AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE (Benjamin Franklin)

Benjamin Franklin was certainly not thinking about healthcare in the 21st century when he made this famous statement, but the quote still sums up what healthcare providers have learned and the resulting changes in the practice of medicine. You may have noticed that your primary care doctor, whether an internist, family practitioner or GP, has started to talk more about prevention at your appointments. If you have not experienced this yet, you will soon.

Many doctors are starting to stress preventative medicine over simply treating disease. Those that aren’t, should be. When possible, it is safer and more effective to prevent an illness than to treat it. Also, anyone who already has a chronic medical problem needs their treatment to include prevention of complications from their disease.

While it is true that there are now medications available to treat many conditions that had no good treatment in the past, which is a wonderful thing, that should not lull patients or healthcare providers into thinking that prevention is not important. A good example of this is type 2 diabetes. Diabetes can be treated but not cured. However, it is a preventable condition in many cases, because for many it can be avoided by maintaining a healthy weight, eating a healthy diet, and getting regular exercise. As difficult as this might seem at times, there is no risk to any of these lifestyle changes.

In fact, doctors will still tell person who has type 2 diabetes to do all these things anyway, in order to help control the disease with as little medication as possible. More often than not, people don’t follow the recommendations, and more drugs are needed. People whose diabetes is not under control often need multiple oral medications and sometimes even injectable insulin. All drugs have side effects. They also cost money, which as many people have experienced, falls more and more on the individual to pay for, as opposed to insurance picking up all the bills. Furthermore, even the best control of diabetes makes complications less likely, but does not eliminate them.

Diabetes is also a condition that can be predicted to a certain extent. Besides obesity and a sedentary lifestyle, other risk factors include a family history of type 2 diabetes, diabetes during pregnancy (gestational diabetes), and pre-diabetic conditions which can be called impaired fasting glucose or impaired glucose tolerance. Type 2 diabetes also frequently occurs in the company of other factors, including a large waist (central obesity), high blood fats called triglycerides, low good cholesterol (HDL), and high blood pressure, together called the metabolic syndrome. Has your doctor ever warned you of any of these?

Even with medical interventions, diabetics are at increased risk for many serious other problems.

These include:

  • Heart disease, which can lead to heart attacks, heart failure, and death.
  • Strokes, which if not fatal can leave a person with impairment of speech, movement, or other neurologic deficits.
  • Kidney failure, which may necessitate dialysis and can also be fatal.
  • Disease of other blood vessels, which can lead to loss of adequate blood supply to the feet and legs, at which point amputation may be necessary.
  • Nerve damage, called peripheral neuropathy, which is extremely painful and difficult to treat.
  • Damage to the blood vessels in the back of the eye, which can cause blindness. 

What sounds better, trying to lose the weight, eat healthy, and exercise, or not do any of that, become diabetic, take medications with their associated costs and side effects for the rest of your life, still be told to exercise and lose weight, and in the end wind up disabled or dead due to one or more of the complications of diabetes?

 Another way to look at prevention is thinking about what will happen if you are already diabetic and you don’t take care of yourself. If you follow your doctor’s advice and take prescribed medication, you may be able to prevent some of the complications. Wouldn’t you rather prevent kidney failure than be on dialysis? Wouldn’t you rather not have the pain of diabetic neuropathy when there is no good way to treat it?

Important Study on Prevention

A study published on April 17, 2014 in the prestigious New England Journal of Medicine demonstrates just how far medical science has come in terms of treating diabetes and preventing some of its complications. A lot of progress has been made. The article entitled “Changes in Diabetes-Related Complications in the United States, 1990-2010” outlines just how far the treatment of diabetes has come in terms of reducing the worst complications and outcomes, while at the same time noting that the rates of diabetes are going up, not down.

The researchers compiled data from a variety of reliable sources in order to come to conclusions. They could not separate type 1 and type 2 diabetes for the purpose of this study. Type 1 diabetes comes on earlier, does not usually run in families, always needs insulin, and in general is a more devastating disease than type 2. It cannot be prevented. Both types of diabetes can cause the same types of damage.

Rates of complication from diabetes have decreased fairly dramatically, including heart attacks, strokes, amputations, and end-stage kidney disease, with the greatest decrease in heart attacks.

There are a number of reasons why these complications are declining, including better treatment of diabetes as well as other so-called “co-morbid” conditions such as high blood pressure, elevated cholesterol and vascular disease; a decrease in the number of people smoking; possibly better eating habits; and possibly earlier diagnosis, among others.

However, even with all these improvements, the percent of people who have diabetes (called prevalence) in 2010 was three times as high as it was at the beginning of the study. This is what the authors call the “burden of disease” because diabetes is increasing, not decreasing.

More focus on the prevention of diabetes is critical 

Doctor ordered Prevention Method

Doctor ordered Prevention Method

So your doctor may be more vocal about trying to convince you to eat right, exercise, maintain a healthy weight, and stop smoking if you smoke, in the hopes of preventing not just diabetes but also heart attacks, strokes, and kidney failure, among other serious health problems.

Try and help protect yourself from many of these diseases, not just diabetes. Try and prevent complications from any illnesses you already have. Listen to your healthcare providers. Get educated, looking for reliable sources of information.

Medicine will continue shifting its focus toward prevention, which many people actually appreciate. In addition to the medical community and patients, health insurance companies, some employer groups, and federal programs like Medicare and the Affordable Care Act are also adding to this drive towards prevention.

 

References

Curious about your risk for type 2 diabetes? Take this quick test online from the American Diabetes Association.

http://www.diabetes.org/are-you-at-risk/diabetes-risk-test/

Changes in Diabetes-Related Complications in the United States, 1990–2010

Edward W. Gregg, Ph.D., Yanfeng Li, M.D., Jing Wang, M.D., Nilka Rios Burrows, M.P.H., Mohammed K. Ali, M.B., Ch.B., Deborah Rolka, M.S., Desmond E. Williams, M.D., Ph.D., and Linda Geiss, M.A. N Engl J Med 2014; 370:1514-1523. April 17, 2014

DOI: 10.1056/NEJMoa1310799

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