With headlines like “Economic plague of death, despair, diabetes, and obesity”, it is no surprise that the public is fearful of the future. And we should be worried. Diabetics have a higher risk of death, heart attack, stroke, amputations, cancer, depression, blindness, birth defects and more.
Beyond the human cost that diabetes is having on society, the financial impact on insurers is significant. There is a huge amount of money being paid out against diabetes on life cover, critical illness, disability income and, of course, medical expenses. Add to that increased likelihood of depression and of absenteeism, and the indirect costs really mount up too.
Here are five big surprises the insurance industry needs to know about diabetes:
1. It’s big, and getting much bigger
WHO statistics reveal that there were nearly half a billion diabetics in 2014, up from around 100 million in 1980, and the number has climbed higher in 2017. The problem is actually worse as there is a large proportion of people with “pre-diabetes” which, in many countries, is estimated to be half of the entire population. Although it is a “pre-” condition, the situation is not comforting as pre-diabetics also suffer from an increased risk of death and health problems, and are likely to progress to full-blown diabetes.
Diabetes is so severe it has even started to impact global mortality trends, according to “Emphasis Magazine” by Willis Towers Watson this year. Mortality improvements have now stalled in many countries, and diabetes and Alzheimer’s have been identified as part of the problem. Interestingly, Alzheimer’s is now being seen as Type 3 diabetes, since it is associated with insulin insensitivity of the brain - and thus both conditions are related.
The Middle East faces the same problem. The number of diabetics in the region has more than doubled from around 6% of adults in 1980 to over 14% now. In Qatar and Kuwait, over 20% of the population is estimated to be diabetic, with the percentage reaching over 30% in the elderly.
2. Professionals cannot even agree what causes it
In simple terms, diabetes is a problem where the body doesn’t produce enough insulin to regulate blood sugar, or is not able to fully use the insulin which the body does produce. In even simpler terms, diabetes is a condition of excess carbohydrates. It really does come down to that.
Unfortunately for the past few decades, medical science had it completely wrong. It began when Ancel Keys published a study in the 1950s which, through selective data usage, incorrectly implied that fat causes heart attacks.
Governments over-reacted and pushed us towards “low fat” diets, recommending we should be eating carbs instead. As insulin is produced by the body to metabolise carbs, this dietary shift (including all the added high fructose corn syrup) put a heavy strain on the pancreas, leaving it less able to produce insulin.
Further, in response to the excess levels of insulin, the body makes itself less sensitive to insulin as a protection mechanism – which means the body then needs even more insulin to achieve the same effect. By this stage, the inflammatory nature of insulin would have played havoc in the body, resulting in death, heart attacks, strokes, cancer and depression.
For healthy people, this vicious cycle is progressive, and diabetes is the outcome. But for diabetics, who are still being advised to follow high-carb diets, this is deadly.
The evidence is clear – we can no longer classify diabetes as a result of obesity. Rather we now know that both diabetes and obesity are caused by excessive carb consumption. And this is the problem we have to address.
3. It is expensive, and it is getting more expensive
In the US alone, the estimated cost of diabetes in 2012 was $245 billion, with the additional cost of 113 million days off work due to the disease.
While carb consumption and insulin usage continue to spiral, pharmaceutical companies are selling more drugs and devices for treating diabetes, obesity and related conditions.
But who’s paying for the spiralling bills? Certainly governments pay some of it, insurers pay large amounts, and sadly because of limits on both, much of the costs fall on the diabetic patients as out-of-pocket expenses. This is not sustainable for anyone.
4. “It is incurable”, but that is not true
We have been told for a long time that diabetes is incurable and progressive. And yet when we hear from doctors who specialise in patients with obesity and diabetes, like Dr Jason Fung (author of The Obesity Code) and Dr Sarah Hallberg (who gave a popular TEDx talk on this), we see that diabetes in many or most cases is curable to the extent where patients no longer need diabetes medication. Generally diabetes is only progressive when you follow the advice of the vicious cycle of high carb intake and insulin.
Both experts use carb restriction as their first approach with their patients. According to Dr Hallberg: “Low carb intervention works so fast that we can literally pull people off 100s of units of insulin in days to weeks” – resulting savings of thousands of dollars a year per patient.
Each week, more doctors are announcing that they too have been using carb restriction with their diabetes patients and are getting great results. And more individuals are adopting low carbs, high fat (#LCHF) diets, losing weight and reducing their diabetes medications. And the positive results from scientific studies keep pouring in from around the world, including doctors and researchers like Dr Tim Noakes, Gary Taubes, Nina Teicholz and Dr Aseem Malhotra.
Returning to the insurance sector, recently in the UK’s “The Actuary” magazine there was an interview with Swiss Re’s global Chief Medical Officer, Dr John Schoonbee, who was very clear in his support for a #LCHF diet.
5. Current treatment protocols and dietary advice are a bigger problem than the problem
If the evidence is so clear about preventing and curing diabetes, and if this could save billions of dollars a year, why aren’t insurers actively promoting this updated set of nutrition guidelines?
As decades of “accepted wisdom” are being challenged, a frightening picture emerges. Almost weekly we see articles about how Coca-Cola and Pepsi have funded almost 100 health organisations over years, including the Diabetes Research Foundation.
And other articles show that pharmaceutical companies are paying billions annually to doctors to promote drugs; and an increasing number of authors of “independent” research into nutrition are having their conflicts of interest revealed.
A lot more research has to be done before we can point fingers, but regardless of the vested interest that Big Pharma and Big Sugar may have in the vicious cycle that fuels obesity and death, the insurance industry’s vested interests are the opposite: we actually benefit if we can keep our policyholders healthy and alive.
And so …
If we carry on this trajectory, the human cost to society and the financial cost to insurers and governments will go from bad to worse.
Yet if we get this right, if as an industry we sponsor research with a vested interest in curing rather than sustaining diabetes, the positive impact will be significant.
In the meantime, much has to change. For example, we need to stop recommending low-fat diets in our wellness programmes. We also need an overhaul of the reinsurers’ medical underwriting manuals – with a greater emphasis on insulin sensitivity and inflammation.
But first, we need to change our own lifestyle habits so that we ourselves do not become part of the “diabetes plague” that was referred to at the start of this article. M
Mr Greg Solomon is Managing Director and Head of Life & Health Reinsurance Broking at Willis Re, part of the Willis Towers Watson group.