Global Differences and Interdisciplinary Collaboration: Asia
Understanding global differences is essential due to increasing population migration and diversity. Clinical aspects of T2DM vary in different populations and this understanding will enhance recognition of diabetes, including severity in North America.
Dr. Juliana Chan, a globally renowned diabetologist and the founder of the Asia Diabetes Foundation, has made many important contributions to diabetes research, care, and education.5 Her research identified that T2DM in the East Asian population differs from among those of European descent due to occurrence with lower body mass index (BMI), visceral adiposity with slimmer waist circumference, younger age of onset with early insulin resistance, early insulin treatment, and higher risk of complications including renal disease and cardiovascular complications.6) She led the 44‑member team of global experts in diabetes and public health that authored the 2020 “The Lancet Commission on Diabetes: Using data to transform diabetes care and patient lives”.7
Consider “Clusters of Comorbidities”
The impact of T2DM on mortality and morbidity should be considered as part of a tapestry of comorbidities including but not limited to obesity, hypertension, hyperlipidemia, cardiovascular disease, renal disease, obstructive sleep apnea, and psychiatric conditions. These comorbidities are causally interconnected and integrated assessment in medical care optimizes outcomes. Undiagnosed hyperglycemia may lead to organ damage and contribute to microvascular and macrovascular complications before T2DM is diagnosed.8
What Have we Learned?
Among the many things we have learned from more than a century of discovery are beneficial approaches to diagnosis and treatment of T2DM. Increased knowledge about T2DM has led to population screening, early diagnosis, and improved medical management and outcomes. For example, new treatments such as GLP‑1 agonists optimize diabetic control. Additionally, increasingly available are tools to optimize environmental factors such as diet and exercise via digital approaches and wearable technology. Efforts to decrease stigmatization continue as practitioners work to dispel the misperception that diabetes is caused solely by bad “habits”. This message is reinforced by knowing that diabetes is caused by complex interactions between thousands of genes and environmental factors, including prenatal factors. Global collaborations in research and education are increasing.
Despite these advancements, there is a need for ongoing vigilance in monitoring, studying, and educating people about the disease. Among the ongoing challenges are the increasing prevalence of obesity and other risk factors, such as diet, associated with the increasing prevalence of T2DM and comorbidities. The increasing prevalence of diabetes in children and adolescents aligns with the increasing incidence of childhood obesity. Ongoing disparities of access to medical care and treatment must be addressed, with particular attention to the high cost of insulin in some countries, which amplifies health risks and access disparities. More recently, in addition to the challenges presented by their high cost, off-label use of GLP‑1 agonists to treat obesity has created drug shortages for those with diabetes.
T2DM and comorbidities significantly impact population mortality, morbidity, and the economic burden on health care systems. T2DM represents a highly variable group of conditions; even with optimal management, complications and treatment challenges may occur.
What Have we Learned?
Insurers recognize the increasing need for internal and external multi-disciplinary collaboration. As part of their ongoing work in Life and Health markets, insurers should keep in mind the following forward-looking practices and suggestions regarding T2DM.
- Monitor the evolving prevalence and mortality/morbidity impact in an era of increasing underwriting acceleration
- Consider the effect of T2DM upon future Mortality Improvement Impact analyses
- Consider the population impact of innovations such as GLP‑1 agonists for weight loss
- Consider integrated “clusters” of disease (T2DM and comorbidities) for data analytics (actuarial, underwriting, and claims)
- Watch for opportunities
- New Product development targeted to diabetic applicants
- Wellness, including prevention
- Consider pricing
- Reassess current practices (e.g., Will pricing for BMI alone address the associated risk?)
- Consider risk stratification (e.g., can it be enhanced with wearables data?)
Enhancing population outcomes for diabetes will require global collaboration and ongoing public health interventions to address the challenges posed by this complex group of diseases.
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