Silent, Sweeping, Stoppable

I’m not an alarmist kind of guy, but I do believe in being proactive. Millions of Americans are developing a dangerous disease and many of them don’t know it. That’s the bad news. The good news is that its progression — once considered inevitable — can be halted or even reversed.

Patients predisposed to or diagnosed with prediabetes are not automatically destined to become diabetic.

There is no cure for diabetes, the chronic condition marked by high levels of blood sugar (aka glucose). Basically, it’s a metabolic disorder that occurs when your body stops appropriately using insulin, the hormone produced by the pancreas to regulate blood glucose and assist in breaking down fats and proteins for energy. Early symptoms can be hard to spot and are often masked among ordinary stresses of modern life.

Untreated diabetes is no joke. It results in damage to all parts of the cardiovascular system. Long-term complications include vision impairment, nervous system problems, and even kidney damage, heart disease, surgical amputation, and stroke. Type 2 diabetes (aka diabetes mellitus type 2) is the most common form of the disease. Diabetes is also often the first in a progression of other chronic conditions, such as coronary heart disease. So it is important to stop diabetes before it happens.

Prediabetes is a condition where you have a higher blood glucose level than normal, but not high enough to be type 2 diabetes. People who develop type 2 diabetes usually have prediabetes first.

The Centers for Disease Control (CDC) estimates that there are over 84 million Americans who have prediabetes — that’s one in every three adults — and that would be considered an epidemic. In my own practice, I’ve seen the numbers rise even over just the past few years. Anywhere from 30 to 50 percent of my patients have prediabetes.

There are many factors that lead to prediabetes, including:

•       genetics (a predisposition that runs in the family)

•       being overweight

•       having high blood pressure

•       not getting enough exercise

You can’t change your genetic makeup, but other predisposition factors can be addressed to reverse prediabetes and prevent the onset of type 2 diabetes.

Prediabetes generally develops from lifestyle behaviors adopted over a long period of time. The best course for reversal is to adjust that lifestyle and change those behaviors. But that’s also a long-term proposition. You can’t take a 10-day course of imaginary anti-prediabetes tablets and fix the problem. You have to lose weight, improve diet, and get enough exercise — and sustain that new lifestyle in perpetuity.

That such a common-sense prescription for health may sound very daunting to a lot of people is indicative of the source of the problem. The behavioral issues driving this epidemic undoubtedly stem from cultural changes associated with the pace of contemporary life. It shouldn’t be so difficult to eat well and exercise moderately for a third of the country — but it really is. This is reflected in the surge in metabolic disease incidence. Diabetes was a rare disease 100 years ago (pretty rare even 50 years ago). Now it’s everywhere.

Diabetes prevention programs (DPP) are evidence-based and effective iterations of the methodology for addressing prediabetes developed by the Centers for Disease Control (CDC). Using a combination of techniques focusing on lifestyle management, stress mitigation, diet and nutritional coaching, and community support — it helps people prevent diabetes before it even starts. DPP has proven to be very successful. In fact, the DPP is even more successful than prescribing medication such as Metformin, which is the world’s most widely used anti-diabetic drug.

One of the keys to its success is that people respond to other people. In-person coaching and the community involvement aspect of the program separate it from the host of failed diets and fad exercise regimens that simply aren’t sustainable for most folks.

That’s where First Mile Care comes in.

The greatest barrier to better prediabetes treatment from a doctor’s perspective is that need for the human touch. I’m only one person and I’m already counseling my patients about better diet and exercise when I see them — but I see them only once a month, if I’m lucky. I don’t have the same ability that First Mile Care does to reach into my patient’s local community and work with them face-to-face each week. That’s what it takes — weekly support and reinforcement to create new, healthy habits. By working with First Mile Care in this way, they become an extension of my practice and my care team. Constant reinforcement really removes barriers to effective treatment. When I prescribe DPP, I know that my patient is going to be getting access to a lot more resources from First Mile Care than I could personally provide or than they could ever find themselves.

When you have an in-person coach and the friendship and support of other people with prediabetes, it makes a huge impact in helping a person sustain positive changes in their lives — and it’s actually kind of fun.

Convenience is key

When it comes to combatting prediabetes, I can’t do it alone — and my patients shouldn’t have to either. That’s where First Mile Care bridges the gap.

First Mile Care leverages the power and convenience of our on-demand culture with an affordable, scalable, and sustainable platform to bring DPP to anyone at risk of diabetes. First Mile Care fosters community-based, peer-to-peer connections that provide individuals with the support system and guidance they need — and they do it in the settings where people actually make lifestyle choices. It’s focus on convenience, strategic support, personal connection, and sustainable lifestyle enhancement makes DPP convenient and enjoyable. So it sets patients up for success.

And it’s setting doctors up to help stop prediabetes in its tracks.