Clinically Speaking: Preventing and Treating Type 2 Diabetes
In the last 20 years, the number of U.S. adults diagnosed with diabetes has more than doubled. Learn more about one of America’s most costly diseases, and the steps that providers and plans are taking to prevent and treat it.
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The Facts about Diabetes

Here is what we know about the prevalence of diabetes in the U.S. today.

  • More than 34 million people in this country have diabetes. The greater concern is that one in five of them don’t know they have it.

  • Another 88 million adults – approximately 1 in 3 – have prediabetes, and more than 84 percent of them are unaware.
  • In the last 20 years, the number of adults diagnosed with diabetes has more than doubled as the American population has aged and become more overweight or obese.

What about the costs? Medical costs and lost work and wages for people diagnosed with diabetes total $327 billion annually, and medical costs for people with diabetes are twice as high as for people who don’t have diabetes.

Type 1 and Type 2 Diabetes

There are two types of diabetes – Type 1 and Type 2:

  • Type 1 is often diagnosed in children and young adults. It is the result of an autoimmune response against the cells that produce insulin. Since the body doesn’t produce insulin in individuals with Type 1 diabetes, the only treatment is insulin.

  • Type 2 is most commonly diagnosed in adults, and is typically caused by multiple factors, including weight, age, inactivity and genetics. Type 2 diabetes accounts for approximately 90 to 95 percent of all diagnosed cases of the disease.

There are many steps health care providers can take with their patients to prevent diabetes, or to control the disease once it is diagnosed, avoiding the potential health consequences—and associated costs—that can result when diabetes is left uncontrolled.

Diagnosing Type 2 Diabetes

The symptoms of Type 2 diabetes can be so mild – thirst, frequent urination, blurry vision, general fatigue – that the patient may not even notice them.

A diagnosis of Type 2 diabetes or prediabetes is confirmed by a simple hemoglobin A1C blood test. It provides a view of the patient’s sugar level for a period of two to three months.

The A1C is commonly done in conjunction with annual checkups or wellness screenings—another reason for plan sponsors to encourage members to get regular screenings.

Today, more health plans are making wellness visits easier to access and more convenient by giving members the option to do them virtually or by rewarding them with financial and other incentives.

Type 2 Diabetes Complications

Type 2 diabetes is often characterized as “insulin resistance,” where the insulin found naturally in our body is not as effective as it should be in managing glucose levels. As glucose serves as an energy source for the entire body, if not regulated properly, it can impact many of the body’s systems. This can result in complications or secondary conditions for patients, including neuropathy—or nerve damage and loss of sensation in the hands, legs and feet. Damage to the tissue at the back of the eye that can lead to blindness, called retinopathy. And, diminished kidney function called nephropathy.

Patients with type 2 diabetes are also at twice the risk of both heart attacks and strokes than the general population. All these complications can lead to downstream costs that negatively impact patients and their plans.

Treating Type 2 Diabetes

Treatment for Type 2 diabetes includes diet, exercise, medications, and ultimately insulin if it cannot be controlled through other means. A common cause is often excess weight and inactivity. So, a focus on healthy living is essential to any diabetic treatment plan.

Unfortunately, lifestyle changes can be challenging to maintain. Many plan sponsors are giving members access to digital engagement tools that personalize their journey to better nutrition, exercise, and weight loss. This includes digital coaching and education as well as active and connected blood sugar monitoring that enables physicians and pharmacists to track and analyze blood glucose readings to provide proactive and meaningful patient interventions. These types of tools are proven to be effective and lower overall cost-of-care.

If patients can’t control their target blood sugar level with diet and exercise, there are a whole host of medications doctors can prescribe to help patients manage or control their diabetes depending on their individual circumstances. But they come with cost challenges for patients and plans.

When you consider that 1 in 10 adults ration their medicine because of the cost, innovative programs that cap the cost of insulin for up to a 34-day supply can improve predictability and therefore encourage adherence.

Other advances in pharmaceuticals are making treatment for individuals with Type 2 diabetes who need insulin therapy more affordable for both patients and plans. Earlier this year, the FDA approved the first interchangeable biosimilar insulin product for treating diabetes in adults, giving millions of Americans access to a safe, effective and clinically equivalent alternative to a high-priced biologic medicine. Biosimilars can result in considerable savings through direct cost savings and competition that encourages lower prices for patients, employers and health plans.

Lastly, it is important with any chronic condition to address the patient’s mental health. According to the CDC, people who suffer from diabetes are two to three times more likely to have depression than people without diabetes. Struggling with depression, or another mental health problem, could make it harder for the patient to stick to a diabetes care plan. Getting people with diabetes the mental health support they may need is another important component of helping them control the factors contributing to their condition.

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See how our solutions can help
Express Scripts PBM Patient Assurance Program
The Patient Assurance program protects patients from high out-of-pocket costs, capping member copays at $25 for up to a 34-day supply of select diabetes medications. Beginning January 1, 2022, the program will expand to include select cardiovascular medications that have been proven to reduce the risk of stroke.

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