January 20, 2017
There are about 26 million people with diabetes in the United States. That’s a lot of people!
But this number is dwarfed by the more than 86 million who currently have a precursor to diabetes called pre-diabetes; most of whom are not even aware of it. Evidence tells us that most of these 86 million will progress to diabetes within a decade if lifestyle changes don’t occur.
As a review, pre-diabetes is a medically defined condition: a fasting blood glucose level of 100-125 mg/dl or a glycated hemoglobin (A1C) test result of 5.7-6.4. Both of these levels are also referred to as “impaired glucose tolerance”… which means that the pancreas is stressed and not able to keep up the production of sufficient insulin to maintain a normal glucose level.
Because pre-diabetes often progresses, over time, to diabetes, the CDC started a study called the Diabetes Prevention Study nearly two decades ago that proved lifestyle change, and not medication, was the best approach to reversing the pre-diabetic state. But, little substantial progress has been made in stemming this oncoming Tsunami.
All of the pre-diabetes programs are based on a Diabetes Prevention Study done more than 15 years ago. In 2016, CMS announced that they will start to reimburse recognized diabetes prevention programs based on this study starting January 2018. This announcement has generated significant interest nationwide including “marketplace” companies such as Equity Health and Solera Health.
Interestingly, the YMCA has led much of the focus on diabetes prevention. Currently 252 YMCAs offer the group meetings, typically 15 people at a time who meet in person for one year in order to learn strategies to improve nutrition and increase activity. The YMCAs led by the Y-USA in Chicago, have become critical partners with the CDC on helping stem this tide.
As bullish as I am on technology, I also like the idea of “old-school” group meetings—there is an enormous body of evidence in medical literature that people are motivated to change while participating in groups. But in total, these 252 participating YMCAs have only served about 50,000 people. Their results are amazing, but at this rate, cannot even keep up with the absolute number entering a pre-diabetic state each year.
A visionary leader in Kansas City, John Mikos, realized several years ago that for the DPPs to work they needed to scale, and that meant using digital medicine. John is the executive vice president and chief operating officer of the YMCA of Greater Kansas City. Recognizing the vital need to scale the success of the diabetes prevention programs delivered by his team John began investigating how technology might provide scale and the ability to “meet people where they are.”
He recently announced that he is partnering with Noom, a behavior change company that offers structured programs to treat chronic and pre-chronic conditions spanning the acuity spectrum—including the Diabetes Prevention Program (DPP).
The exact plans are still in the works, but essentially the idea is to pair the Noom digital platform with the YMCA coaches. Using Noom’s mobile app—Noom Coach—YMCA participants will be able to track their physical activity, log their meals, receive ongoing support from their health coach and peer group as well as read DPP curriculum content. With support from Noom’s coach dashboard, YMCA coaches will be able to see behavioral patterns and trends surrounding each participant's actions as well as granular details such as the nutrient content of specific food choices.
This will allow coaches to interact and intervene in real-time, giving feedback at moments of greatest impact which allows for significant scalability and flexibility in delivering the program across large populations. Mikos is also looking into utilizing cloud-based communication strategy to obtain referrals from and provide feedback to the referring physicians, the main source of participants in the YMCA DPPs.
But, the YMCA is not just stopping at pre-diabetes. They are also in the midst in working with Noom on how to leverage Noom’s technology in other chronic illnesses.
Medicine is a local issue. The YMCA’s have a 165-year history of helping people in the United States—including me. I basically grew up in a YCMA a few blocks from my home in Tarentum, Pennsylvania. The YMCA’s have a footprint in thousands of communities in the United States and this partnership has the potential of helping not just thousands, but millions of people facing a future dealing with type 2 diabetes.
And for that, I commend John Mikos in pursuing a hybrid approach— an approach that offers the best of many worlds!