Type 2 diabetes’ enormous impact on the U.S. health system is well known — millions of Americans experience declining health and increased healthcare costs each year as a result of the epidemic and chronic disease. According to the CDC, diabetes costs $327 billion annually, with the total cost increasing by 60% from 2007 to 2017. Most of these are direct medical costs from medication or care for symptoms of illness.
To the dismay of those concerned with diabetes care, it’s not a mysterious, misunderstood disease. The risk factors behind diabetes, the link between the disease and diet and activity levels, and ways to slow its progression through lifestyle choices are well known and supported by decades of research. But still, the way we treat diabetes doesn’t match what we know causes it.
Typically, the primary form of treatment offered to people with diabetes is pharmacology. While we have incredibly innovative and effective drugs that reduce diabetes symptoms, they so far fail to address the underlying causes of the disease. This means that without accompanying lifestyle changes, patients will inevitably be on a path to disease progression, leading to more adverse events, increased drug use, and increased healthcare costs.
This pattern is at odds with what we know about how best to treat type 2 diabetes, and leaves patients failing and providers without the tools they need. In fact, the issue is so critical that the American Diabetes Association has recommended a new standard of care, calling for the use of mobile apps and digital solutions for treatments like behavioral counseling and lifestyle changes as first-line treatments. So why isn’t this an experience for the millions of people with the disease?
In short, it’s a challenge of scale. Making lifestyle changes at the best of times can be difficult, let alone dealing with chronic disease. People need support to change long-term eating and exercise habits, and with so many people living with diabetes and many other cardiometabolic diseases, providing one-on-one support is often impossible, especially when Primary care physicians in the model were most likely to oversee diabetes care.
But the good news is that there may be another option—using technology to scale up the delivery of behavioral therapy to people with type 2 diabetes. Prescribing digital therapies can and should be considered part of type 2 diabetes therapy because they can help provide the first line of defense required by current standards of care. Backed by clinical research and regulated by the FDA, these can be easily prescribed by doctors like any drug treatment and require only the smartphones that many of us use every day to provide always-on, tailored support that implants Proven Therapeutic Treatment (CBT) rooted in Cognitive Behaviour.
CBT has been used in psychological practice for decades to treat conditions ranging from anxiety and depression to addiction, as well as to help change nutrition and activity. Based on the concept of helping patients interrogate and understand the subconscious basis of habitual behavior, CBT has been shown to be an effective way to help people make healthier dietary choices, achieve glycemic control, and minimize the progression of cardiometabolic disease.
A growing number of prescription digital therapeutics for a variety of conditions, including cardiometabolic disease, will soon be available, and clinical trial data show that they do work. Organizations such as the American Diabetes Association have taken steps to update guidelines to include the use of these proven digital tools. While drugs are a key part of the type 2 diabetes treatment landscape, they have long been the exclusive and de facto first-line treatment. While they provide relief to patients, when used alone, they are also part of a cycle of increased costs and decreased health outcomes. Patients, physicians, payers, and the entire health system deserve better prescription digital therapies that can help patients take control of their cardiometabolic health, which could be part of the solution.
PHOTO: MURAT GOCMEN, GETTY IMAGES
