AMA takes aim at type 2 diabetes and cardiovascular disease

The American Medical Association’s role in addressing chronic health problems attracted a lot of attention in June, thanks to a decision by its policymaking body, the House of Delegates.

The vote by the assembled delegates to recognize obesity as a disease created a buzz both in the news media and in the public health community. With one in three Americans considered obese, the U.S. is caught in an epidemic that only is going to get worse and raise health care costs unless steps are taken. The declaration by delegates, observers say, will help influence changes in the treatment of obesity, as well as affect insurance coverage, research and health policy.

But before the obesity designation captured the spotlight, the AMA already had started work on two related chronic problems plaguing the nation — cardiovascular disease and type 2 diabetes. As part of its strategic plan, the Association in April announced it was launching the first phase of a multiyear initiative to improve health outcomes for people with those two conditions. The idea behind the multimillion-dollar effort is to partner with other stakeholders to focus on prevention and treatment, bringing about better health to millions of Americans.

Why target cardiovascular disease and diabetes? As is the case with obesity, consider the numbers, and it makes plenty of sense.

One in three deaths in the United States is related to cardiovascular disease. About 70 million Americans have hypertension. Every 30 seconds, heart disease causes a heart attack. Every 60 seconds, it causes a death.

At present, more than 100 million Americans have diabetes or prediabetes. But only about one in 10 who has prediabetes is aware of it, according to the Centers for Disease Control and Prevention. If nothing changes, one in three adults may have diabetes by the year 2050.

The cost of these two diseases: $535 billion a year in medical expenses and lost productivity.

These conditions are an everyday battle not only for tens of millions of patients, but also for the nation’s physicians. The AMA’s targeted initiative fittingly encompasses solutions for both patients and doctors. The AMA is partnering with Johns Hopkins Armstrong Institute for Patient Safety and Quality in Baltimore to improve treatment and control of hypertension. The institute is skilled in putting quality improvements into practice, perhaps most notably by developing and helping to implement a checklist method that has reduced cases of central line-associated bloodstream infections.

Initially, the focus will be on patients who don’t have hypertension under control. The project seeks to help meet and surpass the federal Million Hearts campaign’s goal of having 10 million more Americans get their blood pressure controlled by 2017. Six clinics are being selected to test a variety of evidence-based strategies for managing blood pressure and identifying barriers to improvement.

The first target of the diabetes initiative is prediabetes. The AMA is working with the YMCA of the USA to boost doctor referrals to the Y’s diabetes prevention program. The evidence-based project is geared to help patients diagnosed with prediabetes develop a healthier lifestyle through better eating habits, increased physical activity and weight loss. Research has shown that even small reductions in body weight offer benefits for people at risk for diabetes, and the program’s goals call for losing 7% of one’s weight and increasing exercise to 150 minutes per week.

The YMCA program is a proven success — it has reduced the risk of developing type 2 diabetes by 58%. It also is the recipient of a $1.8 million grant from the Centers for Medicare & Medicaid Services as part of the CDC’s National Diabetes Prevention Program.

There was debate, both inside the House of Delegates and out, whether the disease classification for obesity was proper. The delegates made their decision, and it very much appears the disease designation has energized the dialogue on how to think about obesity.

Diabetes and cardiovascular disease require no debate on how they are classified. The AMA’s initiatives are energizing the fight against them in a different way but with the same overarching objective — seizing the opportunity to create a healthier nation.