Over a year ago, I wrote that things could be different, but as the world's obesity crisis worsens, the diabetes prevalence continues to grow in its wake. Swiss Re's Trend Spotlight on diabetes released this week talks about the growing size of this deadly triple threat and what it means for insurers.
The world refers to this disease as "chronic" and "progressive" but I would argue that it's our management – or mis-management -- of the disease that makes it so.
What we eat matters more
The root causes of obesity and type 2 diabetes are physiologically similar. The same increased insulin levels that drive fat storage, increase weight and lead to obesity, also drive fat storage in the liver and pancreas which lowers the insulin response to reduce blood sugar and eventually even reduces insulin secretion. Therefore, what we eat and how our diet affects insulin levels, becomes critical in how to address not only obesity but also type 2 diabetes.
The current medical paradigm and understanding of this disease that we have been taught for decades (and astonishingly, are still being taught) is to primarily use pharmacology to keep blood glucose "under control". We make the body more sensitive to insulin, and eventually give additional exogenous insulin as well. Said another way – we increase sensitivity to, and increase the level of, the key molecule that drives both obesity and diabetes.
This is a flawed paradigm and that's good news
There is a growing group of frustrated physicians who for many years have refused to accept the status quo of seeing their diabetic patients getting progressively worse. These doctors have begun to challenge conventional nutritional advice and are going back to first principles of root cause. What they have seen time and time again is their obese type 2 diabetic patients are able to lose weight, reduce or stop their medications entirely, and the majority have normal blood glucose levels. But anecdotes only are not good enough for evidence-based medicine.
However a number of studies have recently shown that diabetes can change direction by changing nutrition in order to lower insulin levels. What exactly constitutes a cure (or reversal or remission) is yet to be defined. But let's not get tripped up on the language – what's clear is that previously diagnosed type 2 diabetics on medications (many on insulin) have been shown to change the course of their disease to such a degree that they reduce or completely cease all diabetic medications, and a significant portion end up with normal blood sugar levels. By current clinical standards and testing they would be classified as "non-diabetics".
A study by Dr David Unwin et al. shows how 68 of his metabolically diseased patients (including pre and diabetic) showed remarkable improvement in weight, blood glucose and other parameters by changing their nutrition.
A more recent landmark study published in the Lancet in December 2017, and presented at the International Diabetic Federation Conference in November, was titled : "Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial".
Using "remission" and "type 2 diabetes" in the same breath is groundbreaking!
The study showed that at 12 months 46% of type 2 diabetics in the intervention group were in "remission", defined in the study as an HbA1c of less than 6.5% and off all diabetic medications. Higher weight loss (%) led to even higher rates of remission which reaffirms the root cause of raised insulin.
The study concludes: "Remission of type 2 diabetes is a practical target for primary care." A new paradigm indeed!
Swiss Re has partnered with the British Medical Journal to support their quest to drive better evidence in nutrition science. We are sponsoring 12 key articles in nutrition and are hosting a top international event to launch these articles in June. This includes 200 top experts who will discuss, debate and determine the
way forward to drive the best evidence which, in turn, drives better policy.
We'll follow this with a "Redefining Diabetes" event including research, clinical, and behavioural experts and companies who are helping to drive this change through various mediums with diabetic and obese patients.
Swiss Re has invested much time and many resources into how we can improve the health of people with type 2 and pre-diabetes. We have found the best partners, linked in the 100s of clinicians around the world who are improving the lives of their type 2 diabetic patients. We have modelled the impact of these
new strategies on sample portfolios, and have solutions ready to roll out to our clients. For diabetic or obese policyholders (and their insurers) this could be magic!
Category: Funding longer lives: Health/medicine, Longevity risk