Modernizing Policy and Practice to Usher in a New Era of Care for People with Type 2 Diabetes

By Gregory Daniel, Ph.D., MPH

Lilly has been a global leader in diabetes care since 1923, when we introduced the world's first commercial insulin. Today, we are building upon our heritage by working to meet the diverse needs of people with type 1 and type 2 diabetes, which includes not only continued innovation to deliver increasingly advanced treatments but advocating for policy solutions that strengthen how our overall health system addresses diabetes and its prevention.

Type 2 diabetes is a growing epidemic and one of society’s greatest public health challenges. It affects nearly 30 million people, disproportionately impacts racial and ethnic minorities, and frequently leads to complications that include heart disease, stroke, high blood pressure, atherosclerosis and kidney disease. Approximately 88 million adults have prediabetes and up to 70% eventually develop diabetes. Further, it has been estimated that 40% of COVID-19 deaths were among people with diabetes.

With the extraordinary advancements in scientific understanding and medical innovation, care for type 2 diabetes has reached a new era. The availability of highly efficacious medicines, sophisticated glucose monitoring devices and digital tools from telehealth to app-based programs to data analytics that can help guide expert care, has the power to drive gold standard outcomes for all people with type 2 diabetes.

Yet, there has been little progress in the prevention and treatment of diabetes in the past decade. Effective glucose and weight management are key aspects of diabetes care, but only 50% of people with diabetes in the United States achieve their glucose level goals (measured by the HbA1c test). Only about 20% achieve combined HbA1c, blood pressure and cholesterol standards. Further, the most demographically and socioeconomically disadvantaged continue to experience the greatest impact and morbidity from the disease.

Numerous challenges exist that prevent bringing the full value of this new era of care to people with diabetes and those at high risk, including inconsistent use of diabetes care guidelines and aged quality metrics, stark health care inequities, fragmented care delivery, reluctance of health care professionals to intensify treatment when clinically indicated (“clinical inertia”), social determinants of health and gaps in preventive measures. Moreover, while there is clear evidence that reducing excess weight can help manage glucose levels, medical bias against obesity continues to be a barrier for effective care.

To fuel discussion and advance policy solutions, Lilly provided unrestricted support to Health Affairs, the leading publication in health policy research, to commission a series of studies by pre-eminent researchers to take a critical look at these challenges and provide concrete steps policymakers can take to solve them. Notable opportunities highlighted include:

• Expansion of value-based approaches including alternative payment models (APMS) and value-based insurance design (VBID) oriented toward prevention and control of type 2 diabetes

• Development and adoption of modern quality measures for diabetes and obesity

• Increased support for health care providers in underserved communities, including community health workers.

A consistent theme in these studies is the stark health disparities in type 2 diabetes. American Indians/Alaska Natives (14.7%), Hispanics (12.5%), African Americans (11.7%), Asians (9.2%) all have a greater prevalence of diabetes than their White (7.5%) counterparts. The impact of these disparities is further compounded by access to insurance and social determinants of health.

Modernizing the policy and practice of diabetes care has never been more urgent and these series of papers provide important solutions to get there. Making strides to improve outcomes for all patients with diabetes is within reach and doing so will have significant impact on reversing the ongoing trend of health inequity. Further, there is no proper policy discussion about type 2 diabetes that does not include its link to obesity. Obesity is the number one risk factor for diabetes, and it is estimated that 59% of adults around the world have overweight or obesity. Alarmingly, obesity rates for children are climbing. This link between the twin epidemics of diabetes and obesity prompted the World Health Organization to call it a “slow-motion disaster.”

The good news is that we have the tools and medical knowledge to fight type 2 diabetes. And, if we can muster the political will to solve the complex policy challenges to unlock the value of this new era of care for people who need it most, we can prevent this slow-motion disaster from happening.

Gregory Daniel, Ph.D., MPH, is the Associate Vice President and Global Head of Public Policy at Eli Lilly and Company