America is facing a largely hidden and mostly ignored metabolic health crisis. Although 88% of Americans have clinical criteria for being metabolically unhealthy, many people have never heard the term “metabolic disease.” Why? Even though it plays a central role in a wide range of common diseases –- including diabetes, stroke, heart disease, Alzheimer’s dementia, cancer, gout, erectile dysfunction, infertility, depression, gout, and more – the U.S. healthcare system is abysmal at recognizing or managing it. Abysmal is not an exaggeration: in this study of 21,488 patients, zero (yes, zero) people received appropriate treatment for prediabetes, a form of metabolic dysfunction.
What is metabolic dysfunction? It is a fundamental problem with how the body processes or stores energy and is largely a result of the modern Western diet and lifestyle. And it’s taking our lives: it contributes to 9 of the 10 leading causes of death in the U.S. and is a central player in declining male and female fertility. One of its telltale signs is elevated blood sugar levels, a signal that the body is not efficiently using glucose, one of the primary energy fuels for all the cells in our body.
While 13% of American adults have diabetes, the condition of severe blood sugar dysfunction, more than 40% have higher-than-normal blood sugar levels, a condition called prediabetes. And nearly a quarter of 12-19-year-olds now have prediabetes as well. Indeed, prediabetes and full-blown diabetes are so common among teenagers these days that it has made the term “adult-onset diabetes” obsolete.
The Measurement Tools Exist. Let’s Use Them
Unfortunately, the reactive provision of healthcare in the United States focuses on treating medical disorders once they have arisen. As an example, providers typically don’t treat high blood sugar until it progresses to Type 2 diabetes. Nor do we encourage people to pay attention to their own blood sugar levels until they become sick. This is why tools for tracking and improving blood sugar, like continuous glucose monitors (CGMs), are only FDA-approved for people who have already been diagnosed with diabetes. This approach of waiting until people are flagrantly ill to treat a problem is like having a fuel gauge in your car that only comes on when you’re out of gas.
Many doctors don’t see this approach as backward because we are explicitly trained to practice reactionary, sick-care medicine. With 90% of our $4 trillion in healthcare costs tied to largely preventable chronic conditions—most downstream from metabolic dysfunction—we should engage every prevention and risk mitigation strategy possible. Clearly, one of the best ways to do this is to measure and track biomarkers known to be associated with risk for chronic disease, so we can catch things early and institute aggressive lifestyle strategies to avoid disease.
The concept of providing tools like CGMs before the onset of disease sometimes gets an eye roll, even from physicians. Some feel that giving people early insight into metabolic biomarkers is useless, dangerous, not evidence-based, or “for fun,” as one prominent endocrinologist said. This approach is irresponsible and short-sighted in its assumption that patients can’t handle more health information about their bodies. (It also conflicts with the growth in wearables showing people are seeking more information about their bodies.)
Ironically, the moment patients cross the threshold into Type 2 diabetes, then they suddenly get access to this data via CGMs and are instructed to track it and learn from its insights to adjust their diets and medication management. Instead, why not try to prevent many of these diagnoses in the first place by providing data years earlier so patients can make appropriate and effective diet and lifestyle changes?
Today, glucose measurements are done at the doctor’s office and are a limited-use point-in-time metric: they tell us what’s happening right now but nothing about what’s causing that level or how it’s changing. The process that leads to diabetes can start more than a decade before elevated blood sugar levels show up on standard glucose tests. By that point, severe dysfunction has set in.
That is if our providers screen us. More than 84% of people with prediabetes don’t know they have it. In one study, fewer than two-thirds of patients get screened for prediabetes despite being eligible for testing under U.S. Preventive Services Task Force (USPSTF) guidelines. Of those screened, one-quarter met the requirements for diagnosis. But only 5% were diagnosed. None received appropriate treatment. Worse, as much as 20% of people with full-blown diabetes are undiagnosed.
The Case for Introducing CGMs to Healthy Individuals
A key way we shift to a truly preventative model of health care is to empower people with tools, such as CGMs, that allow them to make tailored individual decisions that stop the progression of disease.
Naysayers of the broader use of CGMs cite the price tag, despite diabetes accounting for nearly 1 in every 4 dollars spent on healthcare, and people diagnosed with diabetes incur almost $10,000 in medical costs per year for related care and treatment. In 2017, diagnosed diabetes cost an estimated $327 billion in medical expenditures and lost productivity in the U.S., according to the American Diabetes Association. That amount doesn’t include the cost of treating other conditions linked to poor metabolic health and diabetes, such as mood disorders, infertility, Alzheimer’s, erectile dysfunction, cardiovascular disease, and cancer.
We have the opportunity to acquire and utilize fundamentally important, actionable data that can positively impact the largest health scourge plaguing us globally. It’s time we all become familiar with the term “metabolic health” as our key health priority, get out of reactive crisis mode, and embrace being proactive and preventive through health empowerment.