’ve recently been getting more involved in one of them.
We’ve all heard the phrase “an ounce of prevention is worth a pound of cure.” But what if that ounce of prevention was really expensive and we still ended up needing the whole pound of cure? In other words, what if the effort put into prevention didn’t do anything? That debate is currently going on for community-based efforts at preventing diabetes through lifestyle interventions. This is an important issue. The Affordable Care Act is being implemented to try and improve the health of Americans, and a lot of money will be spent in that effort. Debates about how best to spend health care dollars are taking place at many different levels and in many different areas of health care.
For diabetes, we know from randomized clinical trials that implementing lifestyle changes in high-risk patients can work to prevent the disease. The current 2014 American Diabetes Association guidelines recommend that people with prediabetes should be in a program to target a 7 percent weight loss and 150 minutes per week of moderate physical activity. But we also know how hard it can be to translate the results of clinical trials into real-world outcomes. And unfortunately, it’s easier to take a pill than it is to change our lifestyle. Recognizing this, a couple of authors recently did a review of the published literature regarding community-based interventions for diabetes prevention and concluded that there is no good evidence that they work. Therefore, the debate is whether or not we should continue to fund these efforts, especially with public dollars.
While thinking about all of this, I recently heard a piece on the radio about the Heart Attack Grill in Las Vegas. It serves burgers ranging in calories from 2,500 to nearly 10,000. Clearly, not all people are ready for efforts aimed at lifestyle improvement. Efforts to improve health, however, can be successful for others. When offered a structured support program with a helpful group of peers, many people make changes in their lives that make real differences in their health.
But we do need to recognize that health care is expensive, and it is fair to ask us to implement programs that really work. So, for any Diabetes Forecast readers who are trying to change their lifestyles with the help of community-based programs, I offer sincere words of encouragement and the reminder that people are watching. Success in these programs helps those who are enrolled and helps ensure that these programs will be here for the next person who needs them. While the 10,000-calorie burger is a reminder that not all people are ready to change, a lot of us are betting that many more people are ready. Now let’s all go out and prove it.