Goodbye, Diabetes: A New Approach to Reverse the Epidemic

Patients with type 2 diabetes should be making decisions about their conditions hour-by-hour, not appointment-by-appointment.

Sami Inkinen

5 min read

Thirty million people in the US have diabetes. Another 84 million are pre-diabetic. Medications that treated diabetes nationwide last year accounted for 214 million prescriptions. Yet, new research reveals diabetes care advancements over the past decade have not produced meaningful improvement in population-level treatment outcomes.

Nevertheless, the medications that fail to improve the diabetes epidemic are so  expensive that the Centers for Disease Control and Prevention released its own research on strategies used by diabetes patients to reduce their prescription drug costs. Among adults with diagnosed diabetes who were prescribed medication in the past 12 months, over 13 percent did not take their medication as prescribed; nearly a quarter asked their doctor for a cheaper option.

Traditional Care Delivery is Appointment-by-Appointment, Not Hour-by-Hour

Patients with type 2 diabetes (T2D) sometimes make decisions about their conditions on an hourly basis, like what to eat, what medicine to take, and how to best manage their symptoms throughout the day. Yet the prevailing healthcare model lets them see a primary care provider for 15 minutes every three to six months.

Some patients turn to digital health solutions, but most of these just help people better monitor (not treat) their disease. They don't fundamentally change, on their own, how care is provided and have not changed outcomes for the better.

Fortunately, some chronic diseases are reversible through proper lifestyle modification and the application of medical nutrition therapies that address the root cause of disease. For instance, according to the American Diabetes Association, in its 2019 Standards of Medical Care, “low-carbohydrate eating plans may result in improved glycemia and have the potential to reduce antihyperglycemic medications for individuals with type 2 diabetes.”

But successful delivery of these medical nutrition therapies is challenging. Not only do they require expert coaching to facilitate behavior modification. They also require always-on access to medical providers. Because the right root-cause intervention restores someone’s blood sugar naturally and quickly, licensed practitioners must be available on-demand to safely de-prescribe medications at the exact moment of need.

Realigning Care to Reject the Status Quo and Reverse Diabetes

What’s needed is a non-traditional approach based on medical nutrition therapies, continuous patient monitoring, and communication. Virta Health, for instance, combines a new care model (real-time access to health coaches and physicians who de-prescribe medications, as appropriate) with a proprietary nutritional intervention that tackles T2D’s root cause. That model has produced a reduction in HbA1c below the diagnostic threshold for T2D while eliminating diabetes-specific medications in 54 percent of two-year completing patients. Results like these demonstrate sustained diabetes reversal, raising new hope that more diabetes patients will reduce or eliminate their need for insulin at all.

By scaling this model, constant patient monitoring and regular contact between patient and care teams across the greater healthcare industry will enable contact at crucial moments of treatment – whenever they occur and however often. The patient can determine when contact is desired, and that contact can be both medical (with the physician) and motivational (with the expert coach). Physicians can also reach out based on biomarker readings before patients even know they need care. The care can be given without an office visit, avoiding needless waiting (and, in rural areas, expensive time-consuming travel).

Diving deeper into this idea, a recent two-year study confirms that among the 74 percent of patients enrolled in the Virta Treatment over two years, 67 percent of diabetes-specific prescriptions were discontinued, and patients simultaneously experienced a 0.9 improvement in HbA1c. Ninety-one percent of patients who began on insulin were able to reduce or eliminate their dosage.

Thirty million people in the US have diabetes, and another 84 million are pre-diabetic.

Accelerating the Transition to True Value-based Care

By aligning care models to disease across the greater healthcare industry, together, we can achieve a combination of clinical results demonstrating diabetes reversal and performance-based payment that dramatically alters the landscape of diabetes treatment. Virta Health has already embraced a unique payment model that puts 100 percent of fees at risk – with employers and health plans paying only if patients reach and maintain diabetes reversal metrics.

In this continuous remote care model, physicians can proactively reach patients, care happens continuously, and patients don’t even have to visit their doctor. Treatment costs are reduced through prescription elimination and fewer emergency visits and adverse events, and payments are based on performance.

The time is now for continuous remote care in treating T2D and applying the concept to other chronic diseases. This movement offers the prospect of population-scale improvement – reversal of a massive growing epidemic through aligned economic incentives between patients and payers.

  • Sami Inkinen