Some have said that health insurers don’t make the effort to improve care in cardiovascular and related conditions because Americans change health plans so often and it does not matter to them. By the time their extra effort and cost shows benefit, the patient will be in another health plan. That view is very short sighted and it is certainly not patient-centered. Most healthcare costs come from patients with multiple chronic conditions and we all have a stake in improving the approach to these illnesses across the entire country and for all age groups.
In the Steno-2 trial for patients with type 2 diabetes and small amounts of protein in the urine, the average age at entry into the trial was 55. It compared optimal medical therapy (OMT) for diabetes with usual care—the care that most people receive. Eight years into the trial, the difference in serious major cardiovascular events like stroke and heart attack was so striking, that the investigators considered it unethical to keep half the population in usual care. After that, everyone received OMT. Even so, the difference between the OMT group and the usual care group continued to widen over the next 13 years and we have twenty-one years of follow-up in this study. The main source of medical costs is hospitalization. OMT reduced hospitalizations for heart failure by 70% compared with usual care. The OMT patients lived eight years longer and heart attacks and strokes were delayed by eight years.
The best explanation for these persistant differences in spite of OMT for the entire population is epigenetic change. Epigenetics refers to changes in gene regulation. High glucose switches on genes that should be quiet in a vicious cycle and those genes stay switched on to produce these profound differences in deaths, heart attack, stroke, and dialysis. Aggressive care early pays big dividends. We all have a stake in OMT early for patients with diabetes and cardiovascular disease. Patients who did not receive OMT suffered an average of two major cardiovascular events over the course of the study. By age 68, half the patients in usual care were dead. The number needed to treat (NNT) to prevent a major cardiovascular event was three. That is by far the lowest I have ever seen. OMT early is critical for all of us. Isn’t it unethical to continue usual care for patients with these conditions? Don’t the facts demand efforts to spread and scale OMT?
For the readershio you need to provide a succinct discussion of OMT.