Greg Solomon, managing director, head of life and health reinsurance broking at Willis Towers Watson, explains why even beyond the human cost that diabetes is having on society, the financial impact on insurers is significant.

With headlines like “Economic plague of death, despair, diabetes, and obesity”, it’s 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.

Even 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.

But it’s time now to discuss the five big surprises the insurance industry needs to know:

  1. A growing epidemic

WHO statistics reveal that there were nearly half a billion diabetics in 2014, up from around 100 million in 1980, and it’s even higher than that in 2018.

And the problem is even bigger than that, because there is a large proportion of people who have so-called ‘pre-diabetes’, which in many countries is estimated to be half of the entire population.

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But the fact that it’s “pre-” isn’t particularly comforting, because even these people suffer from 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 research by Willis Towers Watson.

Mortality improvements that we’ve been seeing have now stalled in many countries. Diabetes and Alzheimer’s were identified as part of the problem – but interestingly, Alzheimer’s is a type of diabetes (‘Type 3’ – a disease of insulin insensitivity in the brain), which means it’s all connected.

And the UK is facing the same problem, with approximately 4.6 million people living with diabetes now. This is double what it was 20 years ago – an almost unbelievable increase. This means that 6.6% of the UK population currently has diabetes, ranging from 3.6% in Richmond  through to 10.4% in Bradford.

2. How modern medicine got it so wrong

In simple terms, diabetes is a problem where the body doesn’t produce enough insulin to regulate blood sugar, or isn’t 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 last 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’ everything, recommending instead we should be eating carbohydrates.

Insulin is produced by the body to process carbohydrates, so this dietary shift (including all the added high fructose corn syrup) was putting a heavy strain on the pancreas, leaving it less able to produce insulin.

Further, with 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. The inflammatory nature of insulin by this stage is playing havoc in their bodies, and we see 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.

Yes the evidence is clear – we can no longer classify diabetes as a condition of obesity, but rather we now know that both diabetes and obesity are caused by excessive carbohydrate consumption. And this is the problem we have to address.

3. The soaring cost of diabetes

In the US alone, the estimated cost of diabetes way back in 2012 was $245 billion, with the additional cost of 113 million days off work due to the disease.

All this time, while carb consumption and insulin usage continue to spiral, the pharmaceutical companies are selling more drugs and devices for treating diabetes, obesity and related conditions.

But who’s paying the spiralling bills? Certainly governments pay some of it, with insurance companies also covering large amounts, but sadly limits on both means that the diabetic patients themselves are having to foot much of the bill as out-of-pocket expenses. This is not sustainable for anyone.#

4. The incurability myth

We’ve 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 point where patients are no longer taking any diabetes medications).

Generally, it’s only progressive when you follow the advice of the vicious cycle of carbs and insulin.

Both experts use carbohydrate restriction as their first approach with their patients. Dr Hallberg says “Low carb intervention works so fast that we can literally pull people off 100s of units of insulin in days to weeks” – resulting in a 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 changing their own diets, losing weight and reducing their diabetes medications. And the positive results from scientific studies keep pouring in from around the world, including leading doctors and researchers such as Dr Tim Noakes, Gary Taubes, Nina Teicholz, Dr Aseem Malhotra and others.

Indeed, returning to the insurance sector, very recently in the UK’s The Actuary magazine 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. Diabetes, the sugar lobby and big pharma

If the evidence is so clear about preventing and curing diabetes, and if this could save insurers and governments 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 is emerging.

Almost weekly, we see articles which talk about how Coca-Cola and Pepsi have for years been funding almost 100 health organisations, including the Diabetes Research Foundation; articles reveal that pharmaceutical companies are paying billions annually to doctors to promote drugs; and increasing numbers 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 and as an industry we sponsor research with a vested interest in curing rather than sustaining diabetes, the positive impact will be significant. But in the meantime – a lot has to change.

For example, we need to stop recommending low-fat high-carbs in our wellness programmes and we need an overhaul of the reinsurers’ medical underwriting manuals, with a greater emphasis on insulin sensitivity and inflammation.

Finally, society as a whole needs to take greater responsibility by helping individuals to make behavioural changes, including encouraging parents to buy more nutritious food and educating children on the importance of making healthy lifestyle choices. Without such initiatives to support the global fight against this 21st Century plague, the cost implications will be huge and the health consequences severe.