·
Spending on diabetes
drugs in the U.S. reached $53.7 billion last year, more than double what it was
in 2013.
·
Roughly 100 million
Americans have diabetes or prediabetes.
·
The Fresh Food Farmacy
program, being tested by Geisinger Health System in Pennsylvania, which
includes education and free nutritious meals, can lower diabetes treatment
costs by 80 percent.
·
The high-fat,
low-carbohydrate ketogenic diet is being used by new health-care start-up Virta
Health, which aims to treat 100 million patients by 2025.
Meg
Tirrell | Jodi Gralnick
June 21, 2018
At first glance Sami
Inkinen, an elite triathlete and co-founder of the real estate company Trulia,
and Rita Perkins, a grandmother of eight in central Pennsylvania, have little
in common.
But they do share one
thing: Both have grappled with diabetes.
"I thought, This
is absolutely nuts," Inkinen recalled of his diagnosis with prediabetes.
"It was really a personal experience and a shocking experience that a
world-class triathlete can become type 2 diabetic or prediabetic."
For Perkins it was
less of a surprise. Diabetes ran in her family, she said, and her weight had
reached 300 pounds before she lost about 100 just through increased walking.
But her diet was still bad, and she struggled to control her blood sugar.
Now things have turned
around for both Perkins and Inkinen. And their paths were both through food.
In Shamokin,
Pennsylvania, about 75 miles northwest of Allentown, Geisinger Health System is
trying something new for some of its diabetes patients.
Instead of relying
solely on drugs to manage the disease, doctors are writing prescriptions for
certain patients to enter its Fresh Food Farmacy program: 15 hours of education
about diabetes and healthier living, followed by 10 free nutritious meals a
week for participants and their families.
"In health care
we spend an awful lot on drugs and devices because it's business," said
Dr. Andrea Feinberg, Geisinger's medical director of health and wellness.
"But we spend a very small amount on preventive medicine. … It's sort of
like we're upside down and backward."
The program targets
people with diabetes and food insecurity, those for whom it's not always clear
where the next meal will come from.
"We understand
the relationship of food insecurity and the impact that poverty has on
developing certain lifestyle conditions, like type 2 diabetes," Feinberg
said. She added that the goal is "to diminish complications of diabetes
and also close the meal gap to end hunger."
The program, started
18 months ago, is a partnership with the Pennsylvania Food Bank. So far, it's
enrolled 150 patients, feeding a total of about 450 people a week.
Food as a
specialty drug for diabetes and the heart
Rita Perkins, her
husband and three grandchildren who live with them are among those families.
For Perkins the program has been transformative.
Each week, she visits
the Farmacy and picks out food with guidance from a nutritionist. Perkins said
the food, along with what she learned in the course about managing diabetes,
has changed not just her approach to eating but also her family's.
"Before, I'd
never buy this stuff; I would never buy fresh fruit," Perkins recalled.
"Money was tight. And now since I get this stuff for free, I can put it on
the table for the kids."
Since she started the
program, Perkins said her weight has dropped to 134 from 179. She walks all
over town and said her doctors are evaluating the doses of her diabetes
medications. Her blood sugar, measured by an A1C test, has been a steady 5.8
percent for the last six months (normal A1C, according to the National
Institutes of Health, is below 5.7 percent).
Those results aren't
atypical. On average, patients in the
program have seen their A1C levels drop from a pre-enrollment
level of 9.6 percent to 7.5 percent, Feinberg and colleagues wrote in an April
article in NEJM Catalyst that they called "Prescribing Food as a Specialty
Drug."
"Clinically, we
see great outcomes," Feinberg told CNBC. "The impact is that we
really know long-term that we'll see a decrease in incidence of heart disease,
the No. 1 killer here in the United States, because if you improve
the diabetes, improve your cardiac risk factors, you have less heart disease as
well."
The program also
should save money. With operational costs of $2,400 per patient each year,
early findings show costs for patients in Geisinger Health Plan dropped by 80
percent: from an average of $240,000 per member per year, to $48,000 per member
per year.
"If a new
diabetes drug became available that could double the effectiveness of glucose
control, it would likely be priced considerably higher than $6 per week (and if
it wasn't, the pharmaceutical firm's stockholders would be in revolt),"
Feinberg and her colleagues wrote.
Indeed, spending on
diabetes drugs in the United States reached $53.7 billion last year, more than
double what it was in 2013. The number of prescriptions in that time rose 18
percent, to 227 million, according to data from industry researcher IQVIA.
Ketogenic
diet led to drop in blood glucose, weight and drug usage
Almost 3,000 miles
away, in San Francisco, Inkinen got his startling diagnosis: He was pre-diabetic even as he set
records in endurance sports (in 2014 he and his wife rowed
across the Pacific Ocean, from California to Hawaii, he said on his blog: 2,750
miles in 45 days and 3 hours, setting a speed world
record for two people.)
His solution? The
ketogenic diet, a high-fat,
low-carbohydrate way of eating that's enraptured many in
Silicon Valley.
"There is a way
to reduce insulin resistance without exercise, without dieting or without
bariatric surgery, using the traditional ketosis," Inkinen told CNBC.
"But to deliver this type of treatment, you would need technology and the
ability to continuously monitor and deliver care."
Inkinen's online real
estate information company, Trulia, was sold
in 2014 to Zillow for $3.5 billion. So naturally, the next step for
Inkinen was to start a new company. He teamed with a doctor and a scientist,
Stephen Phinney and Jeff Volek, and founded Virta Health.
Virta connects
patients virtually with doctors and coaches who help tailor the ketogenic diet
to their lifestyles and monitor certain biomarkers daily.
In a trial of about
260 patients, published last year in JMIR Diabetes, Virta's treatment led to reductions
in blood glucose, weight and use of diabetes medication after
10 weeks. After a year A1C levels were down an average of 1.3 percent, diabetes medication
usage was down 48 percent, and body weight was down 12 percent.
To cardiologist Ethan
Weiss, who sits on Virta's scientific advisory board, the outcomes are strong
enough to recommend the program to his patients.
"For people with
type 2 diabetes headed toward bariatric surgery, to have this result, that
they're coming off almost all insulin, coming down on almost all other diabetes
medicines, losing weight, feeling like they control their diet, I think it's an
awesome thing to recommend," said Weiss, an associate professor of
medicine at the University of California San Francisco.
While most of the
metrics move dramatically in the right direction — Inkinen says 60 percent of
patients see their diabetes reversed in a span of between two and nine months —
Weiss notes one data point that may not. Levels of LDL, or so-called bad
cholesterol, appear to rise on the ketogenic diet. But he notes a distinction
in the type of LDL that goes up, saying it may not be the type that leads to
clogged arteries. And he says LDL levels can be controlled with drugs called
statins, like Lipitor, if that's a concern (though he said to him it's not).
Virta's program, which
costs $370 a month after a $500 initiation fee if patients pay out of pocket,
also saves money, according to Inkinen, who estimates an average savings of
$9,600 per patient in the first 24 months in drug and medical costs. After the
first year the cost drops to $199 a month.
The company is working
to expand to more coverage from insurers and employers, with the goal of
reversing diabetes in 100 million people by 2025.
That's about the
number of Americans with
diabetes or prediabetes, according to the Centers for Disease
Control and Prevention.
As usage — and costs —
of diabetes medicines rise, both Geisinger and Virta are showing that food,
along with a healthy dose of education and support, can go a long way in
changing the course of this disease.
— Additional reporting by CNBC Producer Karen Stern
https://www.cnbc.com/2018/06/20/diabetes-defeated-by-diet-new-fresh-food-prescriptions-beat-drugs.html?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202018-06-21%20Healthcare%20Dive%20%5Bissue:15878%5D&utm_term=Healthcare%20Dive
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